fleconaide and pulmonary vein isolation

[Jfjfern]

I have had paf since I had pneumonia when I was 37.I am now 45 I was well controlled on verapamil but have the occasional episode of af with triggers - food salt content dehydration. I have recently seen the cardiologist who has offered my pulmonary vein isolation. Is this the normal ablation or different as I have read from here posts abount cryotherapy. I am worried to have the procedure due to the risks of stroke and cardiac temponard that he talked about.I am wondering if its worth taking the risk of the procedure as things can go wrong is it best to stay as I am. He also wanted to start me on fleconaide this also scares me. He is arranging an echo 24 hr bp monitor as I mentioned I was really hot in the summer and felt really ill with thr weather and he thinks I might be having low bp. I have 2 young children 5 and 9 yrs old. I am scared of the op .Can anyone given me advice on it. I would love to be cured though and it would be nice to lead a normal life without thinking about the AF all the time eg been hydrated avoiding certain foods, If I was to have the procedure would I be able to start enoying a normal life again and maybe having a drink of wine.I do miss a glass of wine. Thanks Julie

[BobD Volunteer]

Hi Julie and welcome to your world. Pulmonary vein isolation is also called ablation . If you go to AF association website there are a great number of booklets and fact sheets which explain just about every aspect of having AF and I am sure will help to allay many of your fears.

Ablations come in different types and cryo ablation just uses a different way (extreme cold) than RF ablatuion which uses heat. Many of us have had at least one and sometimes many such procedures amd i for one. as a devout coward would not go that route if there was any real danger. Yes there are risks in everything we do even doing nothing and of course just having AF makes us five times more at risk of stroke than if we did not. Obviously five times nothing is still nothing but if we have any co morbidities such a high blood pressure, diabetes etc our risks will increase. Ablation does not really change this.

Remember also that in these litigious times doctors have to protect themsleves by telling you every little thing that might possibly go wrong.

Should you have an ablation? Only you can say. Remember that any and all treatment for AF is only every about improving quality of life (QOL) and do understand that it should be regarded as part of ongoing treatment.

Regarading the wine, this was how my AF started about thirty years ago. As a shareholder in a vinyard this has to be one of lifes jokes.

[Hidden]

Hello Julie, I see you joined the forum over 4 years ago and have only just started to make contact so does this mean your AF is starting to become a bit of a nuisance? I can't help you with the gravy problem, I guess I'm just lucky but I can eat (or is it drink) any gravy that's plonked down in front of me and it doesn't seem to have any adverse affect.

The fact that you are talking about a cryoablation and flecainide suggests that your episodes are becoming more troublesome. I can't add much to what Bob has said about the risks other than I would not hesitate to have another one if it was deemed necessary and I have now had two. Is your doctor talking about using Flecainide as a regular daily maintenance dose, or as a single dose PiP to be taken once an episode has started. We are all different, but in the past I have been prescribed both. Taking a hefty 300 mgs in one go scared the pants off me, but in the event it was no big deal, the only side effects were a slight dryness around the mouth and some constipation but both eased within 48 hours and getting quickly back into rhythm was a welcome result. As my episodes increased, the daily maintenance dose was introduced and that successfully kept AF at bay up to my first ablation which was the cryoablation. I can almost hear you thinking why did I need a second. The expanding balloon which is used to freeze the entrance to the pulmonary veins can sometimes miss part of the tissue because us human beings don't always have totally smooth and symmetric tissue so occasionally it is necessary to have a second to "touch up" the missed bits which is what I had 3 months ago.

With two youngsters it is easy to understand your concerns. This forum mainly covers the UK, States and Australasia, so just think about how many thousands of ablations are carried probably in a week. It is extremely rare to hear from anyone saying that they regret having one but nevertheless, it has to be a decision you feel comfortable with.

If I was you, I'd find out what the waiting time is likely to be, get on the list and then use the time to research, ask questions and satisfy yourself and your family that its the right thing to do. If you then still have doubts, you can always pull out and don't worry, there will be absolutely be no problem for the hospital to fill your slot......hope this helps.....John

[secondtry]

Hi Julie, as has been said it is a personal decision and no one will know including yourself if its the right one as you will never know what the alternative would have been like. The important thing is with either route is to avoid procrastination as the more AF you get the more it will increase. Also get well informed, this Forum is an excellent start.

I would throw in a couple general factors in the 'for ablation' pot before you make your mind up 1) you are young so mentally & physically (if you are in good shape) easier to deal with an ablation 2) with a young family and maybe a super stretched life it will not be easy to adopt a whole raft of lifestyle changes to control AF possibly with some drugs.

Against this and from a cynical & more cautious old man of 65, I would say the surgeons know that an ablation on a younger person is more likely to improve their record, which of course argues for an ablation but does not remove the possible complications. I am adopting the policy of drugs first to stop the AF, while I work on lifestyle changes and the medics improve their success rate (70% quoted to me). My QOL is fine at present but should it worsen the decision will be made for me to request an ablation as I am certainly no fan of drugs. Good luck!

[Nutmeg44]

Hi

You might want to try the tablets first before contemplating the procedure. I had abaltion 2 months ago. I was on Flecainide but the dose was increasing and I knew it was an invetibility before I was in permanent AF.

By the sound of your PAF is infrequent and might be well manageable on tablets.

Having said that if you decide on ablation consider it a safe and effective treatment for AF. There are no right and wrong decisions. Give yourself sometime.

Best wishes

[KMRobbo]

My AF got more troublesome and frequent and intrusive. In July 2017 I was in high rate af (130-190 bpm) for the best part of 8 days, and was eventually cardioverhad by flecainide infusion in the CCU of my local hospital. I then to go on flecainide 2× 50mg rhythmn control and diltiazem 200mg for RATE control. The diltiazem certainly had side effects that are tiredness, increasing brain fog, massive exercise intolerance and some breathlessness. It also seemed to be getting cumulatively worse. Flecainide may have been partly responsible. So as my AF was obviously "developing" for the worse I decided to have an ablation.

I had a pvi cryobablation in January and that fixed the a fib. I then developed flutter after 9 days, and had to have an rf ablation at the end of feb to fix that. ( no flutter evident her the 2.5 years I had afib. ). This development was somewhat unusual I believe.

Neither ablations were much of an issue. I was 57 when I had them both under mild sedation and with a local for the groin entry.

Pain wise the cryo is like biting into a very cold ice cream as it affects the head. Not pleasant but a long way from agony. The rf ablation I had for flutter was a bit more painful but again not a problem. the pain was evident towards the right shoulder for this.

Both ablations were successful during the procedure, ie the induced afib and the flutter stopped during the procedure. Neither afib or flutter has returned.( So far)

I stopped all drugs on may 15th. I had stopped flecainide 4 weeks prior and 3 weeks before my EP review. Brilliant felt a lot better a month after.

If a fib did return tommorrow morning I would happily go for another ablation tomorrow afternoon to keep off the drugs!

Best wishes

[007talullah in reply to KMRobbo]

KMRobbo, I had exactly the same experiences as you and would also take another ablation to stay off drugs

[KMRobbo in reply to 007talullah]

Did you develop a flutter after an a fib ablation?

[007talullah in reply to KMRobbo]

Yes - cryo ablation for AF - developed atrial flutter18 months later -> RF ablation for atrial flutter and to touch up my PVI. 18 months later I've started experiencing flutter again

[Jfjfern]

Thanks everyone for the comments and advice . I am going to think long and hard about it before I decide what I’m going to do . It’s such a big decision.

[007talullah]

For me, alcohol is a trigger for the ectopics that precede AF so post-2xablation I still basically don’t drink. For me, it’s easy to choose NSR over having a drink