12 months post ablation - Good News and a bit of a dilemma

[davegm]

I had my 12 month post ablation review with my EP yesterday.

I have not had any AF episodes since the first two weeks following the procedure. I have had ectopics either individually or in groups of two or three together and on a couple of occasions runs of ectopics lasting an hour or so these seem to be fading away over time. These ectopics have been identified on the monitors I had at three and six months and the EP showed me print out and confirmed that these were premature beats and not AF. Fortunately they correlated exactly with my dairy and there were no other events I was not aware of.

My EP is happy to, in effect, discharge me but will also happily see me again should I have any concerns (or any episodes of AF). He thought the chances of getting a return of AF were very low.

The ectopics are fairly rare now and we agreed to use bispoporol as a pill in the pocket if I get a particularly bad run of them. He said that those who have had AF are acutely aware of them and we are attuned to every little blip that most people get but are not aware of.

Now the slight dilemma - anticoagulation!

We discussed this at some length - my CHDS2VASC score is 1 based on controlled hypertension. He said the stroke risk was very small and happy to recommend stopping the Apixiban, but should I have an AF episode to start again. He also mentioned the bleed risk with taking anticoagulation.

I did ask specifically what happens when I reach the age of 65 and become a 2 and he said without AF episodes the risk is the same as any 65 year old. This of course is a different take on things than the often expressed views here.

Based on the fact that I fully trust him, his skills and his judgement, and my preference for not taking drugs where possible, I agreed to stopped the Apixiban.

Has anyone else had this discussion after an apparently successful ablation? I would be interested to know if this is common particularly with patients treated at Liverpool.

Overall I am very pleased with the way things have gone and would without doubt have another ablation if necessary - certainly hope it won't be but you never know.

Thanks for all the support over the last 12 months.

Regards

Dave

[jeanjeannie50]

That's all good news to hear and if I were you I think I would have stopped the Apixiban too. It's just personal choice really isn't it. I know a lot of people on here would say carry on with it, but I'm with you.

Jean

[davegm in reply to jeanjeannie50]

jean

Thanks for your comments

[Dave1961]

I personally feel that if you are not experiencing any AF symptoms and you have a 1 as your CHDS2VASC score then I really don't see the need for the Apixiban . I know this is NOT in line with conventional wisdom round here which is to take them, take them, take them but you are extremely low risk and sometimes we forget that these medicines are not just there lollies they DO contain strong chemicals which can help BUT also have side effects.

If I do not have to swallow a capsule of chemicals I would prefer not to.

What a fantastic outcome from your ablation.

Was it your first?

[davegm in reply to Dave1961]

Thanks Dave

This ablation was not my first as I had a focal point ablation about 16 years ago, however it was the first attempt at the full pulmonary vein isolation ablation following the return of AF symptoms about 2 years ago.

[BobD Volunteer]

Hi Dave, I agree that if no AF then risk is low BUT there is no consensus amongst EPs as many feel that continuation of ACs is correct. They feel that the work done in the heart can cause eddying which can result in clots. Also how do you know that you don't have AF. End of the day it is a personal choice. I haven't had AF for 7 years since my 3rd ablation but would never consider stopping warfarin myself but others can't wait to get away from it.

Not very helpful I'm sure.

Bob

[davegm in reply to BobD]

Bob

Thanks for your comments, I know you have strong views on this subject.

I made my decision based on an informed full discussion with my EP who I had trusted my life with to carry out the ablation (as we all do).

Incidentally, how do you know you have been AF free for 7 years (or anyone else for that matter) unless we are hooked up to an ECG 24/7?!!

Best wishes

Dave

[BobD Volunteer in reply to davegm]

My point exactly. At the end of the day it is a personal choice and what you chose is right for you.

[dedeottie]

I think I would probably opt to keep taking anticoagulation as long as it wasn't causing me any problems. Luckily I don't have this decision to make . Having had 3 T.I.As I score 3. Before I had the T.I.As I scored zero so was not on anything. I therefore feel very nervous about anyone coming off the tablets although I suppose it may be different if there was no longer any A.F. x

[davegm in reply to dedeottie]

Thanks

I understand how you feel

[Elbows]

Just had my 12 month review post a successful ablation and have been off all drugs Including warfarin for some 6 months now as I have been in continued sinus rhythm and I am Chad Vasc Zero. This is with the agreement and support of my EP at Barts.

[Runcrans in reply to Elbows]

Great to hear this elbows 👍👍👍👍

[Hidden]

I ask my EP every time I see him (twice a year) whether I should continue with my Warfarin and he always says yes. I had AF 10 years ago, it was controlled by drugs so no symptoms, then an ablation which cleared it and I stopped the rhythm drugs, then 8 years later a bit of AF came back, now again controlled by drugs. So all in all, I've nat had much actual AF in all that time, not even asymptomatic because I've had monitors which show nothing.

But I've been anticoaged throughout and will be indefinitely. And that's even though my CHADS score was always zero till I hit 65 recently so now it's 1. I have no family history of strokes, I'm average build and I'm fit for a 65 year old.

So next time I see my EP I'm going to ask him instead if his advice is general or whether there is something about me individually which pushes him towards anti-coagulation.

Koll

[Japaholic]

Nice to hear a positive story, thanks for sharing.

[davegm]

Japaholic, Koll, Elbows

Thanks for your responses.

I does make me think EP's take more individual factors into account when recommending anticoagulation after ablation rather than just a "one size fits all" approach.

[Runcrans]

Brilliant news that your af free and very good to hear because I've just got my dates through for the 27 th of this month , as I see it I've had paroxomol af for nearly a year and at one point I had 20 hr runs in af nearly every other day with no anti coagulation and came to no harm ,but it's a personal choice and I'm sure these clever electro physiologists should no what there on about cheers Paul

[Elbows in reply to Runcrans]

Good luck Paul, best decision I made and I will not hesitate to have it done again if I ever go back into AF. Let us all know how you get on.

[Runcrans in reply to Elbows]

Thanks elbows , I will keep in touch with my progression through this cheers Paul

[rosyG in reply to Runcrans]

runcrans I think it's risky if you have prolonged AF and no anti-coagulation- was this the advice of your doctor?

[Runcrans in reply to rosyG]

Hi rosyG, yes it was my cardiologist who said I didn't need anti coagulation which I never had for several months until my ep has put me on warfarin for the ablation , got three weeks to go so starting to worry a little cheers Paul

[davegm]

Paul

Thanks

And good luck for the 27th

[rosyG]

Hi Dave

I always think I can feel any AF but it is often said we can't feel everything- I think if I were in your shoes I would invest in an Alivecor monitor so you can check when you have ectopics that you are not having any small runs of AF too.

hope all goes well with you

Rosemary

[davegm in reply to rosyG]

Hi Rosemary

Yes I have thought about getting an Alivcor but two reasons I have not so far.

I am very conscious of any AF episode, and can readily differentiate between these and ectopics when the ectopics are single or a run of ectopics interspersed with regular beats. I am however less sure when there is a short run lasting only a few seconds. On the short runs recorded they have only been identified as ectopics but as you say are others not recorded short runs AF?

I'm not exactly sure how an Alivcor works but I presume you have to activate it to record and the short runs are so short they would have passed by then. Equally, if I (or anyone else for that matter) is getting AF they are not aware of how do you know to record unless on a completely random basis.

The other main reason is because as with a blood pressure monitor I know I would become obsessed with taking recordings which would probably lead to more ectopics and the start of a vicious circle.

thanks for your comments and I am CHADS2VACS - 1.

Regards

Dave

[dedeottie in reply to davegm]

This could have been written by me! I am 5 months post ablation and for the first 3 months I felt nothing at all except regular beating(heaven ). I was still on a lot of flecanide and E.P. said to start reducing flecanide to nothing eventually. I am now taking only 50 mg only once a day which I am pretty is just a placebo as I don't think it would be keeping much at bay! However, I can now feel all the ectopic beats,runs of ectopic beats last I g only a few seconds at a time. Are they ectopic or short runs of A.F......I don't know as I have not got Alive cor and am sure I would never catch one of these runs as they are so short and rhythm and rate between these runs are totally normal. Guess I will have to wait till next appointment in November but I'm impatient and would love to know if the A.F. has really gone!

Good luck and keep us posted.x

[davegm in reply to dedeottie]

Thanks Dedeottie

As I noted the short runs that have been recorded have all been runs of ectopics as the EP showed me on the print out of the recording. He is pretty sure I am not experiencing any AF and I am going along with that. The small doubt does creep in however but I haven't had one of these for about 5 months and single ectopics are now few and far between.

I do think if you trust your EP you go along with his expert opinion but question him as much as you can.

All the best - you seem to be doing fine - still relatively early days for you.

Dave

[rosyG]

Have you checked your Chadsvasc scoe?

The details of how to score it are on the AFA website?

[Fussyface]

Hi Dave

I had a surgical ablation and isolation of the left atrial appendage 4 months ago at Liverpool. I had previously had 2 unsuccessful PVI ablations, although this has been a tough proceedure to get over and I still take Pregabalin for nerve pain across my abdomin and at the incision sites, I'm glad I had it done as I feel so well, have not had any symptoms since. Every ECG since has been normal, even if I feel a slight awareness of my heart, when I take my pulse, it's steady , right rate, right rhythm ( hope, I'm not jinxing myself).

I have been off Amiodarone for 2 months which was my most important concern and am now Bisoprolo and Warfarin free. I was a bit wary about the anti coagulant, but I too score 0. I had a 24 hr tape Mon / Tues, so fingers crossed for us both.

Out of interest, which consultant are you with, I'm with Mark Hall and Mr Medriatta ?

Best wishes

Chris

[davegm in reply to Fussyface]

Hi Chris

I sent you a PM as I don't want to name professionals in the open forum (even though they were very good)

All the best

Dave