Ablate or not Ablate... that is the question

My last 7 days Holter monitor showed very low burden of Afib/Aflutter (0.17%) and AV Node irregularities: AV Block 1, Mobitz 1, BBB. Just back from my appointment with EP, expecting my ablation to be scheduled soon. I understand that early ablation intervention in Afib is recommended, however, i am very concerned that AV issues i have can be made worse as a result of ablation and require PM as a result. I only had 2 episodes of Afib in the last year, one lasting 2 hours and another 45 mins, self converted. Anyone has advice or faced similar situation?



by Lavender - 2023-12-08 19:12:57

In October you posted this:

"From Holter results perspective - not seeing any signs that can cause symptoms. I was in NSR 99.8% of the time. Pauses, skipped beats, long PR Interval (no concern), BBB, Wenkerbach (no concern) - not progressing to higher AV block (total for above symptoms 13%), night time bradycardia (18%) - quite normal, cannot contribute to my symptoms. Average heart rate during 7 days Holter 66bpm. I was in Afib only 0.17%. Not recommending PM or Ablation at this point"

On one hand, the results are good, but i was secretly hoping of finding a reason for my symptoms. Cardiologist suggested looking into either organic causes or depression (yes, i had it for a long time, but never have felt that exhausted). No follow-up at this point. Will also see EP soon and have a Sleep Study. 

So my questions are:

What changed from not needing a pacemaker or ablation to again reconsidering it in such a short time?

Did you have the sleep study?

Afib = stroke, that is the question

by ANDREW75 - 2023-12-09 09:07:36

 Hi Dimabai

Gemita and others have given you advice in your three posts, here are my stories.


In 2018 my wife suffered a stroke, and 18months of having a link monitor she had a lone Afib attack. Her EP (now also mine) said he was 99% sure this was “The smoking gun” reason for her stroke. He called and directed her to pick up Eliquis in lieu of aspirin immediately!

My wife was exceptionally lucky, she got on a wonder block buster drug within the three-hour window and did not have surgery for her blood clot, and she was lucky the EP monitored her. We are five years past this.

My Friend Bob:

Opposite to my wife, Bob had reoccurring Afib. He was a windsurfing friend and I saw him every year for at least three years. He was a character and loved to relate his Afib experiences to everyone to the point of boredom. This was 12 years ago, and I guess before all the new medical advances. I saw him recently alive and still happy to be windsurfing, he still has Afib, but I don’t know his current treatment.

So there are different types of Afib, my wife had the “once in a blue moon” type, yours may be different. There are thousands of sites and videos regarding this topic available on the web.

My understanding is any Afib can cause strokes, no question about it, sounds like you need both pacemaker and ablation with your mixture of issues.

Hope this helps Andrew


by Julros - 2023-12-09 19:24:38

Hi. In my opinion, if you are having symptoms that affect your way of life, then I would get the ablation. If you can't even sense that you have it, then I would wait. Either way, your doctor should assess your risk for stroke, and if high enough, you should take an anticoagulant.

I have had 2 ablations, because I feel very weak and have no energy when I am either afib or aflutter. I have already had a stroke, so that immediately indicates I need anticoagulation. I take Eliquis. 

Afib intervention

by Tracey_E - 2023-12-11 19:07:44

Early intervention is important with afib because it can cause strokes. However, they usually start with meds. Ablation is the last resort when the other options aren't working. However, having the block complicates things, tho it appears yours is minor. There are some people who get the pacer in order to be able to take the beta blockers for afib safely. I've never heard of ablating first. Have you had a second opinion?

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