Why an ablation?

[racketball]

I am being hassled into an ablation which I have refused, because I would be 'an excellent candidate.' My episodes are not that frequent, and I would rarther treat them as they occur, than risk the procedure. I have also read that post ablation it is common to get 'silent AF attacks'. Surely the pulse would still be irregularly irregular, so...how can they be' silent. Is it just that some people are more aware of their pulse than others?. If this is happening, then ablation is not curing AF, it's just transforming the symptoms, and presumably the stroke risk would be the same?
Help please -i'm confused, and my Dr can't answer my questions.  



This discussion is related to post PVI ablation paroxysmal atrial fibrillation.

[Jerry_NJ]

I think you should at least take an aspirin a day, perhaps a low dose. Yes, check with you doctor on that too, but the main concern here is your stomach, not you heart as far as possible bad side effects are concerned.  I think it is common for people under 50 (to pick a number) who have no other risks than occasional AFib to take only an aspirin, no anticoagulants like coumadin.

As for a "good candidate", seems like a strange way to say:  I believe you have a very high probability of a successful ablation.  Ask for a %, 90% would be high.  The other aspect is the benefit to risk.  All procedures have some risk of making things worse, so there has to be sufficient benefit to take any risk.  My doctors treated my AFib over the years by trying to control/stop it with drugs, didn't work but I never too any of the high power stuff.  Then with electrocardioversion with follow on drugs.  This worked but always temporarily - up to 18 months.  An ablation that is successful will hold a patient in NSR without drugs for many years, maybe even for life.  

So you have to decide what your risk/benefit number is, supplemented by the likelihood of success.... good candidate.  If you have insurance coverage that could be a factor too in you decision.  It is my view the medical insurance situation in the USA is in a nose dive, and do-it-now may be the best advice.

Hope not too much ramble.  Summary:  mitigate stroke risk, aspirin may be enough, decide what you benefits of ablation are compared to other non-invasive methods (shock/electro) and drugs.

Wishing a decision that best meets your needs/style.

[racketball]

Thanks so much for your responses, and I wish you all an AF free year!.I did get a second opinion, but as the first the Dr was focused on how good a candidate I would be rather than whether I really needed it or not.
I did find that by eliminating wheat and most grains, along with most sugar, my symptoms lessened to the point where I had an3 mo free period. Not easy, but I am convinced somewhere there is a link. I have had a couple of just hour long attacks since, which for me is a vast improvement.I'm still in the paroxysmal phase, so will wait on the ablation.
Please keep in touch all. it's so helpful to hear other people's advice and experiences!
Thanks again!

[SDalb]

I just had my second PVI ablation on December 14.  My first ablation was August of 2010. After the 2010 ablaltion, I had Afib episodes for several months.  Then nothing for almost two years.  I started to have infrequent episodes last summer and chose to have another ablation.  Since December 14, 2012, I have not had any episodes.  I wear a heart monitor when I exercise which would show when the heart rate is abnormal.    I have never had any silent episodes.  I am one of those who notice palpitations.  For me the biggest positive for the ablation is not having to take meds any longer, and no more episodes.  I don't know if you can say there is a "cure" for afib, but an ablation is as close to a cure as you can get.  The whole procedure had improved in the two years since my first ablation.  My recovery time was only a week this time around.  Is it always a success?  No.  does it make your symptoms worse? It could.  But it could also eliminate your symptoms.  This is just my experience.  I hope it helps.  I agree with DeltaDawn23 and michellepetkus, that afib does progress if left untreated.  Keep us updated. Good luck.

[DeltaDawn23]

Also, re the silent afib, I have been told that sometimes happens after an ablation.  Symptoms are gone, but so is your awareness of the episodes and my EP sounded like that outcome was not positive.

[DeltaDawn23]

Afib usually progresses from paroximal, to persistent to permanent.  If you are having infrequent episodes and are still able to be converted, I think you still have time to wait and see.  If you are moving in the persistent stage, as I am, you might want to start considering it for the future.  It is my understanding that the longer you are in constant afib, the chances to return to nsr are less.  Don't be pushed into a procedure you do not want.  I suggest a second opinion.  I am amazed at the number of ablations I read about on here with just a few -- sometimes one or two -- episodes.  I have been told in a couple of years there will be some real innovations in treatment of afib.  I'm hoping I can wait.  Good luck with this.

[MichelleP_3811]

You are never obligated to accept medical advice.  It is your choice to do the ablation.  I do know ablations for afib don't have the success rate that ablations for accessory pathway svts do.  From what I understand the first 3 months may find that the patient still has afib episodes but if it was a success then after that the episodes should be gone though I do believe there is a higher reoccurance for afib than other svts.  It is a tough decision.  From what I understand the longer you wait to correct afib the harder it is to correct and you may come to a point where they can't fix it.  That said you have to go by what feels right to you.  Never feel pressured into anything that makes you feel uncomfortable.  I would say take some time to assess how afib affects your ability to function, what your risk factors are for your long term health and whether or not if feels appropriate to do.  I was absolutely terrified to do my ablation for avnrt (super high success rates) but though I was out of my mind in fear I had an underlying sense of calm and knowing that I should do it and that it was the right path for me.  So listen to your inner calm and follow that path.  Though do make sure if you have afib to stay on your blood thinners or aspirins if you were prescribed them to minimize any stroke risk.  I might even suggest seeking a second opinion if that will help you to decide but ultimately go with what feels the most right to you and you can't go wrong.  Take care.