A-fib long term

[chuckd223]

Have had A-Fib for 7 years. Failed Flecinade, Multaq. Been in constant a-fib for a year- last electrocardioversion in Nov 2010 failed. Had a serious bleed on warfin, now on Dabigatron, 3 months, no problems. Not vrazy about having an ablation. Life/health generally good. 55 yars old. Can I expect to manage my A-Fib with rate control and Dabigatron without any problems?
TY
Charles Dickerson

[DeltaDawn23]

I am very grateful for the information from whoever has input.  When they bring my heart rate down with drugs, my bp falls very low.  So I'm not sure if that would work for me.  The Rhythmol didn't work as a "pocket pill" for me, but I'm wondering if being on it at a lower dose as an anti-arrhythmic would work.  It didn't bring my bp down like the other drugs they were trying -- Cardiazem, digoxin.  

I would prefer drugs, then ablation, so I guess the ablation plus pacemaker would be my last choice too.  One of the women I formerly exercised with had an pacemaker/defibrillator and she is quite young -- in her early 30s perhaps.  She said she had the ablation and it didn't work, so I think that was her last resort.

[Jerry_NJ]

Not sure what questions were addressed to me rather than Chuck... so I'll answer just in case.
While in Permanent Atrial Fibrillation, the 50 mg Metoprolol (generic Toprol) and 240 mg of a Calcium Channel Blocker keep my resting HR (ventricle) around 80, which is in the normal range. My fibrillation of the atrium (or both of them) is not felt.  My Ventricle rate is a bit irregular, I think it is in fact a few "PVC" due to extra signals getting through the medications.  My NSR rate, albeit with some BB taken as a maintenance for the electrocardioversions, was in the low 60s, and my jogging (6 miles an hour) was around 150... maybe upper 150s, but that was before I went into permanent AFib in April 2007.  

I believe complete burn of the sinus node and a fully dependent Pacemaker life is an option, but one of last choice in my view.  

[chuckd223]

Big Picture, yes I am hoping for another 30. Now I have a bad day (feel like crap, no reason, no energy, malaize) once in a while and so far can do everything I want. I have some physical slow down, but some is expected at my age.
If I knew I would maintane (with normal aging "slow down) I would not even think of an ablation. But want to make the best of it!
My rate is well controlled with Toporal. Even on the tread mill can't get heart rate over 115. Of toporal, 180 easy. I failed my last cardioversion, have been out of SR for a year, so I guess I am "perminate" at this point. I too want to know good options.
Thanks
again
chuck

[DeltaDawn23]

When I have Afib, I have a rapid ventricular response.  It's like running a marathon 24-7.  So if you are talking permanent afib, you must not have the continuous high heart rate?

What about destroying the sinus node and having a pacemaker?  Is that an option?

It looks like I'm moving toward persistent or permanent Afib, so I'm trying to learn all I can about the procedures.  I also have a mild to moderate atrial enlargement, which lessens the chances for success in an ablation, or so I've read.

[Jerry_NJ]

Exactly, the AFib (left atrium) is the most difficult/risky of ablations because of what you have noted.  That said, my doctors said my case isn't worth the risk.  I'll be lucky to make it another 15 years in any case.  I bring up that because the case study (somewhere in the NE) my doctors quoted showed no improvement in longevity for AFib sufferers between those who regained NSR and those who treated HR and Cloting, as is done in my case.  I recall the study period of 15 years... so I assume that the results apply directly only to that length of time.

At you age, it is another matter.  You should be looking for another 30 years.  

I have followed my doctor's advice and remain in permanent AFib.  

[chuckd223]

Concerns are:
The whole "punching through the heart wall", Seems that most need 2, and it seems that long term results are showing that many people return to A-fib.

But also read that long term A-fib is not so goot for you, and where I started at a young age, that too is a concern. My hospital/EP are very conservative, and are leading me away from ablation.

Thank you for your experiences and thoughts
chuck

[Jerry_NJ]

I think you should check out what your "odds" of a successful Ablation are, then make a decision.  I agree at your (relatively) young age, an Ablation should be considered.

I had considered the same myself, and sparing you the many details, my Cardiologist and a consulting EP said "NO" for an Ablation for my AFib.  Reason: not a good chance of success in my case and my symptoms/risks are managed with BB and Warfarin.   Then too, Electrocardioversion worked well for me (periods exceedy a year in NSR) until the age of 68.

I may be, hate to think so, too old for an Ablation.  I have not sought another opinion.  I'm sure even with the low Medicare rates I can find an EP willing to do the job... just guessing.  

[twinbee]

Just curious, why are you 'not crazy" about an ablation?  You are too young to have to deal with this.
I had an ablation done 3 years ago, and I feel it was the best decision I made. It did take me 2 years to research the procedure, EP's, but I finally went for it.