Can't help with your specific question but can share 2 experiences:

1. Had my own RF ablation about 6 years ago (age 42ish) after sudden onset afib that could not be corrected acutely with meds (had to be cardioverted twice, 6 months apart). Like you, really struggled with the maintenance meds and decided that was not a long term solution. Ablation went fine - lots of hot spots fixed, back training within a few weeks. No arrhythmias since.

2. Wife also had RF ablation at 43ish after years of intermittent SVT. Doctor wiped out her AV node (not on purpose obviously) resulting in permanent bradycardia and eventual pacemaker installation (now paced at 100% effectively). she's all good now, but I share to say that risks are real - they are not hypothetical. Side effects of 1% sound really small until is happens to you, so if they are saying your situation is higher risk overall, take that into consideration vs. the meds. Those meds suck, I 100% get it, but are they worse than the potential alternatives - that's a decision only you can make.

Hope it turns out well for you!

Much appreciated and am glad to read that things ultimately turned out well for you and your spouse. Must have been traumatic to go through a cardioversion, then constantly living in fear that it would happen again, which it did. Just curious, did your EP do PVI or was it elsewhere - and how many "burns" were involved (for me it was 14 the first time around - all in the right atrium) ?

As to the risks involved in my case - yes indeed I could remain on beta blocker and it wouldn't be the worst thing in the world - that is, if my condition stayed the same. I've recently had to ratchet up the dose twice - and at the current level even during moderate efforts my HR is still shooting up much too high for too long. So while I'm still on a relatively small dose, it's the trend and what it portends that's troublesome. EP has discussed alternate meds but each has its own drawbacks. So given all the pluses and minuses I'm leaning toward cryo, Have discussed with my spouse and immediate family, and comforting to know they are on board.

Will keep you posted.

I don't recall any mention or notes about PVI, all I remember is asking how long I was down and it was 'multiple hours' and 'a lot of hotspots' - he might have said 30-ish or something like that. Seemed like a lot to me considering I had zero symptoms for 40-something years until this started. The human body is a crazy thing.

I am scheduled for an upcoming ablation. I’m younger at 24 y/o. My history of training includes occasional bursts of arrhythmias and my heart rate spiking to 220-240. I have no symptoms with it but it does cause me to slow down in races to keep my heart rate in normal rhythm. My EP doc said if it wasn’t affecting my life as an athlete he wouldn’t suggest anything to treat it since it is so infrequent and asymptomatic. So basically it was my decision to try and solve the issue via ablation. Hopefully all goes well and we can solve the root of problem.

I was on a handful of meds for 8.5 months while waiting for approval for an ablation. I was so miserable on those, and they only managed to control the rhythm about 90% of the time. It was bad enough that going into the hospital the morning of the ablation, I was surprised to find myself not feeling nervous at all. The only feeling I had was "finally, this will all be over"...

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"I'm thinking of a number between 1 and 10, and I don't know why!"

Wishing the best for you as you await the procedure. mattyboy makes some good points about ablation and risk which I'm sure your EP discussed, and that your decision is well informed. Interestingly on the face of it there are some similarities in your symptoms (or lack thereof), although my peak is lower at 200-210 bpm. No classic symptoms here of syncope, dizziness, chest tightness or shortness of breath either. However I cannot maintain anything north of 175 for long (165 is my peak while in sinus rhythm). So the only symptom I experience is increasingly pronounced fatigue at that lofty level (which is quite high for someone in their mid 60's). It forces me to back off the pace significantly or stop (for up to 2 minutes) until I revert to sinus rhythm. EP says my situation now has gotten to the point that cryo is an option worth considering.

I've trolled ST for many years for information and never responded - so apologies in advance for the novice and long winded response.

I'm soon to be 60, 6''1" and 190 lbs and have been doing triathlons for the last 20 years or so. I recently (10 days ago) had a combined RF and Cryoablation procedure to address Afib and Aflutter. I had my first known episode of Afib five years ago while being transferred from Santa Rosa Medical Center (accident occurred day before Vineman 70.3) to Sacramento following 6 days in ICU due to a pretty nasty bike crash. My recovery was focused on getting my body moving again and I didn't pay much attention nor were the Docs even slightly concerned with it at that time. Over the last few years I experienced more frequent episodes where I could feel my heart beating randomly and unpredictably. Instead of approaching it with medical pros I convinced myself that it was stress related and I'd be fine. And for the most part this was true. I maintained a pretty heavy training and work load and was able to manage thru these random occurrences. Over the last 7 months ago the frequency and intensity of them increased. My initial foray with a Cardiologist lead to an echo, EKG and Holter Monitor. Everything was "OK", a few episodes of Afib were recorded but nothing alarming. The medical advice was to dial the training down 25% and drop alcohol. I read the "Haywire Heart" and did a little bit of research and figured I'll focus more on hydration and recovery and things would get better. Quit coffee and alcohol entirely. Yet the episodes increased from every few weeks to every 5 days. Went back to the medical professionals whom prescribed antiarrhythmic drugs and beta blockers. I felt like shit, yet any thought of a cardiac ablation was pegged for "the future". My only daughter is getting married the end of July and I didn't want her to have to endure me being one of the chance few whom have a major setback from the procedure. After two failed cardio conversions and no improvement from the meds I reversed course, stopped the drugs, and insisted on the ablation. I've had a few random Afib sessions since leaving the hospital the following day, but nothing lasting or overly alarming. I swam 2,200 yards Thursday and had a very easy spin on the trainer today for about 40 minutes. I had 4 insertion points in my groin (3 on the left and one on the right). I have a substantial hematoma and "comfort" issues on the left side but will heal. I had planned on racing Honu 70.3 on June 5th but just recently pulled the plug. I am still hoping for St. George in Sept. and maybe IM Sacramento in Oct.

I canvassed many for advice and questions leading up to my decision, and I think the most valuable in order are 1) Decide - a lifestyle of meds and blunted performance or a potential improvement with a risky ablation procedure?, if the latter, 2) How many of these has the EP done, 2) If there are any complications does the setting have other skilled Pro's to deal with it (Cardiac Center), 3) Do they have access and first hand knowledge of your current medical condition (i.e. other ailments), 4) Can you return easily for follow-ups and with the same EP if another procedure is needed.

Best of luck to you!

Hello sudtirol and All,

My wife had an ablation a few years ago that was not successful but controls her Afib and sometimes just normal rhythm high heart rates with meds.

She was looking at a second ablation or some other procedure that might be helpful.

My sister in law is associated with the Adventist Hospital System and suggested the two part 'hybrid maze procedure' which has a high success rate.

https://www.adventistheart.org/arrhythmia/

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Cheers, Neal

+1 mph Faster

In 2009 (age 40) I was in persistent (not paroxysmal) afib and had rf ablation. This was after a couple of cardioversions, meds, etc.
Ablation was successful and had no episodes until training for Ironman in 2019. Afib came on suddenly and I'd find myself in afib during every bike/run. Returned to normal after exercise.
Had cryo-ablation surgery in 2019 (age 50) and no problem training for Ironman this year.

edited: was persistent afib, not paroxysmal

Pretty much same as Randy for me. I had paroxysmal afib off and on for 9 years then, in 2010 had RF ablation. Only a month ago, 11 years post ablation, it came back suddenly. It's not as chronic as before, and half the time its just one PVC after another. I plan on getting a touch up ablation this summer.


Edit: Just realized you were interested in cryoablation. Can't help there.

I had RF ablation, so this doesn’t answer your question, but it could help others be more aware that cardiac ablation isn’t as straightforward for everyone, especially the recovery. I have had SVT since I was young. I am a female. First episode at age 17. It never happened during my six Ironman races or 13 marathons. The past two years my heart went into SVT while swimming. Most recent episode was in late Jan 2021. Couldn’t convert out of it so 911 was called. They were finally able to catch the SVT on ekg. It had never been caught on ekg prior because it was so infrequent. I was in SVT for 21 minutes. Saw an electrophysiologist at the Cleveland Clinic and had an ablation on March 10th, 2021. She was able to induce it right away. She ablated my slow pathway with RF energy. I was under general anesthesia because she wasn’t sure she could find a substrate and may have had to spend more time with the EP study.

Recovery has been rough. Three weeks post ablation had an infection in my left catheter site. The following week had this awful adrenaline like feeling in my body and bad tachycardia. I ended up in the ER three times because the tachycardia and adrenaline was horrific. My third ER visit was two weeks ago and I was also hospitalized. No SVT, just sinus tachycardia. Heart rate got as high as 157. No one in the ER’s knew what was causing this then finally, the electrophysiologist on call, who is a colleague of my electrophysiologist, changed my beta blocker to counter act the adrenaline. He said my sympathetic nervous system was in overdrive because of the ablation, thus causing increased adrenaline and tachycardia. Basically the ablation can damage your nervous system, because those nerves are inside your heart and can cause parasympathetic nervous system withdrawal. He said I have post ablation tachycardia and they see this sometimes with SVT ablation. He said the three month mark is usually when it will go away because that is when the heart should form the scar tissue and be fully healed.

I have been through the ringer and it’s been pretty traumatic because this is my heart. Probably won’t do anymore ironman races because I don’t want a different arrhythmia down the line. Cleveland Clinic is still top notch, but there should have been more communication as to what could happen the first three months post ablation. I am in no hurry to jump back into intense cardio. I’d rather let my heart heal. I was on medical leave for two months because of this. Hope this helps. No one talks about post ablation problems. Thanks for opening up the conversation.

I'll pile on the "had RF ablation, not cryoablation" experience cause I'm bored and who knows, might provide some insight.

First off, I am an Emergency Med MD and have treated folks with acute SVT's and (A. fib/flutter...and much worse for that matter) for near 30 years. Who better to know when they are having runs of SVT right??!!

I'm a 56yo, 6'5", 210-220lbs typically - a big dude not particularly suited to endurance events but luckily for me, there is no rule that says you can't partake even if you suck...so I do 'em..and have since the early nineties. I did many a tri in my speedos for chrissakes. For many years, I would have a brief palpitation/flutter sensation typically immediately after a hard effort where I would be trying to settle back in to a steady rhythm...think trying to maintain momentum over rollers. They were very self limited and seemed to improve/go away with better conditioning as each season rolled along. Like many I had a period of time away and when I was turning 50 I decided I would get back into it and do a 70.3. I recall while training having a few flutters but not being particularly bothered by it...nothing sustained. Race day I for me nailed the swim and bike and was settling in to my shuffle/run when about a mile in I just couldn't catch my breath. I didn't feel the typical onset flutter or anything but just lost my energy. I felt like my chest was tight and went so far as to take my HRM strap off. I kept at it and ultimately straggled across the line just to say I did it. I attributed it to just being out of condition for an event of that duration. The next year I was doing 70.3 Boise and I knew I was not in as good a condition as I should be so was actually going pretty reserved. Coming in on the bike leg in a decent descent from Micron to the river with one little roller that if you give it some stick you can maintain some speed. I gave it some stick over the top, settled into my extensions then immediately felt like I was passing out and felt my heart flutter and continue - my heart rate was steady 140bpm no matter what. My energy was gone. I coasted pretty much back to T2, felt like crap but decided to push on and tried to run...but couldn't...at all. I walked and passed my wife at about mile 3 and told her I was sitting down at next aid station and if it didn't settle down I was quitting (I'd never quit before). The aid station was in wide open direct sunlight so I just said hell with it and pressed on. In the shade of the greenway, my back started feeling really stiff so I did a hip hinge/squat, stood up...and felt fine!!! My heart rate was suddenly 95. I had my eureka (you're an Emergency doctor for hellsakes moment) and realized I'd been having SVT all along. My heart tracing from that race is awesome and tracks it perfectly.

I knew what situations triggered it for me - hard effort, deep breath, settle in...SVT. I could pretty much avoid it by simply not doing those type of things - keep things nice and steady. I had a few more brief episodes training and racing (some I thought might just be anxiety about having SVT) then I had a very long episode at 70.3 CDA that began in the swim about halfway. I was swimming nice and steady, just about to first L turn when a person next to me just went straight sideways over the top of me. I took a sudden big breath out of rhythm...SVT, heart rate 140. My immediate thought was get to a paddle board but I calmed myself down, sort of doggy paddled around the corners to the long home stretch swim in and said "either quit or suck it up and swim" I swam in and that was the most fatigued I have ever been in my whole life. I literally would have laid on the beach like a washed up whale if there wasn't thousands of people watching and cheering. In T1 I tried multiple valsalvas/squats/sitting/laying...nothing worked...so I did what any self respecting "paid a bunch of money to do this" athlete does and took off on my bike. I had no energy. I got passed by everybody. At mile 24.9 going up gentle grade...it stopped...I felt fine...and I took off and actually finished out my day feeling not too bad minus the 1.5 hour SVT spell.

SVT can be really variable in how people tolerate it. For me, at it's onset it would cause a very brief, almost syncopal feeling - I would get a feeling of the ground rushing up at me of sorts...then my energy would just be gone. That's probably because when it occurs often the atria are contracting against AV valves snapped shut by the already contracting ventricles...and it makes you feel like shiz. I decided I needed to do something about it, saw an EPS Cardio and wore a monitor for a month. We caught a few episodes of fo' real SVT at 140 rate but also interesting several episodes of MAT (multi-focal atrial tach) with rates to 190. I had RF ablation with Propofol sedation, took 5 hours and he found 4 ectopic atrial sights that triggered the MAT with rates up to 190 and a typical accessory track for SVT - and ablated all those. When I woke up, I was whoooooped - I mean really tired and my chest was heavy. I thought I might be having an MI but saw the post procedure EKG looked perfect. I had some bleeding from my right inguinal access sight with a whopper hematoma but all in all it was a piece of cake deal...I'd do it again right now if I had to.

I researched before hand and, it's mostly anectdotal, but the folks that really took the time to heal and didn't press their heart rates up seemed to have much less recurrence/failure. For the next two years I pretty much became a Zone 1/2 zombie...and I loved it. I took a beta blocker for those two years as well - I had alot of PAC's initially but they settled down. I can spin along forever now like that...used to bore the shiz out of me. I'm in year 3 now post procedure and turning up the throttle quite a bit more - I sustained HR's in high 160's for duration of the local time trial last Wednesday...my max is probably 172/173. I haven't felt a flutter/flip/anything since my procedure. I quit taking my beta blocker as well this year.

There is a saying in amongst medical folk that "A. fib begets A. fib" or "SVT begets SVT" which basically means the more a heart goes into it, the more it goes into it...that was certainly my experience. I committed myself to a long period of sustained low heart rate training to really iron in my normal sinus rhythm pathways and would encourage anyone that has this to do similar - I would not rush back to high, sustained HR efforts...unless your career as a pro-cyclist/triathles/runner, etc necessitates getting back at it sooner.

It's a frustrating deal, can be very individualized, and wish ya' luck on sorting it out!

I just turned 60 this year. I've been doing triathlons/marathons for almost 20 years. I trained and raced hard and pretty much made it to the top - Kona, 70.3 worlds, Nationals, Boston, etc.

About 4 years ago I first experienced afib. It came on suddenly during a running race. I had no idea what was going on and I feared a heart attack. The crazy thing about afib is that once it stops your back to normal, within about 20 minuets I felt fine and by the end of the day I just let it slide. This dynamic of afib unfortunately helps you go into a denial pattern. I did see a Cardiologist, had an echocardiogram and everything was good. They thought it was probably PVC's and not to worry. However, starting last year, I started to experience it more and more, (about once every 2 weeks while training) this change happened fairly quickly. I went back to the Cardiologist, wore a 24/7 monitor and within the first week they called with the news that I have Afib. Technically I had both Atrial flutter and Afib. I was devastated by the news and since I am otherwise very healthy, I feel that endurance sports (with maybe some deep recessive gene) are the culprit. I guess I will never really know but the subject is being studied more and more with an increasing consensus that extreme endurance training is not good for heart rhythm health. My afib became much worse this last year reaching a point where I experienced it almost every day. Drugs were really not an option for me, the side effects and effectiveness just didn't make sense to me, so I opted for the ablation. Since I was having both Flutter and Afib ablations they used heat instead of cryo. My procedure took 4.5 hours, but I was released the same day. The procedure itself was pretty difficult and left me really beat up but it was a complete success. So successful that it feels "miracle" like. No afib at all since the procedure (going on 6 weeks). I ran a week and a half after and have been biking and running every day since. Afib now seems like a thing of the past.

I will never race again and have transitioned to exercising for "fun" versus training. It's a hard transition and I'm still adjusting. The procedure for flutter they consider curative, however the afib part they do not. It can and most likely will come back some day. My goal is to push that out to a long time from now. I feel that endurance sports simply can’t be in the mix - at least not to the extent that I previously competed at. Living a healthy lifestyle and staying fit are both critical to healthy heart rhythms and maintaining a successful ablation outcome. I’d be curious to hear other triathletes’ stories on afib and ablation outcomes.

61 this year, endurance sports since 1968 (swim, run, tri, canoe).
So far I've had one episode of afib with svt, and that was enough ;-) it went on for some hours, ended up in ER.
Like you have backed off hard efforts/racing, also cut back on alcohol and caffeine to weekends-only one a day. So far no re-occurrence..

A friend had his first episode of afib age 62 while we were out hunting pheasant, walked 12 miles in heat with not enough water. It was quite a long drive to the nearest ER, I was spooked.. After that he had multiple episodes. The ablation didn't work the first two times but the third got it it seems. He wasn't an endurance athlete, football when younger, since then long hours and a great deal of stress in his job..

Watching this thread, I first developed AFib a few months after doing my first (and only) IM back in 2006. Have managed it with meds ever since, no side effects for me, but the ablation is always out there as a possibility. Had some much more frequent episodes back in early 2020 and increased my meds and it went away, but at the time was looking at the ablation very seriously.

Didn't realize about the possible complications from ablation, thank you for sharing. I'll echo what others have said, limiting caffeine, alcohol and not going overboard with the training I think are all integral (but don't guarantee) making these easier to manage. I've done 4-5 marathons since then, plenty of tris and bike races, but just keep the training in the 7-10 hrs per week (maximum).

I'm curious as to why you went back to running and biking so soon after your procedure? Why not just walk and let your heart heal for 3-4 months as your heart forms scar tissue?

All of my running and biking have been at super easy Zone 1 maybe occasional Zone 2 pace. Runs have been run/walk for about 30 min. and rides are around 45 min - 1 hr. This is VERY low volume and effort compared to what I was doing about 6 - 8 months ago. I am careful about anything even close to overdoing it. There is however a strong link to fitness and better outcomes following ablations. Keeping fit and staying active not only feels good but is one of the keys to keeping my heart rhythm healthy. Basically the sooner you can get back to some form of fitness the better.


https://my.clevelandclinic.org/podcasts/cardiac-consult/higher-cardiorespiratory-fitness-linked-to-better-outcomes-following-atrial-fibrillation-ablation

Ok, thanks for replying. Guess everyone's body responds differently to an ablation. I had an SVT ablation at the Cleveland Clinic in March of this year and had complications about 3 weeks in. I'm hitting three months post op on June 10th, so that is when my heart should be totally healed. I've only been walking fast up to 30 minutes, then 20-30 minutes easy walking. Because of the tachycardia episodes that landed me in the ER three times and being hospitalized on the third ER visit (these occurred 4 weeks post-op), I am a bit scared to run or bike and get my heart rate up. The new beta blocker seems to be working and haven't had the tachycardia for about a month now, but the complications really affected me mentally.