AC after ablation

[Mejulie69]

Given that I am 1 month post ablation and I haven’t had a single bit of AF since, plus my CHADS-VASC score is zero, is there any need for me to continue taking anti-coagulation medication? My EP intends for me to keep taking it until my 3 month review, but I think this is overly cautious, and potentially slightly risky (bleeds etc). Thoughts?

[Hidden]

yes, your heart has been burned/frozen. There is a big risk of clots developing during the 3 month HEALING period.

Stay safe

[Hidden]

I’m surprised that someone would consider ignoring the advice of their EP. We see many posts where low risk patients are asked to remain on anticoagulants before and for 3 months after an ablation so there must be good reason for this. Unless you, or close members of you family have a history of internal bleeds I would just bow to the knowledge of the experts.

[perkman]

My EP stated there is a higher risk of clot up to 3 months post ablation.

He took me off all meds after 3 months. I would listen to your EP.

[UScore]

My thoughts have gone the other way; I'm only on half-dose anticoagulants for the 3 months post ablation, because I was coughing up small amounts of blood for a few days after the procedure. Now I'm worried I'm not protected enough - even tho I'm also Chads 0 and have had no afib.

[Mejulie69 in reply to UScore]

Perhaps I am missing something, but I don’t understand why we are at increased risk of stroke post-ablation if we are not in AF.

[MarkS in reply to Mejulie69]

The current thinking is that clots and AF are both symptoms of the same underlying disease - a kind of inflammation. Consequently getting rid of AF does not necessarily get rid of stroke risk. Indeed the ablation creates a lot of inflammation which is why stroke risk is exacerbated until the inflammation has died down after 3m.

[UScore]

Yeah I essentially asked the same question, from the other perspective healthunlocked.com/afassoci...

(although it seemed like everyone answered for what happens AFTER the 3 months is up)

The answer I keep getting when I've asked about stroke risk vs frequency of Afib, is that the statistics don't take into account how often you have AF. It seems counterintuitive that someone who gets Afib every day is the same risk as someone who gets it every six months, but that's the current scoring method.

So I guess the statistics show that 3 months post ablation is the 'danger' period, regardless of your chads or afib.

Glad your recovery is going well. I've also been afib free so far. Barely an ectopic felt.

[Mejulie69 in reply to UScore]

Yes, there is a lot of work to be done on the whole AF / stroke risk thing. It’s illogical at best! I did my first proper bit of exercise last weekend – a 20 mile bike ride at reasonably high intensity. I think I felt a couple of uncomfortable ectopics / pauses during the ride, but none since. I commuted by bike to work on Tuesday (6 miles) and felt really lousy all day afterwards, so I am going to reduce the exercise for the next couple of weeks. I think my body is saying it’s a bit too much too soon. A bit frustrating, but otherwise, I am still loving being in NSR - it’s so smooth! Hope you are recovering well also.

[UScore in reply to Mejulie69]

Yeah I'm being super-cautious. I won't do any proper exercise for at least another month I reckon, and then it'll be a very slow build up. My hope is that I can play football again around September/October time.

I haven't quite worked out when I am going to allow myself a beer. Might give it a few more weeks.

[momist in reply to UScore]

UScore I would guess that the answer to your point is that whether the blood pools once every six months or every day, the risk of stroke is there. Nobody wants even one stroke. I think the AC risk of bleeding is exaggerated, except in a traumatic injury such as a car crash, and nobody wants even one of those.

[UScore in reply to momist]

Yeah, but the whole point of the chads score is to give a rating of risk. Otherwise it might as well be a YES or NO binary value.

That's why it doesn't seem right when 2 people have the same score but completely different AF burdens.

I'm not saying it's wrong, but it's why people question it all the time. It feels counter intuitive.

[Hidden]

You are only 1 month post ablation.....anything could happen. For goodness sake take the advice of your EP and keep taking your A.C.

[Mike11]

If you are one month post ablation you shouldn't even be on a bike. Your heart has undergone a severely traumatic event and needs 3-6 months to heal. Stressing it before this always leads to the same outcome - a second ablation.

[Mejulie69 in reply to Mike11]

Mike, this seems to be one area where EP’s and patients disagree - many EP’s say you can start exercising as soon as the insertion site is safe (1 week).

[Mike11 in reply to Mejulie69]

By exercise they mean light walking. Cycling and running are strenuous activities which I cannot believe any EP would approve.

[Hidden in reply to Mejulie69]

Mejulie69, I have just read a number of your previous posts, including the one with the picture of you posing by your hospital bed and I am afraid to say I have come to the conclusion that you are either stupid or just attention seeking.

Frankly, I don’t care if you decide to wreck your ablation and exercise your way back into AF. Nor do I care if you decide to ignore your EP’s advice and stop taking anticoagulants tomorrow. I and other’s have offered our advice and all you do is challenge the logic upon which the advice is offered.

What really sickens me is the tax payers money that is likely to be wasted on someone who wants to ignore the bl***ing obvious.

I would urge you to read the final line of your post with the photograph - My Big Day

[ajaxaf in reply to Hidden]

Whilst we may understand your sentiments here, perhaps you could express them in a more constructive and less aggressive way maybe? This is generally a friendly and supportive forum.

[Hidden in reply to ajaxaf]

I understand the point you make, and the majority here will recognise that my contributions are hopefully always helpful. Me Julie was gracious enough to “like” my original reply but then subsequently goes on to argue the same point with others. I used to drive ambulances for Patient Transport for many years, and one of the sadnesses was having to take young stroke victims to day centres in wheelchairs in order that their families had some respite from the ordeal of caring for their loved ones. Unlike those patients, Mejulie is fortunate enough to have been advised professionally of the risk and he now challenges the need to be anticoagulated. Although I have no intention of upsetting anyone, I feel I should make people aware of the risks. Thank you for your comments

[Mejulie69 in reply to Hidden]

I never said I was going to go against my EP’s advice, I was merely questioning it. In life, it is good to question decisions made by others - they don’t always get things right. This applies to doctors including EP’s. When people stop questioning, we end up with Europe 1939-1945 again

[Hidden in reply to Mejulie69]

Thank you for your courteous reply. You draw an interesting analogy between well meaning people who take the Hippocratic Oath and the consequences of the Second World War. Good luck....

[fnurd in reply to Mike11]

Mike,

Please can you provide evidence for your very strong statments.

[Mike11 in reply to fnurd]

Observing this forum since my own ablation 4 years ago its noticeable that many people needing ablations have been cyclists or marathon runners. I myself am an adrenaline junkie but took my EP's advice to be sensible for a year and have never regreted it. Yesterday I threw myself down a luge track a la Olympics and it took my heart all night to calm down, but it never went into AF. My impression is that if people just took 6 months off work and did gentle walking post ablation we would see far less repeat procedures needed and the NHS backlog could be cleared, but obviously it's impossible to prove this until EPs get stricter with their patients. I would help if they stopped calling it a procedure and instead called it a major operation. Nobody mistreats their heart after open heart surgery but it seems many are happy to do so after an ablation.

[KMRobbo]

I was told at hospital that I could go back to exercise a week or two weeks after the ablation depending on the ablation done. I did not get the impression they meant me to run a Marathon after the first week however, but they did not specifically say I should not. I think there was "recommence exercise" in the statement.

I was also advised by my E P that I could drop the meds after TWO months, so this appears to be another variation. I suspect there is a safety factor which varies.

I agree with you about the logic of not being in a fib, so why use an anticoagulant However a lot of what has happened to me so far with this A Fib has not appeared logical!

Best wishes and I hope you continue A Fib free!

[cuore in reply to KMRobbo]

Interesting, KMRobbo. I had two ablations in approximately a five month timeline. Amiodarone was prescribed after both ablations meaning that Amiodarone was taken for the five months before second ablation. Post second ablation, I was supposed to stop Amiodarone, like you, in TWO MONTHS. But, as the arrhythmia has occurred on and off, then rather than stopping the med., my EP has increased the timeline twice, so that I am taking it for nine months continuously. Concerned, I will be switching to Flecainide.

My recent EP has said that I should continue to use my anti-coagulant (Eliquis) although he did say that there has been a recent study about anti-coagulation and whether one should continue or not. I don't remember the name of the study.

[Marney]

If EP recommends 2 or 3 weeks without exercise why not do that, it’s not as if your going to damage your body in a few weeks. Take 3 or 4 weeks then gradually work up to more exercise over the next 3 or 4 months. Why take the risk, it’s just not worth it for a little excercise. I have had 1 mini stroke and 1 medium stroke . IT IS HORRIBLE, I AM GOOD NOW HOWEVER IT DID LEAVE ME WITH A OCCASIONAL MOOD THAT I WANTED TO CRY FOR NO REASON. It is getting better, but please take it even easier than the docs recommend. It is not a sacrifice. It is sensible

Marney

[UScore]

I've got a meeting with my EP next week, so I'll ask lots of questions about levels of exercise following my ablation. I did ask before the procedure, and was surprised at how soon they said, although I can't remember verbatim what it was

Sometimes we are told these forums mustn't give medical advice and you must listen to the doctors, other times you are chastised for listening to the doctors and not following the forum's advice!

[Mejulie69 in reply to UScore]

Hehe, well said!

[mdub]

Perhaps you'll find this informative: acc.org/latest-in-cardiolog...

[Hidden in reply to mdub]

Thanks for this, very useful. Point number 10 gives food for thought.

[sjanee11]

My dr (here in the US) didn't put me on anticoagulation meds and I kinda wish he did. A week post-ablation I was diagnosed with a pulmonary embolism and I am on Eliquis now. I was low risk for developing clots and took care to not just lay around but I still got one. I was under the impression that lowering risk of DVT and PEs is the reason why people are put on anticoagulants since they go in through the veins in the groin.

[Rdiehl01]

Your doing great! Keep it up!!!