Ablation assessment at St Barts

I had my ablation assessment at St Barts and it has been proposed that I have an ablation in around 6 months. The EP I saw was very good and provided lots of information about the procedure and AF generally. There are a couple of points in this post which might be of interest to those with AF generally, although many people will have heard them before.

First, he thinks the procedure should take no more than 60-90 mins under sedation and has an 85%+ chance of success on the first attempt. He doesn’t think it is a very risky procedure. I will not, apparently, notice the wires going into the heart. He stressed that the procedure was to treat *symptoms*- a point often made by Bob.

I will need to be on an anticoagulant for about three months before the procedure, but he agrees that I should see an ophthalmologist before taking it, so I will have an appointment at Royal Brompton in about 6 weeks.

He thinks my symptoms are not very bad -and my stroke risk is not very high-and there is no reason to suppose they will get worse- I had PAF a few times since my late thirties and often this sort of PAF gets worse with age but doesn’t result in permanent AF; however, it is impossible to know for sure.

He said that flecainide and digoxin might be better for palpitations and ectopics than sotalol and I have a prescription for these which I will try in a few weeks when I am on holiday. Does anyone have any experience to relate after changing from Sotalol to flecainide? What are the side effects of the latter?

Tips (which some may not have heard): studies show that losing weight greatly improves the burden of AF for a lot of people-losing 10lbs is the magic figure! Stopping alcohol also improves burden, although he said that he shouldn’t think drinking 6-8 units would do a lot of harm in my case as long as they were spread out. Control of blood pressure is very important for those with AF.

On the question of when to call an ambulance, he said to call for one of the AF went on for a long time/ longer than usual or I had breathlessness etc.

Overall I was very pleased with the consultation.

[meadfoot]

Pleased tovhearvyou had a good confident consultation. I take flecainide as pill in the pocket now, ie take it when I have a PAF episode. In the past I have taken flecainide twice a day and was fine on it. I had some strange flashing lights when moving from a dark to light room but that settled over a couple of months. Hope flecainide works for you.

Good luck with your ablation and here's to a af free future.

[Hidden in reply to meadfoot]

Thanks for this info- were the lights definitely the flecainide?

[meadfoot in reply to Hidden]

Yes definitely. They started after two or three doses which was initiated while I was in hospital after a particularly bad PAF episode. I asked the registrar if it was flecainide driven and he said he hadn't heard of it before. However that was several years ago and I have since read of people having the same aura so it's not uncommon.

It wasn't an awful side effect just annoying so I certainly wouldn't dismiss flecainide on the back of that side effect and it settled down over time anyway. You may well not have that or any side effects. Hope it works well for you. X

[Hidden]

That sounds like a really helpful meeting .which I'm sure will be of great interest to those about to consider the implications of ablation.

Good luck !

[Hidden in reply to Hidden]

Thanks

[BobD Volunteer]

Sounds abour right for Barts but I still do not understand why you have been on sotalol as it is not on NICE list here in UK

[Hidden in reply to BobD]

Originally I was offered a choice between Sotalol and flecainide which I was told were more or less the same . I remember being surprised that the choice was left to me as obviously I am not medically trained and knew nothing about either of them. I chose Sotalol on completely arbitrary grounds.

[Buffafly]

Excellent feedback, thank you! It may be helpful to know that when I started having regular symptoms from AF the ectopics were the worst bit (I couldn't tell the difference between an episode of AF and a long episode of ectopics then) and I was prescribed Propafenone (in the same class as Flecainide) which worked very well.

[Hidden in reply to Buffafly]

I’m not sure I can tell the difference , either. I rely on Kardia to indicate whether it’s AF or not.

[Angie06]

I've been on flecainide for over 10yrs since my first attack when AF was diagnosed. I haven't had any noticeable side effects other than hot flushes at night times with occasional palpitations.

I had a heart procedure at St Barts 10mths ago which was followed by constant ectopics but these seem to have subsided in the last month and fingers crossed won't be back too soon. I take 50mg 2xdaily with no problems. Very happy to stay on it as no AF symptoms since I started it. Good luck with your procedure and hope it goes well for you. ☺

[F-M-C-MM]

Hi, I would be interested to know why your EP advised a visit to an ophthalmologist prior to taking an anticoagulant as it may provide an insight into a condition I developed while taking Apixaban. Thanks Samazeuilh.

[Hidden in reply to F-M-C-MM]

The reason was that after I took Dabigatran a few times (last July) I got a subconjunctival haemorrhage. This isn’t a serious condition, but the GP felt that there was an increased risk of an intracranial bleed or a more serious eye bleed if I took more. The consultant and various other parties disagreed and said that I should take an anticoagulant. They said the condition could have been caused by rubbing the eye. I wasn’t convinced and feel vindicated by the judgement of the EP at Barts. I haven’t taken any more anticoagulant since. I have CHADSVASC 1. I note that products like Xarelto (not Dabigatran) list such subconjunctival haemorrhage s as a common side effect of the medication affecting up to 1 in 10.

[F-M-C-MM in reply to Hidden]

Thanks for sharing your experience of this drug. 1 in 10 is quite a high ratio. Did they suggest an alternative anticoagulant such as Warfarin in place of the NOACs?

[Hidden in reply to F-M-C-MM]

He said apixaban and adoxaban might be better.

[Hidden in reply to Hidden]

What do you feel caused your subconjunctival haemorrhage?

[Hidden in reply to Hidden]

The dabigatran.

[Tikaneko]

Thank you for your excellent information. I go for my ablation assessment on Tuesday, I take only half my medication (Adizem) as the side effects are unpleasant. It is enough to keep my AF under control! I am on also taking Apixaban, but had to stop it for a short while as I had terrible migraines, and I am not a headache person. I was interested to read your comment about weight loss, I eat a very healthy diet and watch my weight very carefully. But since I have been on Apixaban I have gained weight. This doesn't help at all and bothers me. Has anyone else experienced weight gain?

[Morzine]

Why did he suggest seeing a guy fir your eyes?? I’m interested asi Had eyesight problems when this started, they’ve calmed now, it was the tablets.....

Sue

[Hidden in reply to Morzine]

See reply above to FMCMM. It was related to a (likely) problem with Dabigatran.

[radagast58]

Who did you see at Barts?

[Hidden]

I don’t think that is the case. The ablation was offered as an option. I don’t think it is needed urgently, and in any case I have to be on anticoagulants for some months before the procedure is possible. If I paid for the procedure I think it would cost around £20, 000. On the question of socialised medicine see Gerd Gigerenzer’s book -he is director of the Max Planck Institute-where he discusses Mayor Guliani’s criticisms of the NHS and claims in favour of private medicine, and demonstrates that these are based on flawed reasoning.

[Hidden]

I have PAF. The consultant said that it just isn’t possible to project the trajectory for any individual. Some will stay at PAF, others will progress through persistent to permanent AF. And this could be after a few months or years (or not). All I can do -any of us can do-is to try to do the things which *might* delay or stop progression-attain an ideal weight, drastically cut stimulants like alcohol and caffeine and avoid stress. There is some fairly limited data which shows that these things will *in some cases* reduce the AF burden. An ablation simply addresses the symptoms- there isn’t much evidence that it will reduce the stroke risk for example.

[Hidden]

I’m not sure this is correct. If PAF isn’t addressed by ablation, then my life expectancy might or might not be shortened significantly depending on how/if the condition progresses- there is no way of predicting, or limited data on which such a prediction could be based.

It’s not known that abalation returns stroke risk to normal, however it may reduce it somewhat. See:

academic.oup.com/eurheartj/...

[Hidden]

Ablation does not *cure* AF.

[MikeyF]

Yes of course ablation does not (and can not) address the underlying cause of one’s AF, but I certainly consider no AF to be an exponential improvement over some AF! Semantics aside, from a practical literal POV, if an ablation stops AF from happening, then the AF itself has been ‘cured’ and that’s surely an excellent outcome in and of itself. Even cancer is considered cured if the cancer is gone even where the underlying issues that caused the cancer are still in place. Heck at the end of the day even just being alive is highly dangerous condition that having only one inevitable outcome is pretty much incurable!!

[Hidden]

The ablation procedure suppresses the AF, it does not cure it. The underlying mechanism remains, and the condition may reoccur. It would probably be better to see the procedure in terms of the isolation of a malfunctioning component from the rest of the heart, which results in its no longer, in the short term at least, being able to wreck havoc.

[wilsond]

It does not cure it. It is not a disease but a condition. I spoke about this with my excellent EP who is also a Professor only two weeks ago. Ablation is ' purely for quality of life for people who are very symptomatic and for whom at least two types of drugs haven't worked well' he went on to the say I would need to stay on anticoagulant s for life with a chase score of 2,and that ablation changes our perception of the irregular rhythms,and may very likely continue in slow AF. He said all the current research has not indicated that there is strong evidence of stroke risk reduction.Symptom control is the reason for ablation,but as the cause of AF is not known,that causality can mean At returns at any point.

[djbgatekeeper in reply to wilsond]

Spot on 👍

[MikeyF]

Suppose one has an ablation and then no AF for 15 years (a friend in London fits this category - ablation in late 03 in Bordeaux). For me that’s a cure end of. As for it can come back, of course it can. Just like any other disease/condition can reoccur or, for that matter, occur for the first time. As I said before, an aging organic body subject to unavoidable oxidisation and inflammation and genetic expression is not a recipe for lifelong freedom from diseases/conditions. All we can do is try to avoid (so far reasonably possible) and treat them.

[Hidden in reply to MikeyF]

Well, to be rid of the symptoms is certainly highly desirable, but that is not really the same as a cure. You would still have the stroke risk for one thing.

[MikeyF in reply to Hidden]

There’s being rid of the symptoms or being rid of the AF. The first isn’t a cure the second is.