More advice pls

[Kevinder23]

I went to see my ep at queen elizabeth hospital and i have a choice of beta blockers flecanide pip or ablation i have had a an ecco test which was entirley normal ,my question is how do you chose.i have tried a small dose od beta blockers before which made my heart rate low at night .i have got first degree heart block but the ep is not concerned about this at present i have been diagnoesd for 1 yr and am so fed up of worrying and unable to relax and enjoy life .worried about ftaking flec and worried about long term effects of beta blockers x

[rosyG]

I think the anti arrhythmic drugs have more long term effects than beta blockers- (I'm not a doctor)

Choices re ablation are usually made on how your af symptoms are affecting you- all EPs I've met don't want to ablate those without symptoms.........

[Kevinder23 in reply to rosyG]

Thankyou i was in a/f for 5 days last time it usually happens every 2 weeks due any day so now im in the delema of starting beta blockers today and it not being in my sytem long enough to help or take the flec pip when next a/f comes then beta blockers ,, i was gonna go on 1.25 at first as had some side effects on 2.5 thats why taken off them orginally was on them for 5weeks caused ist degree heart block plus nightmares and slight shortness of breath and some lightheadedness and headaches but alot of these i think were down to my anxiety x

[rosyG in reply to Kevinder23]

I think that's a heavy burden of AF- it's frequent and carries on for a long time.

If I were you, I would ask a cardiologist about the heart block while you were on beta blockers. Also, Flecanide is safer when you have a beta blocker too- probably why he said beta blockers with flecanide, but some people who can't have beta blockers are put on channel blockers if they have to take flecanide. Some think Flec. is OK without beta blockers etc if just PIP but some EPs we heard recently like both even if flec is PIP.

The guidance is to take Flecanide under supervision at first but many don't do this cos of resources.

If I decide to take my Flecanide as PIP I will definitely do it in A and e for the first time!!

Please don't take what I say as guidance re your meds- it's meant as guidance re what to ask your cardiologist about!!

You GP could check your ECG re heart block if on beta blockers but a cardiologist opinion would be better- you could ask you GP to ring a cardiologist for advice

[dedeottie in reply to rosyG]

I have first degree heart block and take 2.5 mg bisoprolol alongside flecanide. My EP says it is ok but I have regular checks to make sure tbe block is no worse.x

[Kevinder23 in reply to rosyG]

Thankyou my ep

hasnt said both beta blockers and flec as pip,, just one or the other at min. If i start beta blockers will that be enough to start to control the a/f. I really dont want to take the flec im not seeing my ep until another six months now think hes doesnt know what to say to me as im so worried about everything he was really trying to help me..gp is clueless on a/f said it wasnt a/f if iit didnt go above 100 bpm.

[fnurd in reply to Kevinder23]

Kevinder,

Even if the drugs do control the AF they don't reduce the stroke risk, which is one of the major concerns with AF.

What I did was to go on Flecainide + bisoprolol for about 12 years, and then when the AF looked like it would progress into permanent AF I had an ablation. This was because:

1) I didn't want to be in AF all the time

2) Stroke risk is now thought to be higher if you are in permanent AF.

3) Ablation is getting safer and more effective (with a good EP)

4) It is quite likely, but not totally proved, that stroke risk is much improved after successful ablation. EPs cannot yet claim this, but most believe it, based on the studies which have been done.

Much of the above was unknown 12 years ago, so if I was starting now based on all the improved skill and data I would probably go for the ablation sooner rather than later.

If you do end up going for ablation do make sure your EP has done loads of ablations – 1000s and does over 100 per month. This is important with any surgery, but especially with ablation. You can ask your EP about this. I can recommend an excellent guy in London, and other forum menbers should be able to help for other areas.

[Kevinder23 in reply to fnurd]

Thankyou

[Hidden in reply to fnurd]

What an excellent and encouraging reply! At over 100 ablations a month, your EP must be getting a lot of overtime!

[Uniform96 in reply to rosyG]

Hi, RosyG, why is Flecainide safer when taken with a beta blocker? I ask this because I am on 50 mg BD but no beta blocker.

[Hidden]

Flecainide is a so called rhythm control drug, intended to prevent or terminate AF. Beta blockers are rate control drugs which slow the heart rate, and are not used to prevent AF.

Flecainide is pro-arrhythmic and can cause atrial flutter. Taking a beta blocker with Flecainide reduces that risk. I went in to Atrial Flutter after my first pip tablet of Flecainide. I was however fine and reverted to sinus rhythm after 6 hours, without treatment.

Not sure what you mean by long term effects of beta blockers. My understanding is that beta blockers have many side effects which are fairly quickly apparent and will generally persist long term, but will disappear when the beta blocker is stopped.

[Kevinder23]

Isnt it confushing ive t dicided to try beta blockers again i didnt give it long enough before,but bot worried about the strok risk you say is stil there if in a/f as what is the point of taking them if it doesnt help this risk?im 56 with a chads vas score of 1 for being female and my ep said the risks outweight the benefits at present .thankyou for replying everyone x

[MummyLuv in reply to Kevinder23]

Isn’t it interesting how different EPs take different approaches, I am along the road at Edinburgh Royal, also CHADS score of 1 and I’ve been on blood thinners since diagnosis, one of the reasons I am having surgery is the left appendage will get clamped and hopefully 3 months after healing I’ll be off blood thinners for good.

[Kevinder23 in reply to MummyLuv]

Was it a struggle to get the doctors to agree to the procedure mine at QE hasonly ever mentioned abaltion which i am still not brave enough to do. Since my last post my A/f has progressed im on flecanide 200mg daily, and bisoprolo 1.25. With breakthrough every 10/14 days for which i take an extra 100mg.That usually stips the A/F in a cojple of hours xx

[Kevinder23 in reply to Kevinder23]

Sorry didnt correct my spelling before i posted xx

[MummyLuv in reply to Kevinder23]

Hi Kevinder, My afib is more progressed and I am in afib 24/7, It was before it was diagnosed. My EP here said catheter ablation way to go if don’t want impact of meds, I couldn’t tolerate beta blockers. He also said when young (I see you are only 56) he personally would not leave to progress, he would have cryoablation, it’s best to get early when paroxysmal as has as much as an 80% chance of getting back to NSR at that stage. I had a cryoablation (way easier procedure than you are imagining) which failed and when I researched surgery is more effective in my case (not yours if you are still paroxysmal), surgery is obvs a major recovery though, ERI are not keen I do the surgery so it is private.

[Kevinder23 in reply to MummyLuv]

Thank you so much for your reply, food for thought xxx

[Kevinder23]

Sorry meant to say not on anticoaugulant as ep said risks outweight benefit at present x