19 Months Post RF Pulmonary Vein Ablation and back in AF

I went back into AF at 17 months or is it Atrial Tachycardia as my Electro Physiologist at Barts now thinks? Thankfully he has agreed to another ablation. Disappointed to be out of rhythm again and not on my race bike but realistically I always knew I would need a touch up at some point. But to all of you out there that are considering an ablation it has been the right path for me as I want the quality of life it affords as life is for living and climbing alpine passes and getting muddy, cold and wet in Cyclo Cross races!!! I'm so thankful to the NHS for keeping me ticking and fixing me when broken as I would be a wreck without it. Seriously over the years of cycle racing they have put me back together many times, but I still keep falling off that bloody wall tho! Looking forward to the second ablation knowing I will be in good hands with our fabulous Health Service. In the meantime I need you knowledgeable folk to give me your thoughts on my choice of drugs as I'm rarely in range on Warfarin so I'm looking to start on Apixaban or Rivaroxaban. I have done my reading and there seems little to choose between the two of them apart form Apixaban you need to take 2x daily. But I do remember I was at a AF conference and a Electro Physiologist saying he would choose Apixaban? I appreciate with an active lifestyle it might be better against risk of bleed as it is only in your system for 12 hour at a time with 2 daily doses, what do you guys think? Oh and I'm sure Bob will know how does Atrial Tachycardia differ from Atrial Fibrillation

13 Replies

  • Sorry to hear you are back in AF Elbows, but at least you're back on the correct path. I'm down for a second ablation too. I didn't have the prolonged period of NSR that you had, in fact I have had sporadic episodes over the past 12 months since my ablation. However, I only seem to have 1 episode a month and this hasn't stopped my active pursuits too much. I'm back on warfarin and I was in range for my last ablation, but due to my active lifestyle I was constantly having the dosage adjusted.

    I'm on the list for my ablation and I have been asked if I would take part in a trial around Dabigatran Etexilate (Pradaxa) and PV Ablations. I'm all for it if it helps with further advances of AF and anti-coagulation. I too recall Apixaban appearing to be the drug of choice last October.

    Good luck with it all.

  • Thanks Jason, according to my EP he doesn't think I have AF but Atrial Tachycardia but the treatment is the same. My big gripe is it cut my X season short :-(

  • I have been taking 2x/day dabigatran (Pradaxa) for 18 months now. There is an antidote called Praxbind.

    Pradaxa needs an acid stomach so antacids should be avoided. For some reason my EP prescribed both together. Following advice from CDreamer I binned the antacid and have had no problems since. Liberated!

    Do not put a Pradaxa capsule on to a damp plate as it will dissolve instantly releasing a 1000 tiny white balls which taste vile.

  • Hi Elbows,

    Sorry to hear this news. From the homework I have done, Apixaban seems to be the best choice, and as Jason says, was mentioned at lasts year's AF Conference.

    Best Wishes


  • A Tach is a regular rapid beat rather than a chaotic one like AF. Typically it is about 140 bpm . (twice normal) Looks quite different on ECG as well. I had an attack last year which needed cardioverting which we got done in rapid order thanks to my EP and GP actually working together and me riding a coach and team through the NHS system but it isn't AF so that was good.

  • Thanks Bob, hopefully it will mean as with flutter a greater chance of long term success through a second ablation. Strange tho as my resting rate first thing in the morning is 60 bpm and sitting here now 77 bpm so doesn't seem that rapid to me!. Only raises to 150s when out running and going up hill. Although before going back into AF/AT resting mid 40s.

  • Sorry to hear that.

    When I was initially put on Anticoagulation my EP said he recommended Apixaban for me for a number of reasons. One was the fact that it has to be taken twice a day because the half life is lower and therefore quicker to return to normal in an unlucky event. Another was it is more tolerated and less fussy about / causing affects on the stomach. Low bleed rate. Only came off it so as to have an ablation.

  • I too did lengthy research and decided upon apixaban. For me the only downside was the 'twice a day' thing but with a watch that carries two audible alarms (not all do) it soon became second nature.

  • Hi elbows , sorry to hear this , it's one of them fears I'm constantly worrying about that it will all start again , I'm sure you will get sorted and be back on the bike in no time at all pal

  • Yep, never really relaxed fully as I kept always looking over my shoulder as I know it can take up to three procedures and they were only able to ablate 3 of the pulmonary veins first time around.

  • Sorry about this elbows but it looks like they have it all under control and you will be back on the bike soon. I am in the process of convincing my GP to start me on Apixaban as suggested by my EP when I had my ablation. It looks like the favourite to me. Best wishes.


  • Hi elbows, sorry to hear that you have trouble again. As a fellow cyclist (who had AF and is now post-ablation without symptoms) I can sympathize with your lot. Hopefully they will sort you out quickly. When you say only 3 out of 4 veins were isolated do you know why this was the case?

    Also, did you have irregular rhythm post-ablation? I am asking as my cardio said that being symptom free immediately after ablation is a good predictor for long term success.

  • Hi Grundy, ablation was a success while it lasted as I was not in AF and had good and regular rythym with a resting 42 bpm as pre AF and was racing my bike again. They decided best not to proceed with isolating the 4th vein as the heart was not happy after a procedure of over 5 hours. So I always knew that I might have to have that done at a later date.

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