Input from the crowd on 3rd ablation
I'm not looking for direct medical advice, just some general input from folks who might've walked a similar path before, to help me think about an important decision. I'll try to keep it brief.
I'm 62M, overweigh but very active, and was diagnosed with persistent AFIB in 2020, but didn't act promptly, so was in it for about 8-10 months before being cardioverted out, which dropped ejection to 30%. Without dragging out the story, I had two ablations, one in August of 2023, and, after a couple of returns to persistent AFIB, one in September of 2025.
After pushing myself WAY too hard playing hockey against college kids in March, and apparently not hydrating / taking in enough electrolytes, I went back into Afib. I immediately restarted Eliquis, Amiodarone and Metoprolol, then got cardioverted out 10 days later. I've been NSR since, with RHR of 50-55, and continued the meds, although went down to 25 mg Metoprolol. BP is 130-140 over 75-85. I no longer drink alcohol, and have a CPAP for apnea.
EP scheduled me for a 3rd ablation for July 7 (this Tuesday), and implied that things could get pretty serious if this one doesn't semi-permanently resolve the onsets of AFIB; seems like he's worried about how my ejection fraction declined so much the first time I had it.
Since I now feel like I'm well in control of potential triggers (no alcohol, MUCH more attention to hydration and electrolyte balance, CPAP, retired so no stress), I've proposed to the EP that we postpone the ablation, stop the Amiodarone, and see if I can stay NSR by continued attention to the trigger sources, and possibly start GLP-1 treatment as well. He has said OK to this plan, so I'm planning to cancel the procedure tomorrow and rebook for October (when I can hopefully cancel again).
So, the question after all that is: DO YOU THINK I'M MISSING SOMETHING? Will I expose myself to undue risk by either having the 'needless' 3rd ablation, or by NOT having it, and potentially going back into AFIB again (which would be about the 6th time I've gone in - had a few cardioverts along the way). My EP always seems to say 'Yes' to whatever I propose, so I'm concerned that I'm being too optimistic about being able to control via trigger management and he's not sharing risks with me, especially since communication is via his PA, while she's IM'ing with him through their system.
If you've made it this far, I thank and congratulate you, and hope that you'll share ANY thoughts you might have about this, to feed into my internal 'decision engine'.