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FAQs A-Fib Ablations: Feeling Better in Chronic A-Fib
FAQs A-Fib Ablations: Better in Chronic?
Catheter Ablation
“I’m 80 and been in Chronic (persistent/permanent) A-Fib for 3 years. I actually feel somewhat better now than when I had occasional (Paroxysmal) A-Fib. Is it worth trying to get an ablation?”
With Chronic A-Fib of long duration, perhaps not. Although a few centers get very good results when treating Chronic A-Fib even of long duration (the French Bordeaux group achieves an acceptable success rate after 2 ablations), most centers have a success rate of only around 50% for Chronic A-Fib. And although catheter ablation is a low risk procedure, there are still risks.
Many centers won’t ablate patients who are over 80 years old or in Chronic A-Fib for over a year. There is a higher risk of complications in older people, and it is more difficult to ablate Chronic A-Fib. (In Chronic A-Fib there are often multiple spots in the heart producing A-Fib signals. It’s hard to identify and ablate [isolate] them all.)
The Positive Side of being in Chronic A-Fib: Sometimes people feel relieved to be in permanent A-Fib. There’s no longer the fear, uncertainty, and shock of an A-Fib attack. You can adjust your lifestyle to how your heart behaves, because it doesn’t change much. You may be short of breath, somewhat light headed, tired, and unable to work or exercise hard. But you get used to it. You may even feel better than when you had Paroxysmal A-Fib. In addition, an ablation may be only partially successful and have the unwanted consequence of putting you back into Paroxysmal A-Fib.
You still need to take blood thinners to prevent an A-Fib stroke. But if you get the Watchman or Lariat device installed (very low risk), it closes off your Left Atrial Appendage where 95% of A-Fib clots originate. It’s then possible to go off of Coumadin baring other risk factors for stroke.
The Negative Side of being in Chronic A-Fib: The down side of being in Chronic A-Fib is your heart forever and always will not pump properly. Blood flow to your brain and other organs is reduced by about 15%-30%. This can lead to conditions like dementia and Alzheimer’s. (If you are a superior athlete like a bicyclist or runner, your exercise may overcome this reduced blood flow.)
A-Fib is a progressive disease. It tends to get worse even in Chronic A-Fib. Your atria expand and stretch. Your ejection fraction diminishes. Chronic A-Fib produces fibrosis and collagen deposits which stiffen the heart and make it less flexible. All this leads to conditions such as Congestive Heart Failure and Cardiomyopathy
But please weigh the above statements carefully (the author is concerned that they may create unwarranted fear). How do you feel? If you don’t feel any symptoms and your doctor says your heart isn’t enlarging and/or developing poor ejection fraction, etc., then there’s no need to rush out to get a Pulmonary Vein Ablation which does involve real risk.
The Bottom Line: You can be cured of Chronic A-Fib, even at your age. But it will take at least 2 ablations. And it won’t be easy finding a doctor to do it. (There is a short list of doctors at Specialists In Persistent/Chronic A-Fib. You need someone with a proven track record in ablating Chronic A-Fib.) However, an ablation is more risky at your age.
On the other hand, you can live in Chronic A-Fib. Many people do. The key to living a satisfying life in Chronic A-Fib may be good rate control. For example, a resting heart rate of around 80 beats per minute with an exercise rate of 110 is very close to that of a normal person. People with good rate control of their Chronic A-Fib report a good quality of life and seem less prone to develop other heart or mental problems.
What this Means to You: Are you happy or content with your quality of life in Chronic A-Fib? If so, then the added hassles and risks of an ablation are probably not worth it for you. Only you (and your doctor) can decide if it’s better to spend your twilight years in a perhaps reduced but satisfactory quality of life.
Return to FAQ Catheter Ablations
Last updated: Monday, June 18, 2018
FAQs A-Fib Ablations: Post-Procedure Symptoms and Success
FAQs A-Fib Ablations: Post-Procedure Symptoms
Catheter Ablation
“How long before you know a Pulmonary Vein Ablation procedure is a success? I just had a PVA. I’ve got bruising on my leg, my chest hurts, and I have a fever at night. I still don’t feel quite right. Is this normal?”
After a Pulmonary Vein Ablation procedure, some people feel great and are in perfect sinus rhythm. But for most of us it usually takes two or three months (called a “blanking period”) for the ablation scars to heal and for our heart to learn to beat normally again.
Doctors sometimes help this process by prescribing antiarrhythmic meds for a month or longer. You may also have to continue to take an anticoagulant for a while.
Right after the PVA(I) you may experience the following:
• Your groin will generally have two access site points, one on each side. After a Pulmonary Vein Ablation, some minor bruising is common at each site with minor soreness as if you had banged the area. Bruising may occasionally be seen to extend down the leg. This is normal, as is an occasional small quarter sized bump in the area. (If larger swelling or more significant pain occurs at the area, please contact the electrophysiologist who did the procedure.) One of the reasons for this bruising is the heavy dose of anticoagulants you were administered during your ablation procedure to prevent a possible stroke.
• After a Pulmonary Vein Ablation you may have some minor chest pain for the next week or so. The pain will often worsen with a deep breath or when leaning forward. This is pericardial chest pain from the ablation and is generally not of concern. It should resolve within a week, although it might increase for a day or so after the ablation. (This chest pain may be due to the heat from the catheter ablation burns which may temporarily irritate the Pericardium, the sac around the heart.)
• Your heart may beat faster than before. Usually your heart rate will settle down after the two-to-three month blanking period. But some people report a slightly elevated heart rate even after three months, especially if they have previously been taking rate control or antiarrhythmic meds.
• Low grade fevers of around 99 degrees are common in the first day or so post-ablation. (If you develop unexplained fevers exceeding 100 degrees anytime within the first 3 weeks post-ablation, you need to contact the electrophysiologist who performed your procedure.)
One or more of these symptoms is considered normal, but discuss any symptoms with your doctor during your post-procedure doctor visits.
Thanks to Marva Harp for this question.
Return to FAQ Catheter Ablations
Last updated: Thursday, April 28, 2022
FAQs Understanding A-Fib: Flutter and A-Fib—Does one cause the other?
FAQs Understanding A-Fib: Flutter
“A-Fib and Flutter—I have both. Does one cause the other?”
You can have A-Flutter without A-Fib. And of course, A-Fib without Flutter. But more often than not, they are linked.
If you have A-Flutter, A-Fib often lurks in the background or develops later.
But right now we can’t say for sure if one causes the other. We do know that A-Flutter usually comes from the right atrium, while A-Fib usually comes from the left atrium.
(When Electrophysiologists do a catheter ablation, the first stage of success is to convert A-Fib into A-Flutter, the second stage is to convert A-Flutter into tachycardia. When the tachycardia is stopped and can’t be re-induced, the ablation is considered finished. You can consider A-Flutter as a more organized form of A-Fib.)
Go back to FAQ Understanding A-Fib
Last updated: June 18, 2018
FAQs Understanding A-Fib: Paroxysmal to Persistent A-Fib, What Causes the Progression?
FAQs Understanding A-Fib: Paroxysmal to Chronic
What causes Paroxysmal (occasional) A-Fib to turn into Persistent (chronic) A-Fib?
Researchers are still working to find the answer(s) to this question. We do know that some patients remain paroxysmal (usually with anti-arrhythmic therapy), while a large proportion progress to persistent A-Fib. (In a study of 5,000+ A-Fib patients, 54% of those on rate control meds went into permanent A-Fib within one year.)
The main trigger seems to be increased pressures in the left atrium that cause the muscle fibers within the pulmonary vein openings to start beating on their own.
Uncontrolled blood pressure, untreated sleep apnea and diabetes, or a worsening cardiomyopathy seem to be key factors that make people progress from Paroxysmal to Persistent A-Fib. Research tells us that even after a successful ablation for Persistent A-Fib, “the long term success rates depend mostly on treatment of hypertension and obstructive sleep apnea.”
What does this mean to you? The longer you have Atrial Fibrillation, the harder it can be to cure it. Consider working aggressively to stop your A-Fib as with antiarrhythmic meds or with a minimally-invasive Pulmonary Vein Ablation (or a Mini-maze surgery). You don’t want to be part of the 54% whose A-Fib becomes permanent.
Go back to FAQ Understanding A-Fib
Last updated: July 11, 2021
FAQs Understanding A-Fib: Adrenergic and Vagal
FAQs Understanding A-Fib: Adrenergic and Vagal
“What is the difference between “Adrenergic” and “Vagal” Atrial Fibrillation? How can I tell if I have one or the other? Does it really matter? Does Pulmonary Vein Ablation (Isolation) work for Adrenergic and/or Vagal A-Fib?”
If your A-Fib is normally triggered by exercise, stress, stimulants, exertion, etc., then you may have what doctors call ‘Adrenergically-Mediated’ A-Fib. People with structural heart disease seem more prone to Adrenergic A-Fib. The Adrenal (Adrenergic) Glands sit above the kidneys and produce the hormone epinephrine (adrenaline) in response to stress, which causes an increase in heart rate and blood pressure. This adrenaline stimulates what is called the ‘Sympathetic Nervous System’ to speed up the heart and constrict the blood vessels.
But if your A-Fib occurs at night, after a meal, when resting after exercising, or when you have digestive problems, then you may have ‘Vagally-Mediated’ A-Fib. The Vagus Nerve, in contrast, controls the abdomen and is part of the Parasympathetic Nervous System that tends to slow the heart and dilate blood vessels.
Adrenergic and Vagotonic forms of paroxysmal A-Fib are uncommon.
The majority of patients with paroxysmal A-Fib do not have a clear autonomic pattern. Those with Lone A-Fib (no other related medical condition) seem more prone to Vagal A-Fib. (Many people have a mix of both Adrenergic and Vagal A-Fib.) (Perhaps A-Fib begins as a nervous system problem, then becomes a heart problem after the arrhythmia is established.)
What does this mean to you? It might be helpful to determine if you have one or the other so that you can better identify what triggers your A-Fib, and because the treatments are often different for each.
For example, beta-blockers usually don’t work well with Vagal A-Fib or the antiarrhythmic 1C meds. Flecainide seems to work better for Vagal A-Fib than propafenone. (Though it’s difficult to generalize about A-Fib treatments, because each person reacts so individually.)
Pulmonary Vein Ablation: It seems that both Adrenergic and Vagal A-Fib are ‘focal’ in origin (come from specific points or spots in the heart), and are treatable with Pulmonary Vein Ablation (Isolation) procedures.
Go back to FAQ Understanding A-Fib
Last updated: June 18, 2018
FAQs Understanding A-Fib: Aging into A-Fib
FAQs Understanding A-Fib: Aging
“Why do older people get Atrial Fibrillation more than younger people?”
We know that those over 60 years old are in the higher risk group for developing A-Fib. This may be related to what is called “Interstitial Fibrosis” which is often part of the aging process.
The Pulmonary Vein openings (where most A-Fib signals originate) sometimes become fibrous as we age. The Pulmonary Vein openings are similar in structure and have similar smooth muscle tissue as the Sinus and AV Nodes which generate your normal heart beat signal. The Pulmonary Vein openings are electrically active in the heart like the Sinus and AV Nodes but usually beat in sync with them. When the Pulmonary Vein openings become fibrous, they tend to beat out of sync with the Sinus and AV Nodes which results in A-Fib.
Please be advised that the above statement is an observation, an attempt to explain, rather than a medical fact. Further research is necessary to confirm this observation.
Go back to FAQ Understanding A-Fib
Last updated: June 18, 2018
FAQs from Newly Diagnosed Patient
Frequently Asked Questions by Newly Diagnosed Patients
Newly diagnosed Atrial Fibrillation patients have many questions about living with A-Fib. These are answers to the most frequently asked questions by patients and their families. (Click on the question to jump to the answer)
1. Cause: “Did I cause my Atrial Fibrillation? Am I responsible for getting A-Fib?”
2. Severity: “My doctor says I had an attack of Atrial Fibrillation. How much trouble am I in?”
Related Question: “Is Atrial Fibrillation a prelude to a heart attack?”
Related Question: “Can I die from my Atrial Fibrillation? Is it life threatening?”
3. Anomaly? “Could my Atrial Fibrillation go away on its own? I don’t want to take any medication. Can I just wait and see?”
Related Question: “Is it possible to have a single Atrial Fibrillation attack and not have any others? I had a single episode of A-Fib and was successfully converted in the ER with meds.”
Related Question: “How can I tell when I’m in A-Fib or just having something like indigestion?”
4. Sex/Exercise: “Should I cool my sex life? Can I exercise if I have Atrial Fibrillation? Should I exercise?”
5. Driving: “Can I drive my car if I have Atrial Fibrillation?”
6. Nutrition: “Is drinking coffee (tea, colas, other products with caffeine) going to make my Atrial Fibrillation worse or trigger an A-Fib attack?”
Related Question: “Is there a diet I could follow which would cure my Atrial Fibrillation?”
7. Medical ID: “Should I carry a wallet card or a medical ID? I have A-Fib and take Coumadin (warfarin). In case of an A-Fib emergency, what information should I include?”
8. Coping: “I have a lot of stress at work. Does this stress cause or trigger my Atrial Fibrillation?”
Related Question: “I live in fear of my Atrial Fibrillation. I never know when I’m going to get an A-Fib attack or how long it will last. How do I deal with the anxiety?”
Related Question: “Is there anything I can do to get out of an Atrial Fibrillation episode? How do others deal with their episodes?”
9. Specialist? “Should I see a cardiologist for my Atrial Fibrillation and not just my primary care doctor? (He wants to prescribe medication.) Should I also see an A-Fib specialist?”
10. Cure? “Is Atrial Fibrillation curable? Or can you only treat or control it? Should I seek a cure?”
11. Insurance & Disability Benefits? “Can I get government social security disability benefits if I have Atrial Fibrillation?
Related Question: “I’m on Medicare, can I qualify for Medicaid, too? Should I?”
If you find any errors on this page, email us. ♥ Last updated: Wednesday, June 29, 2022
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FAQs Coping With Your A-Fib Day-to-Day Issues
FAQs Coping With Your Atrial Fibrillation: Day-to-Day Issues
Coping with your Atrial Fibrillation means a patient and their family have many and varied questions. Here are answers to the most frequently asked questions about dealing with the day-to-day issues of having Atrial Fibrillation. (Click on the question to jump to the answer.)
1. Specialist: “I like my cardiologist, but he has not talked about me seeing an Electrophysiologist [heart rhythm specialist]. Should I ask for a second opinion?”
2. Forewarning? “Is there any way to predict when I’m going to have an A-Fib attack?”
3. Exercise: “Can I damage my heart if I exercise in A-Fib? Should I exercise when in A-Fib or skip it and rest?”
4. Progression of A-Fib: “How long do I have before my A-Fib goes into chronic or permanent A-Fib? I know it’s harder to cure. My A-Fib episodes seem to be getting longer and more frequent.”
5. A-Flutter: “They want to do an Atrial Flutter-only ablation, will that help if I possibly have A-Fib as well?”
Related Question: “I have Atrial Flutter that my EP describes as “atypical”. What does that mean? Is Atypical Flutter treated differently than typical Flutter?”
6. Medical Marijuana: “Is smoking medical marijuana or using Marinol going to trigger or cause A-Fib? Will it help my A-Fib?
7. Action Plan: “During an A-Fib episode, when should I call paramedics (911 in the US) and/or take my husband to the hospital? I’m petrified. I need a plan.”
Related Question: “In case I have a stroke, what does my family need to know to help me? (I’m already on a blood thinner.) What can I do to improve my odds of surviving it?”
8. PVC/PACs: “I have a lot of extra beats and palpitations (PVCs or PACs) They seem to proceed an A-Fib attack. What can or should I do about them?”
9. DIY Monitors: “What kind of monitors are available for atrial fibrillation? Is there any way to tell how often I get A-Fib or how long the episodes last?”
Related Question: “My mom is 94 with A-Fib. Are there consumer heart rate monitors she can wear to alert me at work if her heart rate exceeds a certain number?”
10. Heart Rate: “Can I have A-Fib when my heart rate stays between 50-60 BPM? My doctor tells me I have A-Fib, but I don’t always have a rapid heart rate.”
Related Question: “My doctor says I need a pacemaker because my heart rate is too slow. I’m an athlete with A-Fib and have a naturally slow heart rate.”
11. Circulation: “Is there any way I can improve my circulation? I feel tired and a little light-headed, probably because my atria aren’t pumping properly. Is there a way without having to undergo an Ablation or Surgery? I am in Chronic A-Fib. ”
Updated/Related Question: “I’ve heard about an out-patient heart therapy that improves circulation called EECP (Enhanced External Counterpulsation). Would it help me with my A-Fib?”
12. Hereditary A-Fib: “Both my uncles and my Dad have Atrial Fibrillation. I’m worried. How can I avoid developing A-Fib? Can dietary changes help? Or lifestyle changes?”
13. Treatment choices: “How do I know which is the best A-Fib treatment option for me?”
Related Question: “In one of your articles it said that having an ablation was better than living in A-Fib. If your article means all types of A-Fib [including Paroxysmal], then I will consider an ablation.”
If you find any errors on this page, email us. Y Last updated: Friday, April 10, 2020
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FAQs Newly Diagnosed with A-Fib: First Attack
FAQs Newly Diagnosed: First Attack
“My doctor says I had an attack of Atrial Fibrillation. How much trouble am I in? (It was around 11:00 pm I was getting ready to go to sleep when my heart started going crazy, like it was trying to jump out of my chest. I panicked and drove to an Emergency room. But by the time I got there, my heart was normal again.)
A-Fib is probably the most frightening of heart problems. We take our heart for granted until it starts beating wildly out of control. Unlike other heart problems which often build up over time, A-Fib can come on like a ton of bricks, seemingly out of nowhere. A-Fib is a real shock not only to our body but also to our mind.
But as bad as A-Fib feels, it is probably the least immediately threatening heart problem. All things considered, you’re not likely to die from an A-Fib attack.
In A-Fib, the upper parts of your heart (the atria) start beating on their own out of sync with the rest of your heart; your heartbeat is irregular and rapid.
The biggest danger of A-Fib is the increased risk of stroke, because your heart isn’t pumping out properly. But that risk of stroke can be lowered by medications or by insertion of a Watchman device. Over time A-Fib can lead to more serious heart problems (because the heart is stretched and weakened).
Also, A-Fib may lead to mental deterioration because the heart isn’t pumping properly to the brain. As troubling as A-Fib is, many people have learned to control their A-Fib (usually with antiarrhythmic medications). Others seek a cure through a Pulmonary Vein Ablation (Isolation) procedure or surgery.
The bottom line: your A-Fib can be cured and/or controlled. But don’t delay. A-Fib is a progressive disease, and over time becomes harder to cure.
Learn as much as you can about Atrial Fibrillation, knowledge dispels fear. Suggested reading: Overview of Atrial Fibrillation.
Go back to FAQ for the Newly Diagnosed A-Fib Patient
Last updated: Monday, June 18, 2018
FAQs Coping with A-Fib: Predicting Attacks
FAQs Coping with A-Fib: Predicting Attacks
Is there any way to predict when I’m going to have an A-Fib attack?”
Try being a private detective! Start by keeping a log or diary of your A-Fib episodes for three or six months. Then analyze your log for patterns.
By studying your log you may find, for example, that your A-Fib episodes come mostly at night, or after a meal which may mean you have Vagal A-Fib. What is the interval between your A-Fib episodes? Some people have very regular intervals between A-Fib attacks. A-Fib Support Volunteer, Max, for example, had regular A-Fib episodes every morning at 7am. (Read Max’s A-Fib story #43: A-Fib Causes Devastating Effects—From Shanghai to Bordeaux..) Knowing these patterns may help you deal with your A-Fib.
But not every log will be revealing. A-Fib seems to have a mind and schedule of its own that’s often hard to predict.
When I had A-Fib, I had little success predicting attacks. I had very short episodes no longer than five minutes often during the day. I was never able to predict when they would occur, or identify what may have triggered them.
Back to FAQs: Coping with Your A-Fib
Last updated: Monday, June 18, 2018
