Firstly apologies to anyone who was waiting to see the same EP as me today at Harefield, I was with mine for nearly 50 mins, which is I suspect a lot more than time than they usually allocate.
OK results first, no surprises in the 24 hour halter, persistent AF no real change over the day, plus also good news no noticeable enlargement of the left atria from the echocardiogram, still enlarged, but not increased.
So what next steps, we chatted for a long while about the effects of remaining in AF almost without symptoms, his views was that it is almost certainly life shortening, by how much no-one really knows but possible 3 - 5 years, and it's not the AF but cumulative side effects, very high risk of stroke, and/or heart attack.
But should we treat?, and the answer has always been treat the symptoms, not necessarily the AF even though we all know treatment gets harder the longer you have been in AF. And the answer to the symptoms is as I cannot remember being in NSR, do I really have a comparison point? EHRA guidelines still seem to say that only symptomatic AF should be treated agressively, maybe because there there really isn't sufficient data for the long term effects of persistent.
Harefield (with Liverpool) have a new research trial starting comparing catheter and thoracic (surgical) ablations, but I might not even have sufficient symptoms to qualify for that.
So we discussed next steps, and we have agreed that I am going onto amiodarone for at least 3 months, and they will attempt to cardiovert me again in 2 months time. No-one least of all me expects the CV to stick, BUT if they can get me back into NSR with a combination of chemical and electrical cardioverion, for at least say a week, then I will have a baseline comparison point to being in NSR. I should then be able to make a much more informed decision on treatment routes with a goal of NSR (if it is that much better than I am now) He did say he knew patients who had been ablated back into NSR and felt little difference.
So I start tomorrow, usual high loading dose for the first two weeks, and then a daily dosage, and I must admit to being a little scared, I know how powerful this drug is, and how potentially powerful the side effects, although I shall not (hopefully) be on long enough to worry about some of the longer term side effects.
Have to stay out of the sun of course, not that bad in the UK in Feb/Mar and April but for two months afterwards? I might miss both days of our summer this year
Anyway I said I would report back, as I know there are others like me out there, can't say I am deliriously happy about taking amiodarone, BUT I do feel we are jointly making positive steps forward with informed joint consent, and surely that's as much as any of us can realistically expect.