I finally have an appointment with an EP. Could you all help me come up with a list of questions I should be asking her about a potential ablation. I have had intermittent AFib for a year and a half now. While on meds (sotalol , bisoporlol and warfarin) I only had A Fib about one evening every 2+months so my cardiologist wouldn't send me to an EP. He moved to a different practice so now I have an EP for my Doctor. She thinks the cardiologist was slowing my heart rate down too much. She took me off all my meds except for Warfarin and is talking about ablation. Now I have A Fib approximately once a week
thanks for your help thinking of questions.
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shadski
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Hi Shadski and Happy New Year to you as well. My advice would be to ignore your cardiologist and trust the guidance of your EP as these are the specialists with rhythm problems . For a start sotalol is no longer recommended for control of AF and bisoprolol is the fall back drug for just about any doctor who thinks he understands AF. Most don't! Many choose this drug and then when the patient's heart rate drops too low they start talking pace makers. DOH!
Ask her what she thinks she can do for you. How many procedures you might need and what are her success rates. Trust me, better to have an ablation sooner rather than leave it and with luck you could be symptom and drug free within a year.(Apart from warfarin of course. Many EPs consider that this is for life if you have or have had AF).
Bob
Be prepared for the EP that's too busy to consider your case as an individual (my experience, he was running an hour late in his clinic) and acknowledge that you know she won't like lists but…. Give her a typed up list of questions and another list of your medical history/data well laid out, before going through them, refer specifically to any other health issues you have that could delay the decision to go for the ablation procedure now and bear in mind, as my cardio said to me, "if you go to a carpet salesman you are likely to buy a carpet".
I am in no position to question Bob's advice re an early ablation but if I was in your shoes I would also consider that the procedures are improving all the time and whereas a delay may be detrimental so may the selection of the wrong procedure (there are different methods), at a time when you are not in the best of health (other issues) and at the wrong hospital. Lastly, don't forget if you decide on a delay you will need to make lifestyle changes to help keep it at bay.
Hope this helps and doesn't sound too negative but I have found the halcyon days are gone when you assume the doctor has all your information to hand before taking a decision and all you have to do is do as you are told.
I also had a GP and a cardio put me on Bisoprolol on two different occasions. My heart slowed down so much the GP said I might need a pacemaker. I got an appointment with my EP who took me off the Biso and said he wasn't bothered about my slightly fast heart rate. Now on drugs he prescribed and all is well, back to normal.
Going back 10 years, I had underlying persistent AF and my EP talked to me about an ablation to get off the drugs, which were working just about 100% but making life intolerable. I was given the choice of other drugs or an ablation and I went for the ablation, which was a success. I stopped all drugs straight away, except anti-coags, which I'm still on even though I have no arrhythmia actually happening.
I think there are wise points in all the answers so far.
If I were you I would try and assess how bad the weekly episodes make you feel now you are off medication. If they are short and mild episodes you might take a different view than if they are long and vigorous.
My understanding is that ablation should be considered for severely symptomatic patients.
If you have mild, short episodes, you might want to ask the EP if there is an alternative, gentle, drug that would prevent these episodes- this might then prevent the changes in the heart tissue that AF causes.
If the EP thinks immediate ablation is the answer, and if you think you only have mild episodes at present, you could ask about the drug alternative but might want to say that you would like to keep the ablation option open for a future date if your episodes get more debilitating.
There are very mixed views about ablation and some EPs also now want it to be a last resort procedure- some in the States have changed to encouraging a complete change in lifestyle and diet which is proving successful.
I don't know if you are near enough to Epsom to come to our February meeting at Epsom hospital but our medical lead Dr Bogle is going to talk about the latest research into the effect of lifestyle changes on AF frequency and severity..
Other advances are being made with individualised ablation techniques and use of different scanning techniques so ablation may be safer and more successful as time goes on.
So many options it's confusing but you need to research everything carefully yourself - lots of studies online, and then you will be able to make a decision.
I would like to come to the meeting in February with Dr Bogle. I live in South East London - would this be possible? If so, when is it, what time and where?
Of course- you'll be very welcome It's on 4th February at Epsom Hospital Post Graduate Medical centre, Conference room 1. People arrive from 4.45pm and the talk starts at 5pm. The Post Grad centre is on the second floor of the Wells Wing.
If you come to Epsom by train it's about 15 minutes walk to the hospital. If you drive there is a car park (expensive) or some people park on nearby roads.
Guess I'd better jump in and say my ablation didn't stop the episodes at all. My ex (an MD) warned me upfront and did not think I should do it. And made a big point about asking about the success rate but I was too much of a wuss to ask.
I apparently had no AF or flutter during the procedure. I got zapped and maybe that helped long term but made no difference in the now two year short term. I am now off drugs and as uncomfortable as it is occasionally, I'm going to look at the lifestyle changes. I have an appointment Monday. Now that I realize I'm not likely to die any minute, I think I'll find a new doc.
The more I learn about all the different patterns of afib and flutter that people experience, including my brother (he had periodic but extremely severe episodes and eventually three ablations) I actually feel fortunate to have allowed mine to get to the point of full-time afib (never stopped) before going for ablation. Doc was able to locate six areas and was done in three hours. I went right into sinus rhythm and have been there ever since except for some flutter during sleep occasionally. Off all but bp meds though doc says protocol calls for anticoagulant. My choice to avoid for now. Everyone is different is the conclusion I have reached, so getting as much information from as many reliable sources as possible the best way to make choices for your situation. Finding a cardiologist with consistently good outcomes most critical. At 67 after a lifetime of good exercise and food choices, my otherwise strong heart went errant on me anyway, so that's only part of the story. Best wishes in your new adventure!
Couple of years ago but I recall the EP saying he couldn't get my heart to go into the conditions I had described but found some spots to [ zap?] anyway. My guy says I do not have AF. I recently got off Flecainide to ensure I wasn't allergic to it, but I am back on 100mg x 2, as the flutter is many times per day with vision issues, weakness, sob .... Flecainide stops it. I will soon have an ophthalmic consult and a carotid doppler procedure. Hopefully before I stroke out.
My last pacer interrogation, a couple of weeks ago, was the first time in 17 years that any flutter (for lack of a better term) has shown up. I dunno what that indicates. Sorry if I have confused anyone with my ignorance.
Hi, I would like you to discuss with the EP how your episodes of AF affect your quality of life. If it is really one episode every couple of months and really a low burden then the question to ask is if the benefits of an ablation outweigh the risks. As you see by all those who past they are going for their third and fourth ablation, it is no panacea. If you are rarely symptomatic I would not be racing toward that sort of intervention, but rather try some lifestyle changes to help keep the AF at bay. Doing everything you can to be healthy is always a great choice no matter what other decisions you make. Good luck!
Could someone explain what they mean by lifestyle changes? I am a life-long non smoker, exercise for 30-40 minutes (swimming, exercise bike) x 5-6 per week and am not overweight (except when I pig out at Christmas!)? I believe that I eat healthily - low fat, low salt and plenty of fruit and veg. I am not prepared to be obsessive about diet though. What else should I be doing? The main triggers for my PAF are stress and eating large meals in the evening, both of which I try to avoid. Pleased to see some balanced views here, including some caution about rushing to ablation.
I'm also a lifelong non-smoker and exercise most days of the week so for me lifestyle changes meant better attention to stress management, making sure that I get 7-8 hours sleep every night, and taking sugar, dairy, and most meat out of my diet. I was not overweight either, but this brought down my blood pressure, my cholesterol (massively). while knocking 18 lbs off without trying. Most of my AF episodes happen after bursts of adrenalin so staying more calm, and keeping myself off of HIGH ALERT status that was part and parcel of my previously type A personality has made an enormous difference. All these changes were spurred by a class taught by my EP to a select group of his patients who were all highly motivated and we've all had great success.
Thank you Grandma. Was it a question of finding what worked for you, in terms of adjusting your diet, or was it laid out in the class? Being already low salt and low fat, I'd find taking sugar, dairy and most meat out of my diet rather like a prescription for eating nothing that I really like. We already eat a lot of fish and chicken, rarely eat chocolate (Christmas and Easter excepted). We wouldn't be prepared to go totally vegetarian nor give up alcohol. I gave it up for four months once and still had AF. I look at sugar content as well as salt content of prepared food, but am not prepared to make every meal from scratch. It was bad enough, having restrictions when I was on Warfarin. Sorry to sound so negative! I'll look into the stress management issues.
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