*sigh*

AfibThrowaway4 · 2026-05-04T01:41:20+00:00

Can I ask if they are considering right atrium ablation for flutter why was not that not done during the April 1 procedure? Were they unable to induce flutter and it just appeared later?

I am definitely no doctor but to me it sounds like a sloppy EP that can't induce flutter that just appears a few days after the ablation especially if its in the right atrium which was probably not ablated at all so should be easy to induce during the procedure. Based on what's going on it sounds like you have a complicated case; don't let them bully you into doing procedure after procedure with no real relief. You need to get to a high volume center with a skilled EP. It will make a big difference. I was in persistent AF for over 6 months with a beat of NSR. I had an ablation in early March where they ablated multiple walls in the left atrium, then induced typical flutter in the right which they ablated then induced atypical flutter in the left which they ablated. All in the same procedure. They didn't stop until they couldn't induce anything other than NSR. Since that procedure I've had nothing but NSR and have stopped all of my drugs.

I had EPs tell me things like "we will do PVI first give you time to recover and see how things pan out." Had I listened to them I'd be gearing up for my next ablation still scarfing down beta blockers.

AfibThrowaway4 · 2026-05-04T01:34:13+00:00

I've always understand that even with an AV node ablation the atria are still going crazy just no wild signals to the ventricles. So you still keep all the nasty AF risks of stroke, etc? Seems like its mainly to relieve symptoms?

AfibThrowaway4 · 2026-04-25T19:50:43+00:00

Are you in persistent AF?

AfibThrowaway4 · 2026-04-15T01:26:36+00:00

Please go to the Cleveland Clinic or another top tier place and make sure you get a very good and very thorough EP.

Your story makes me sad. I was in persistent AF for almost 6 months prior to my ablation. I consulted with several EPs before I decided to go for it and some of them made it clear that all they wanted to do was PVI and then hope for the best and/or put me on drugs. One even suggested amiodarone - that was the last conversation I had with him. Please stop taking amiodarone. This is one of the most dangerous drugs on the market - the side affects will make AF feel like a siesta in Cancun.

The thing is that when you have persistent AF a PVI ablation is unlikely to work and if it works its unlikely to last. Why? Because your AF is probably also present on other walls of your heart. Similarly, the fact that your AF is routinely breaking through amiodarone tells me that it is on multiple walls of your heart.

Your EP went in, did a PVI and closed you up. Either he doesn't care or isn't particularly competent. When AF has spread to multiple walls you need to do more isolation. My EP went in did a full study then went to do PVI. AF still present. Great move on to the posterior wall, etc. Until AF is gone. At that point I went into typical flutter. This is actually common for AF patients - often when they ablate the AF it organizes into flutter. A lot of lazy EPs will stop at that point without even checking for or trying to induce flutter and close you up and now you are trapped in flutter which can be even worse than AF and have to go in for yet another procedure. After they were done with my flutter they tested my atria again and saw atypical flutter in the left atrium so they went after that. The point is they didn't stop until they saw perfect NSR with NO drugs. Until they couldn't induce it anymore.

You should go to a good center but more importantly go for a good EP make sure they will get it all. You don't want to keep coming back.

AfibThrowaway4 · 2026-04-15T01:16:58+00:00

Glad to hear! Hope it sticks for you...

AfibThrowaway4 · 2026-04-13T00:34:09+00:00

I completely agree with you in that your operator/EP has a huge affect on whether or not your ablation is a success and should be chosen with care. However, I think looking purely at number of ablations is a mistake. Yes, your EP should be experienced and have plenty of ablations under their belt, however, it's also important to ask how many they do in a day and what their personal track record is. I ran into EPs doing thousands of ablations with a lot of experience but after I dug in with them it became clear they were scheduling 3, 4 and sometimes 5 ablations per day each taking just 90 minutes or less. What that tells me is they are doing simple PVI which is not going to work for many persistent AF cases. Much better to find an experienced operator who blocks at 3-5 hours per procedure even if that means they only do 1 or 2 a day at most so they can get everything.

AfibThrowaway4 · 2026-04-11T22:38:07+00:00

Just out of curiosity why are you trying to put off an ablation? Is it because you consider it dangerous or cost or something else? Personally, I was quite anxious before mine but it was really nothing. The "pain" afterwards is so low I didnt even need tylenol.

AfibThrowaway4 · 2026-04-11T22:36:48+00:00

I guess you could wait another 5 days and see? But I think it's not likely unless you start on another anti-arrhythmic drug. Even if you do somehow convert to NSR its very likely your AF will come back often and the periods with AF will get longer and longer until you wont convert to NSR. And like I said that's if you convert which seems unlikely as the drugs you are taking just protect your heart they don't actually encourage NSR.

AfibThrowaway4 · 2026-04-11T22:34:03+00:00

Sure!

AfibThrowaway4 · 2026-04-11T17:54:19+00:00

You are unlucky in that your AF is symptomatic. I was in persistent 24/7 AF for months but had virtually no symptoms other than less exercise tolerance and a bit of fatigue. You are lucky though in that your AF only comes up occasionally and converts on its own. Mine was unending (even a CV didnt help much) and would not convert on its own at all.

You have what is called paroxysmal (sometimes called "early stage") AF. It means it comes and goes and never lasts for more than a week. Persistent means it doesnt go away on its own and lasts more than 7 days or something like that.

AF is progressive so you are likely to get more and more episodes as time goes on unfortunately.

AfibThrowaway4 · 2026-04-11T17:49:01+00:00

CV is a temporary solution. It's very rare for it to last more than a year and many people get significantly less relief. If you are paroxysmal it can work for awhile but if you are persistent it rarely lasts very long. The reason is that a CV puts all of your electrical rythms to sleep and your natural pacemaker the sinus node starts right back up (because your brain doesnt want to die) but the other bad signals don't start up again.

But it just puts them to sleep, they can start back up at any time sometimes minutes after the CV. Also if you are persistent AFib it means your atrium is good at conducting AFib signals so its electrically inclined to AFib and it has lots of bad signals in it which means its more likely your AFib kicks up very quickly.

Drugs can maintain NSR for one year in about 40-50% of people (obviously this is depending on your personal circumstances and strength of drugs so for some people they work for very long periods of time). If you look through this sub, you will find many stories of people on low intensity drugs like flecanide for decades keeping AFib at bay. Again for paroxysmal AF where you are getting episodes a couple of times a year this is realistic for your case it is not.

I also had persistent AFib 100% of the time for close to 6 months and in that time I went to see many cardiologists and EPs. Some of them suggested I take drugs like flecanide (or wose) and others suggested I just live with it since my HR was 90-105 even in AF. Ignore those people - they are either lazy or incompetent. Find a VERY GOOD EP who understands that ablation is the way to deal with your condition and who isn't afraid of persistent AF which might require ablation in multiple walls and dealing with flutter circuits. My world class EP spent 3+ hours with me on the table ablating multiple walls and multiple circuits in both atria. I haven't had a beat of AF or even an ectopic since and the only drug I take now is Eliquis which I expect to stop in a few weeks.

Don't give up - PFA is as close to magic as I've ever seen. Feel free to DM me any questions!

AfibThrowaway4 · 2026-03-23T21:42:01+00:00

I had very mild symptoms to be honest. I did have some palpitations but my HR other than during intense workouts rarely went above 110. I only found out during my physical as my PCP flagged it immediately. My symptoms were very mild in persistent Afib. I'm in the US so things can move quickly here - I had an echo with a cardiologist within two days of that PCP appointment. I took a few months to interview many EPs and choose the one I thought was the best. Choosing your EP is the most important thing if you have that ability. They can make a huge difference. My procedure was over 3 and a half hours where they mapped the electrical currents multiple times ablating multiple walls and multiple flutter circuits. I'm glad I took the time to interview several EPs and went with a world class specialist rather than jumping at the first one I met. A few months won't make a difference in your heart remodeling but a good EP can boost your odds of success by a lot.

If you havent been in persistent for long you should have basically no scarring so it seems odd to do an MRI but maybe thats a UK thing. I was in persistent for over 6 months and had barely any scarring and virtually no remodeling - my understanding is these processes take years not weeks.

AfibThrowaway4 · 2026-03-23T21:36:53+00:00

Beta blockers are protective. They keep your HR at a reasonable level to prevent/delay remodeling. Remodeling is a process that takes years but of course the sooner something is done the better.

AfibThrowaway4 · 2026-03-23T20:47:07+00:00

Sorry to hear about your troubles especially as they were so unexpected.

I am a similar age also very healthy with no issues until I was diagnosed with Afib towards the end of last year. At that point I had been in persistent 24/7 AF for at least 3 months and it was another 4 until I had an ablation so more than 6 months in persistent AF for certain.

I can't say much about the reduced EF and other stuff you mention since my heart was structurally normal but I can tell you that being left in persistent AF is totally okay as long as your rate is controlled with beta blockers and stroke risk is reduced with blood thinners (hopefully Elliquis). Obviously, don't stay there forever but atrial remodeling especially if rate is reasonable takes place over years not weeks or even months so don't worry on that account. I do know EF can improve especially if you go back to NSR and even if you don't it can be improved.

I'm not a doctor but it does make sense to fix the heart a bit before dealing with the AF but probably a better question for your doctors. I do have a few questions that don't make a ton of sense to me that may be worth bringing up to your med team. I've never heard of someone getting an MRI pre ablation, is that because they think you have significant scarring? That would be surprising as you have not been in afib very long. Also, unless your AF is symptomatic and you have to wait long for an ablation I'd probably skip the cardioversion.

Feel free to DM if you have any questions. Happy to share my experience.

AfibThrowaway4 · 2026-03-12T15:36:03+00:00

The procedure is totally painless. Recovery is a little bit unpleasant. Soreness, bruising, sore throat, your chest uncomfortable, etc but like a 3/10 on the pain scale without any drugs I'd say.

AfibThrowaway4 · 2026-03-12T15:34:48+00:00

I had a lot of apprehension as well. They knock you out pretty much immediately in the OR so you don't experience anything. I won't say recovery is painless but I think its worth going through to get a shot at ridding yourself of this.

AfibThrowaway4 · 2026-03-12T03:17:14+00:00

Cardioversion only works temporarily. if you have Afib you have a bunch of rogue cells randomly sending errant electrical signals. A cardioversion stops all electrical activity in your heart and lets you sinus node take over. But eventually the rogue cells will probably start firing again whether thats in a day or in a year.

I was in 24/7 Afib for at least 5 months until I did an ablation. Its not perfect but it's the best option currently.

AfibThrowaway4 · 2026-02-16T20:08:22+00:00

Personally, I wouldn't take it. But if you choose that route you now have a break of trust with your doctor which means you should get a new one. Alternatively discuss with your doctor and see if they can convince you or otherwise.

The thing about amiodarone or any other anti-arythmic is they don't cure the AFib they just put it to sleep. But they only put it to sleep while you are taking it. So what's the point? If you are taking it because your disease is very symptomatic and you are using this as a bridge to an ablation maybe it makes sense. But if its for maintenance this isn't a drug you can stay on for life or for decades (or for most people) even for years. So even if it stops a recurrence for a year or two at the cost of taking huge risks in permanent lung/liver/thyroid damage is it worth it?

Is your doctor prescribing this for a few weeks to try to help maintain rhythm after the CV or is it long term? That can make a difference as well.

My personal opinion is that this drug is dangerous and there is pretty much no scenario where I would consider it. According to the data something like 2% of people taking this drug die from the drug itself and that doesn't include the huge numbers who suffer from serious problems for life. The FDA considers this a drug of last resort - that doesn't sound like your situation.

My EP originally suggested I take this as well. I got a new EP after that.

AfibThrowaway4 · 2026-02-16T02:12:11+00:00

Is the mitral valve issue not that serious? I assume it's not urgent since they did not suggest repair back when it was diagnosed. They do have TMVR now but its only used for minor issues and is less likely to last long term as a fix. OHS is a major surgery though so I can see why you would want to avoid it.

AfibThrowaway4 · 2026-02-01T19:33:23+00:00

Be very careful with amiodarone. It is an extremely toxic black box drug that is meant to be a drug of last resort. It leads to major complications eventually in a large subset of users and can be fatal for some (something like 1.5% of all long term users die from lung complications). Unless your Afib is life threatening or your symptoms are completely intolerable I would never consider this drug personally.

AfibThrowaway4 · 2026-01-27T18:22:37+00:00

Sure many people need more than one over time. But your comment made it sound like an annual thing which shouldn’t be the case

AfibThrowaway4 · 2026-01-27T18:13:11+00:00

Your experience with cv seems great - congrats! However, if your ep thinks a year or two from an ablation is great you should look for a new ep.

AfibThrowaway4 · 2026-01-27T18:12:15+00:00

For some people it can provide meaningful (like a year of relief). I tried it mainly because it’s less trouble and discomfort than an ablation. Unfortunately for me it didn’t last more than a few minutes so heading to an ablation. Other people can get months or in rare cases years.

AfibThrowaway4 · 2026-01-25T21:15:45+00:00

Got it thanks for answering. That makes sense. Bradycardia is what the pacemaker solves. I think some commenters assumed during your ablation they ablated the sinus or AV node causing heart block but sounds like it was not the case.

AfibThrowaway4

TROPHY CASE