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AF Association
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Anticoagulation

So I'm a week before my procedure, and reading people's experiences with ablation it seems all we're on anticoagulation in the lead up to the event.

I know I have to take it for 3 months after ablation but there's been no mention of me being anticoagulated before, my chads/vast score is 0, could this be why

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My first ablation (for SVT) was without anticoagulation. It was in 2011 and I'd just turned 64, female with controlled hypertension. I was diagnosed with AF during the procedure. It was two and a half years before anticoagulation eventually entered my life.

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If I was you I would ring and check that this is o.k. just to make sure. They may give you heparin during the procedure and that might be all she thinks you need. Some E.P.s dont seem to want their patients to be on an anticoagulant and some do. X

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Phone up and check with Sabine.

Most EPs these days do their ablations with the patient being on an anticoagulant and in the last year or so when on one of the NOACs.

As your is different there may be good reasons not to but you don't want to get there and find out they won't do it because you haven't been. My gut feeling is no but I am not a medic!!!

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I think they will tell you if you can come off after the 3 months- if i were you I would see what the procedure works out like also just in case it takes time for your heart to settle down- best to be on the safe side Good luck

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Yes of course, I'm only repeating what's on my letter, id imagine it's a guide

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I was not on any anticoagulation before my ablation 2 years ago. I did not have a PVI though. So maybe it depends on the type of procedure? I did have heparin during my ablation but nothing before. Best wishes for your ablation and wishing you a good recovery and quality of life after:)

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I agree with @PeterWH. As you have a good communication with Sabine it would be a good idea to call her and check.

We are all different, I was firstly on Warfarin 25 years ago but was taken off it after about 2 years. However when I had my first ablation in 2009 I had to be anticoagulanted with an INR between 2 & 3 for the 4 weeks leading up to the procedure.

On each subsequent ablation I had to prove that my INR had been between 2 & 3 for the preceding 4 weeks and it was checked again on the day of the procedure.

In addition I had to have both MRI or CT scans in the weeks leading up to the ablations plus a TOE scan either in advance or in the Cath Lab prior to commencing to check for clots.

The difference may well be something to do with the frequency of your AF.

As has been discussed Sabine Ernst is a very respected EP and is most unlikely to have not considered all aspects of your procedure and your safety but for peace of mind call her and put your mind at rest - if that is possible.

Pete

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I was told to stop taking flecinide two days before the ablation and not to take Bisoprolol on the morning of ablation , no mention of anticoagulant , anyway I'm still waaaiting.

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I find the variations on what they tell you to do fascinating. I am on both Flecainide and Bisoprolol yet was told to keep taking them.

Pete

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Did you take them on day of ablation ?

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On the evening before my ablation I took Warfarin as usual. On the day of my ablation I took Bisoprolol but had to take it at 5.00am rather than the usual 8.00 am.

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Yes on every occasion.

We are all different aren't we but it would seem that the protocol at each hospital or with each EP has variations too.

In my case I have had ablations by 3 different EPs and each one has had the same protocol all at the same hospital.

The most recent of my ablations, however, was done by a consultant who had only recently arrived at the hospital yet the protocol was exactly the same.

This would lead to the conclusion that there are many factors that the consultant will take into account.

In my case I have had PAF for many years and go in and out of AF on a regular basis whereas others, such as @juggsy75 and @Gracey23 have had very few episodes.

Fascinating

Pete

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Thinking does vary according to EP and / or hospital. Part of the reason for that is there has been more knowledge gained and more "what if" to try and optimise and see.

With some patients who are paroxysmal I suspect they stop the meds to try and see if they do have an AF incident to make sourcing easier.

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I think from some patient's aspect it all seems to be a bit hit and miss. But would like to think it is far more scientific than that.

In my case I still have great respect for the skills that are being used to try and solve my pesky heart rhythm problems.

Pete

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No in some cases I'm sure it's hit and miss. It's also down to individual CCG's / Hospital's / EP's preferences. After all there are still some EPs and Doctors who are very anti NOACs (one spoke at Patients day 2015).

There will be plenty of cases where it is medical assessment but by the very nature of AF that I suspect is more of an art than a science in some cases!!!!

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It is all down to experience.

My first EP was a Research Fellow at The Royal Surrey and St Georges Hospital and that was 25 years ago. He is still practicing as a Consultant at The Kings College Hospital London.

But I guess you have a point as any skill is dependent on experience which includes where and for how long they have developed their skills and developing knowledge base and who was the mentor for each of them. This must be true of any skill in life.

We all have to satisfy ourselves that those who are responsible for our safety and care can convince us that they will do their utmost for a satisfactory outcome otherwise we might as well sit at home and suffer in silence!

This is a big subject is it not, but not only particular to the medical profession it applies to all skills for example being an airline pilot.

Hey Ho

We are but pawns

Pete

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Maybe your theory is right, I have paroxysmal .

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I've contacted them regarding this but no reply as of yet

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Sabine has just emailed, it's not needed before but will need to take after

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