Ablation or Flecanide

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In Sept 2017 I had an ablation for PAF. Following that I had a a number of breakthroughs during the autumn resulting in treatment in Resus with Metropolol IV and finally an electro-cardioversion. My EP put me onto Flecanide 150mg twice per day with Metropolol as PIP.

Everything then went pretty well until the start of the New Year when, on the recommendation of my EP, I was weaned off the Flecanide and felt generally fine until a totally unexpected breakthrough in April (not the usual trigger) which resulted in another electro-cardioversion. My EP then put me back onto Flecanide at 100mg twice per day.

Since April I have been fine and have not suffered from any side effects. At the time that my EP put me back onto the Flecanide he also offered me a second ablation sometime during this summer.

Given that I am very happy with my situation, feeling fine, resting bpm of 56 and blood pressure of about 120/80 and no other heart issues, I am of the view that I should not have another ablation unless the Flecanide does not hold the AF at bay, balancing the risks with current good quality of life against those of major surgery (again), etc.

Has anyone else been through this dilemma?

[BobD Volunteer]

The only correct answer is what is right for you.

If it were me I would take the ablation (I had three before my AF was sorted in 2008 ) but I was highly symptomatic and hated struggling through my hectic life like running through mud. I never considered it surgery or an operation (it isn't it is a procedure) and compared with some of the things I have endured was a walk in the park but we are all different. AF begets AF so the more you have the more you will get so best try to end it before it progresses but as I said--- personal opinion only.

[dmac4646]

It all depends on how you feel if the pills work then it makes the choice more difficult and you need to be prepared for a quite lengthy period of recovery despite this not being a major op. Why did they try to get you off the Flecanaide in th3 first place?

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I am feeling fine on the Flecanide, but recognising that I will probably have to have another ablation at some stage in the future but if everything is fine now why not stick with the drugs.

When I saw my EP for my 3 month review, he felt that if I could come of the Flecanide with no AF then that would be the best option and I was happy to try as that would have been a win/win. But I had two breakthroughs, the first resolving itself after a couple of hours. That had occurred because I had pushed it and the resulting indigestion was my normal trigger for AF. Worringly the second breakthrough resulting in the electrocardio version had no obvious trigger apart from a couple of cups of tea.

As both Bob and my EP say AF begets AF, so I have the choice to make.

I will talk with my EP before final decision.

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Ablation or flecainide is a difficult decision and one I've been reluctant to take. I have fairly mild AF which I mostly ignore and it doesn't hold me back. 18 months ago my EP offered me daily flecainide or an ablation and I have rejected both and am happy enough as I am. When I saw him in December last year, he discharged me.

I potter on, wondering if I am doing the best. I do regret taking 300mgs of flecainide a day for a while some years ago, and it's my feeling that the less one takes of it the better. I take it rarely as episodes do self terminate eventually, so I just tend to let AF run on which may not be wise. Having said that, I did use flecainide on the last occasion (just over three weeks ago) as it was in the airport departure lounge. I feel if I really had to decide, I'd favour another ablation (number four) rather then ever more pills.