Questions

[Gracey23]

I've been learning so much from this forum and have been reading lots of info on the AFib website . I have PAF and have been taking Flecanaide with aspirin for about ten years. I've had a successful ablation for flutter and am preparing to get an AFib ablation this spring.

The questions I have are, if medication if keeping episodes at bay does that decrease stroke risk? It seems to me that controlling AFib episodes would eliminate the increase of stroke but I'm not sure my thoughts are correct. Secondly, if after a successful ablation do you still need anticoagulants? Does your stroke risk become same as people without AFib?

[BobD Volunteer]

The simple answer is that your stroke risk exists because you have AF not how often or how seriously you have it. In fact there is no evidence that successful ablation removes stroke risk which is why many EPs suggest and most of us wish to remain on anticoagulant for life unless there are real medical reasons not to.

Aspirin of course is not an anticoagulant and not recommended for stroke prevention.

The old saying is you can stop anticoagulants but you can't undo a stroke.

[Gracey23 in reply to BobD]

Bob, thank you for your reply. It's still difficult to understand how the risk of stroke remains high when symptoms controlled by meds or successfully treated by ablation. Still learning!

[teach2learn in reply to Gracey23]

I had almost your identical situation (am 68 female, but don't know yours) and questions following successful ablation. My EP indicated he was obligated to tell me remaining on anticoagulant preferred for safety's sake, but that statistically there was only a half percent greater risk of sroke (in my situation, with no afib) than of bleeding problem at some point. Also, that it takes 24hours or more of persistent afib to create the dangerous clot associated with the higher risk. That is not to say that any given individual may not have other stroke risk factors that would call for anticoagulant. I was personally comfortable, considering my high activity, low cholesterol, diet, etc. balanced against concerns for easy bruising and other bleeding concerns, stopping the Eliquis I'd been on before ablation. Before ever seeing a cardiologist or taking anticoagulant, I had been in full time afib for months and not formed "the clot" and without any afib at all felt perfectly at ease with that decision. My EP was okay with it, too--all things considered. I know there are others who feel adamant about taking their anticoagulant, so you just have to make the best decision possible between your situation, the doc's advice, and what makes the most sense to you.

[BobD Volunteer in reply to Gracey23]

Yes I use to think the same all those years ago when I started my journey but the more you understand the more you realize what a complex thing it all is. AF causes changes to occur in the left atrium which can make the formation of clots more likely. It is not just about whether or not one is in fibrillation at the time.

If your Chadsvasc says anticoagulant then stopping AF doesn't change that any more than taking blood pressure meds means that you can discount BP from your Chadsvasc. You have had it so you score.

Of course in all things one needs balance so HASBLED needs to be considered as well but generally speaking if your CHADS is higher than your HASBLED then anticoagulation is wise.

I know what scares me most anyway.

[checkmypulse]

Having just had an PVI Ablation 6 days ago I am to remain on warfarin till reviewed at my first outpatients clinic. I assume I will remain on an anti-coag afterwards as EP advises that at the moment there is no evidence that a successful Ablation removes the stroke risk. This despite the fact my Chads risk is 1 and the NICE guidelines (UK only) say no need for anti-coags.

[PeterWh in reply to checkmypulse]

Care England does suggest Anticoagulation if score is 1.

[Barry24 in reply to checkmypulse]

Hi Checkmypulse/PeterWH,

NICE Quality Standard 93 - "Adults with non-valvular atrial fibrillation and a Chads Vasc stroke risk of 2 or above are offered anticoagulation"

Kind Regards

Barry

[checkmypulse in reply to Barry24]

Thanks for feedback, I stand corrected. The Nice Chads/vasc terminology says 'consider'

anti-coag with a 1 score. In my case aged 68, male and with no history of hypertension,

disease, stroke etc my GP and at my initial meet with a Cardiologist they stated I did

did not meet the criteria and I did not need anti-coag. My EP was the one who started me

on Warfarin in preparation for the ablation.So it's down to interpretation, understanding

and experience ( and could budget pressure play a part?). Whether I will continue on

Warfarin or a different one I will wait and see. I note some others have discontinued

anti-coags sometime after ablation but given the choice I think I will opt to continue with

them.

[Barry24 in reply to checkmypulse]

I think you are a very wise man checkmypulse.

Best Wishes

Barry

[PeterWh in reply to checkmypulse]

I agree. You are wise to choose Anticoagulation. If they don't offer it you can insist.

[Mrbill757]

Common sense goes a long way in every area of life including medicine. If all you have is lone afib and its controlled by meds, meaning you never have episodes of afib, that means you never give your heart the opportunity to have blood pooling and thus forming clots in your atria. If the atria is always pumping, it would make sense that you would not need blood thinners. If you've had negative holter monitor results, that means you haven't had afib episodes at night either. Blood thinner has risks of its own. Rule of thumb in cardiology is to convert within 24 hours if a person goes into afib and NOT use blood thinner prior to conversion which means even if a person has been in afib for an entire day, there's no risk of blood pooling and clotting in a 24 hour period. If one goes longer than 24 hours in afib, they'll be put on blood thinner for a predetermined time before setting up conversion attempts since there's greater risk of clotting after 24 hours. Make sense? I've had 3 episodes of afib in 16 years. I'm on flec and baby aspirin as a preventative measure. No blood thinners. I'm always in normal sinus rhythym. Hope this helps.

[Mrbill757]

One other thing. Afib is THE NUMBER ONE CAUSE of stroke so clotting is a huge danger. So if one's atria is not pumping, clotting has a much greater chance of developing. That's why blood thinners are so widely used for afib. But again, if one has normal pumping all the time, why use blood thinners?

[PeterWh in reply to Mrbill757]

One thing that MrBill missed out is also the fact that AF is also the biggest factor in relation to MAJOR strokes.

The stroke association UK website says "AF related strokes are often more severe with higher mortality and greater disability".

The AFA website states every 15 seconds someone suffers from an AF related stroke.

What is also missed out is the fact that very often AF sufferers have other heart related problems or circulation related problems or one or more of a number of other issues (eg diabetes, etc) that increase their stroke risk.

Thoughts for the evening over!!!!

[Mrbill757 in reply to PeterWh]

Peter,

You must have missed my follow on reply regarding everything you just mentioned. But appreciate your comments. Better to be redundant than miss something altogether!!

[PeterWh in reply to Mrbill757]

No other comments from you below mine on this post.

[Mrbill757 in reply to PeterWh]

Peter,

I did in fact mention "lone afib" in my first reply, meaning there are no other medical issues with one's heart.

[Gracey23]

Thank you all for your replies. As I thought, there isn't just one answer regarding use of anticoagulants . Let's all hope that research can come up with one! In the meantime I wish you all good health with no bumps and thumps!

[PeterWh]

Tracey - see my comments to MrBill.

[Mike11]

I should point out you are not on anti-coagulants. Aspirin isn't one.

[Janco]

Gracey

One thing I have read about and experienced myself is that after my ablation I did not "feel" my afib so strong. What I mean is my pulse did not go up so high like pre-ablation where I really "felt" it.

Post ablation for me, when my rhythm went out it was just a strange feeling and not the same as pre-ablation.

On my blog I also wrote about it myafibheart.com/blog/

It can be that post ablation, we cannot feel the Afib so distinctly, and go on with that AF for a few days or weeks, and then the stroke monster can come in.

[Gracey23 in reply to Janco]

janco, I do agree. After flutter ablation AFib episodes do feel different , bears aren't as fast , good info thank you.