Ablation and anticoagulants: Am considering... - AF Association

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Ablation and anticoagulants

F-M-C-MM profile image

Am considering an ablation and am wondering if it were a success would anticoagulants be necessary afterwards particularly if A Fib episodes stopped altogether.

22 Replies

My cardio told me I would have to take apixaban for the rest of my life

Good luck with you're ablation

I believe you do still take anti coagulants

Afterwards .. I speak only from my experience..

hope all goes well

in reply to Roseyuk

Hi, it depends on your stroke risk score:

preventaf-strokecrisis.org/...

Roseyuk profile image
Roseyuk in reply to

Well I have had previous heart attack, so I expect my stroke risk would be assessed on this also

I'm waiting for a third ablation in May.. but am very sceptical as I've had two failures and two cardio versions as a result of one botched , when I had my heart lining punctured

My EP guy only gave my three options , live with AF, another Ablation ... And electrophysiological study of my heart to try to see why my HR is so low all the time around 50 iandI do not tolerate beta blockers

So hr thinks I will not tolerate a pacemaker

Such is life , feel like I'm stuck between a rock and s hard place right now, plus I have a husband with Parkinson's who Will not go into respite so I can recover , sufficiently when I come home, with no help from family.. we have carers, only for toilet calls .

xxx

.

Hi and welcome, yes ablation can be very successful but perhaps you need to think of it as an ongoing treatment rather than a one off procedure cure. It is a procedure with risks and one always has to balance benefit to risk so it can depend on the type of ablation, experience and training of EP, the progression on AF, how symptomatic it is etc, etc.

I had to have a second within a few months of the first, the second was successful and I was AF free for 2+ years - life change as I was very symptomatic. AF returned last September but in much milder form and I could still function, so far had about 4 episodes since September whereas had been 3-4 a week and could never function.

If I were considering an ablation now and with the knowledge I have now I would only consider an ablation at a major Centre of excellence and only with an EP who was performing ablations week in, week out so was doing many in an year.

As to anti-coagulation - depends on many factors not least your CHADSVASC score - you can look that up for yourself link on AFA page. I came off anti- coagulants a year after ablation when it was absolutely clear I had no AF at all. I went back on them last September on first episode and because I had reached the age of 65 - meaning my CHADSVASC score rose to 2 = AC's should be taken.

Latest research (not gold standard) indicates that if your ablation was successful and not experienced AF - even unknown to them - and no score on CHADSVASC, then there was no difference in risk between those who did not take AC's and those who did and a very slight rise in deaths from bleeds. All statistics are just that - no one can predict what will happen to you or me, yet.

Hope that has given food for thought, best wishes CD.

Yachtgirl profile image
Yachtgirl in reply to CDreamer

Very well thought out and written.

BobD profile image
BobDVolunteer

Because treatment of AF is relatively new (circa 20 years) there is little really long term data on the risk of stroke post ablation. For sure I would never consider stopping taking warfarin. My understanding is that even the action of ablation causes changes to the inner surface of the atrium which could promote eddy currents which could allow clots to form. If your CHADSVASC score was such that you needed anticoagulation before ablation then this is still wise afterwards. It was put very well by a leading UK cardiolgist who said it isn't the AF you need to worry about it is the company it keeps. In other words the co morbities which come with having AF or which may have resulted in AF.

I was informed post ablation that I could have stopped taking them but would go back on them at 65 (some gold standard my Cardiologist refers to) for the rest of my life so I'm guessing it entirely depended on what your Cardiologist says.

traveler65 profile image
traveler65 in reply to

@Mags60 General cardiologists do not kinow about afib very much. Only an EP--and a very experienced one at that--know about it.

in reply to traveler65

Hi traveller65

Mine is both EP and Cardiologist and he is very knowledgeable.

My EP told me that there is research being carried out currently which suggests that successful ablation decreases the long term risk of stroke. BUT this has not yet been concluded.

I have been AF free since last September, after 1st ablation. I feel great, but my EP said I should stay on AC, to protect me. After seeing my mother suffer a devastating stroke that pretty much ended any decent quality of life, I think I prefer to stay in Apixaban, and accept the small risk of bleeds. I would not want to increase my risk of stroke at my age, 64 is young and I truly appreciate the skills of my EP and his good works in my heart, why would I want to change things. I hope my AF takes a long time coming back😊

I had my cyro ablation almost 4 years ago with success so far. I have stayed on blood thinners, warfarin, because here in the States the Drs tell you anyone going off has a 60% more chance of having a stroke when you do, regardless of AF. I have been on them for 6 years. So far so good no bleeds.

Good luck to you.

@F-M-C-MM After a very successful ablation, by a very excellent EP, who does nothing but ablations, and ,many per week, has done thousands of them,. at a very, extremely excellent hospital that is 3rd best in the USA for the procedure, and at which none of the dangerous adverse situations during surgery has occurred, also with an excellent electrophysiology team, and with excellent support staff--- I still take warfarin. The ep told me to take warfarin and sotalol forever. Since my INR is measured by an excellent coumadin lab nurse, at a coumadin lab 1 mile from my home=--- where the only thing she does is monitor coumadin--and she is very well versed in how to do this-- and goes to workshops to learn more--actually goes to them at the hospital where I had the ablation-- all I have to do to keep my INR between 2.0 and 2.5 is to take the warfarin aS PRESCRIBED AND EVERY DAY HAVE APPROXIMATELY THE SAME AMOUNT OF THINGS WHICH CAN INFLUENCE THE inr. i ALSO TAKE 90 MCG OF VITAMIN k2-mk7 TO PREVENT THE SIDE EFFECT OF WARFARIN WHICH IS BONE LOSS AND ACCUMULAtion of plaque in artereis. MK 7 activates gla matrix protein (produced in your arteries) which then removes calcium(plaque) from arteries and puts it into the bones, wHAT BOB said about the ablation changing the surface of the left atrium so that blood can pool and eddy there and cause a clot is true. Notice the operative word here is excellent. Also, when you take an antiarrythmic drug and/or a beta blocker-- calcium, magnesium, potassium aND MANY TRACE MINERALS ARE BEING DEPLETED FROM YOUR BODY. so-SEPARATE BY 3-4 hrs., take some forms of potassium (mostly foods and trqace mins), magnesium (glycinate, taurate), and trace mins-- to keep these optimal. I know with sotaloll, if the magnesium falls too low or gets too high I can go into something cqlled "Torsade des Pointes"--this is a fatal rapid ventricular tachicardia. So all is possible to be healthy and symptom free--but it requires a bit of effort on your part. I am telling you "take this" becausre I am not your doctor, or your nutritionisat, or your functional medical doctor, or your ep. BUT this is info that describes how i MANAQGE TO REMAIN OKAY-AND MY INVESTIGATION FOR MYSELF ABOUT WHAT TO DO, STARTED WITH MY EP TELLING ME TO MAINTAIN ADEQUATE MAGNESIUM AND OTHER MINERALS-- OR i WOULD HAVE An AFIB INCIDENT--POSSIBLY A FATAL ONE. aLSO NOT MENTIONED TO ME BY ANY DOCTOR WAS THE IDEA OF THERE BEING TRIGGERS TO AFIB AND THAT i SHOULD AVOID THEM.

hERE ARE THE MOST COMMON TRIGGERS THAT WILL CAUSE AFIB: CAFFEINE, THEOBROMINE, CHOCOLATE (WHICH CONTAINS BOTH CAFFEINE AND THEOBROMINE), ALCOHOL, SUGAR, SALT. (MY EP DID TELLME TO EXCLUDE SALT AND PROCESSED FOODS), ANYTHING YOU ARE ALLERGIC TO (FOR ME NIGHTSHADES AND GLUTEN), LARGE MACROLIDE ANTIBIOTICS (BIAXIN, ZITHROMAX), QUINOLONE ANTIBIOTICS (CIPRO, AVALOX, LEVAQUIN, aNYTHING FLOXIN). over the counter medsa-- aspirin. NSAIDS, cough meds etc. A lot of these meds and the rx. meds mentioned above, will elongate the qt interval (seen on your ekg) to a dangerous point. Also, if your afib comes back while you lie down--it may be caused by an irritated vagus nerve. you can look into that. This way you avoid need3 ing more ablations and more meds.

Yachtgirl profile image
Yachtgirl in reply to traveler65

Very informative 🙂

I was taken off anticoagulants (warfarin) a few months after my 2nd (successful) ablation. However, since then I have suffered a TIA (mini-stroke), after going back into AF. I have now been put onto a NOAC (Pradaxa/Dabigatran) in an attempt to prevent a further TIA. So, fom personal experience, I would warn against coming off anticoagulants post ablation, however tempting it might seem!

Once you are on them you have to stay on them if you are over 65. I'm not sure if you are under 65.

It's nearly a year since my ablation and I do occasionally still have ectopics but otherwise everything is fine.

I feel safer being on anticoagulants as a stroke can be on the horizon as you get older and tha anticoagulants do help against ' pooling ' and clotting.

traveler65 profile image
traveler65 in reply to Nannadee

@Nannadee you can take MK7 while on warfarin so yo9u do not get bone loss and arterial plaque (side effects of warfarin()

Afraid the answer is yes - anticoagulants are for life, not just for Christmas :-)

Seriously even after an ablation your heart will have occasional 'silly times' when you are just glad a stroke/heart attack is probably not one of the possible outcomes. I had one last night. It wasn't proper AF but heart missing beats and low BP.

F-M-C-MM Hi One error in my rresponse. When I wrote " I am telling you ""take this"" ' , I meant to type "I am not telling you to take this" (etc because I am not your doctor etc.)

How do any of you afford Eliquis or Pradaxa?

in reply to Clipper100

Most of us in Uk so only pay prescription charge or free if over 60

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