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AF Association
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Had an EP Appointment Today

I had an appointment with an EP today to discuss where to go next. He did an EKG (ECG in UK) and said I was in afib, which was a shock to me as I'd been feeling great all week with no symptoms whatsoever. Made me wonder how long I'd been in afib as you can imagine!

We talked about ablations and he said he does 2 to 5 a week. Hospital is in Hartford, Connecticut, not a huge city, so is this low, high, or what?

I was currently on 1 x 25mg Metoprolol and a baby aspirin daily. He's now asked me to break the Metoprolol in half and added to it 2 x 50mg tabs of Flecainide daily. He says the dose is very low for both but it'll show whether I have an adverse reaction to the Flecainide and if I do to discontinue it immediately.

Any thoughts? I was shocked about being in afib, as like I say I felt great. He also said people can be in afib for many years and nothing bad will happen, but it's preferable that they try to get back to normal rhythm as long-term afib causes the shape of the heart to permanently change in a negative way.

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Difficult to say what is best and in any case you need to decide where you want to go with this.

Here in UK it would be common at this stage to have a cardioversion to put you back into NSR to see if you feel any better. If they do and you don't feel any different then there is an argument that ablation is an unnecessary risk and that rate control to prevent too much muscle damage is a more appropriate treatment. Remember that any and all treatment for AF is only ever about improving quality of life so it becomes a risk management problem.

Should you go the ablation route then of course you will need to be on anticoagulants for a period before and afterwards to reduce the risk of any stroke producing clots. By the way. here in UK and Europe aspirin has long been discontinued as a prophylactic for stroke in AF as it is not effective yet can still cause harm in the form of internal bleeding. We know from many posts from USA that aspirin continues to be pushed by the drug companies so you need to do your own research and decide yourself. Aspirin is an anti platelet not an anticoagulant and has a place in other cardiac treatment., just not normally AF.

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I decided not to go for cardio version due to what I read on here, I decided to wait and see. I have Svt, ectopics and long pauses in my heartbeat which make me feel as if I,m passing out.

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What put you off the idea of cardioversion? I don't recall seeing anything negative here, far from it.

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Some of the people on here have had unsuccessful ablations with further medications, I do not relish the thought of that at 71 years of age of course I am still considering it if my svt continues. I have the choice to contact Barts in the near future if I decide to go ahead. I have a fairly good quality of life at the moment apart from the bothersome ectopics and svt.

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Didn't realise that's how it worked. The clots can be resident in the atrium for a while, and then a cardioversion, arrhythmia drug or ablation puts you back in sinus rhythm and it ejects the clot into the body..? I'll be sure to ask these questions when I next meet the EP in a few weeks...Thanks Bob.

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If you do go the cardioversion route as Bob says then make sure to take an anticoagulant for one month before being cardioverted so as to avoid any risk of a blood clot (that might form in the atria whilst in AF) being released by the heart once back in normal sinus rhythm. Thinking about it you really in my opinion (for what that's worth) ought to be on an anticoagulant now so to avoid the aforementioned risk if and when the fleclainide converts you back to normal sinus rhythm and for the same reason. As Bob says whilst there is good evidence that aspirin can help prevent a heart attack it is not a blood thinner as such.

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cardioversion will show the medics that your heart can go back into normal rhythm. If it is ok you can then be considered for ablation. If your ablation is successful you will probably go happily on your way and that will be that.

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I didn't realise that was how it worked, thanks Ian. So cardioversion is the acid test?

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That is my understanding. If it works you may find that you stay in normal rhythm for some time, possibly months or years. If it works for a while your ep will know that your heart can be reset. It's a straight forward procedure. I think Bobd's earlier reply summed it up nicely

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Thanks Ian. I'm learning a lot from this community.

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