Ablation Questions & Issues

[Craggy]

It is a while since I last posted and I hope I am not repeating a recent subject. My history is that I was diagnosed with AF in 2014 aged 63. Typically, at its peak, I experienced 2 to 3 episodes per week lasting up to 24 hours each. I was prescribed Flecainide, Bisoprolol & Rivaroxaban

In response,

• I lost 3 stone which reduced my weight to 11 stone (BMI of 20) - everyone said I was too thin.

• Took 300 mg of Magnesium Citrate daily (which I have continued).

• Stopped all alcohol consumption (but see below).

• Increased my level of fruit consumption significantly.

My AF episodes have reduced dramatically. Here is a summary of episodes since my diagnosis (The ones that I have been aware of.)

2014 - 40

2015 – 3

2016 – 0

2017 – 2

2018 – 3

2019 – 6 (3 in July)

I have allowed my weight to increase to 12 stone (21.4 BMI). On reflection, 11 stone was too light. I also have had occasional alcohol, usually with bad results. The recent increase in episodes is almost certainly alcohol related so I have decided to give it up for good (again!).

There are also other problems. I fall asleep most evenings watching the TV then wake up late (sometimes at 2 am) and I can't get back to sleep when I go to bed. This causes frequent fatigue which feeds off itself. I wondered whether this is caused by my medication? In the past my consultant very firmly rejected my request for me to reduce or stop taking the medication. Nevertheless, in 2017 I tried to wean myself off the Bisoprolol and reduce the Flecainide but the AF returned so I went back to the prescribed dose.

I have again discussed my fatigue and medication with my local cardiologist and he has suggested that I consider an ablation so that I can stop taking the Flecainide and Bisoprolol. (I accept that I will always need to take an anticoagulant.) He has referred me to The John Radcliffe Hospital in Oxford to discuss it. When I researched ablations a few years ago I decided that they were unreliable and firmly decided against it. I know some people take an opposite view and some, like Bob, are shining examples of a successful outcome. I also think technology may have moved on since my earlier research.

I will approach this meeting with an open mind but I would like your help. I have read the current AFA booklet about ablations but the personal experiences of others will also be valuable. If you have had an ablation and, based on your experience, you think I should be asking certain questions, or considering related issues, can you please advise me?

Thanks.

[Ridley60]

Hi Craggy, I suppose the question is how would your life differ if you were AF free and off the meds.

Looks like you’re meds are managing the occurrences really well with few episodes.

Personally medication didn’t work for me and as I was getting around 12-15 events a year lasting 2/3 days at a time an Ablation was a no brainer.

I had my 1st ablation in 2014 and was AF free for more or less 3 years before getting reconnections in the PVs. Although I did benefit as a PIP then worked for me and I could terminally most events in a couple of hours.

But I always knew I might need a 2nd ablation which I had 6 weeks ago. I’m currently taking 100mg of Flecainide and 5mg of Bisoprolol daily as well as Apixaban. So I usually fall asleep at about 7pm and again at 9:30pm. At which point my youngest daughter shouts at me to wake me up, so no fatigue due to odd sleeping hours.

I’ll be off all drugs in a few weeks and I know my energy levels will return.

[Hidden]

Firstly, I think your post is great. It’s very helpful to see the link between lifestyle changes and improvements in AF with dramatic reductions in episodes, especially in that you can even relate the recent deterioration to a (temporary) relaxation of some less good habits....😉🍺. Hopefully your condition will continue to improve to its former state ie 2016/2017 but generally, but no always, AF does progress which means a lifetime of fairly potent medication and all the issues that may (or may not) accompany them. I think your approach to ablation is good too. Of course there is no magic wand and sadly no guarantees either but when you consider how many thousands of ablations have occurred in the UK alone, it really is rare to hear anyone write in to say they wished they hadn’t had one. I’ve had two in 5 years and if I ever needed a third, I would not hesitate but it a decision only you can make. At least you are considering all the options, wish you luck in your deliberations. The only direct advice I offer is that if you are offered an ablation, take it because if it’s being done on the NHS, the chances are it will take 6 to 9 months which gives you time to complete your research and cancel if you decide not to proceed....which methinks you won’t......😉

[MarinaT]

Hi Craggy. I have had 2 ablations at the John Radcliffe. The first failed, but the second, in March this year seems to have been successful. I am now only on Apixaban. No recent episodes at all. The team at the JR are excellent. You are in good hands. Good luck!

[Shcldavies]

It is difficult and in fact no one can really provide definitive advice as no one (not even the Docs) know exactly what is causing the AF and how effective an ablation is likely to be. The only way to know is to have an EP study, which is normally done during the ablation process, during this study they try to see where the electrical signals are coming from and only then will they know if and what to ablate (if anything). The extent of any ablation will indicate what recovery will likely be. Keeping an open mind will be difficult, your heart (pardon the pun) will tell you one thing and your brain another. My advise is that its a no brainer - take the advise the doctor gives, they know better than anyone, they are not always right but they are your best chance of getting the right treatment. If you want to know what an ablation is like and what to expect afterwards please read my posts on my first (and hopefully last) ablation I had in February.

[KMRobbo]

I had PAF which was becoming more frequent and less controllable, and was on flecainide and diltiazem. Had several unwelcome side effects from the dltiazem. ( was on this as I do not get on with beta blockers). I had an afib pvi cryo ablation jan 29th 2018. Not had Afib since. I Unfortunately developed reentrant Atrial flutter 8 days later very possibly promoted by the flecainide i was still taking . I had an rf ablation in the right atria for that Feb 26th 2018. The flutter stopped in procedure and gas not returned. I came off all drugs May 15th 2018 which is brilliant. Sometimes get spells of ectopics lasting seconds to hours , but I ignore those . EP not concerned. They were more frequent earlier in the year but cannot remember the last one, probably at least 6 weeks ago. Sometimes (very rarely) get unusually HIGH HR when running, EP cannot explain, however I stop running and it stops. I start running 45 mins later and it does not return!

I am happy with the ablation. If AF returns tomorrow morning I will happily have another ablation tomorrow afternoon to keep off the drugs.

[lifegoeson]

Dear Craggy,

Firstly, congratulations on doing all the lifestyle changes recommended and getting actual results!!! 😁

I was in a very similar situation to you recently. I developed AF in December 2014 and after having had a successful ablation for PAT in 2004(ish) I went straight to my GP and asked to be put on the list for another one! So ...... they put me on Flecainide, Bisoprolol and Apixaban which made feel pretty awful. They had also reduced my dosage of thyroxine as they were convinced it was too high and that was at the root of the problem. So one way or another my life fairly well ground to a halt. At the time I had been working as a dog walker and doing around 15-20,000 steps a day. I had to give up my job, put on weight, and was totally lethargic. Meanwhile the AF kept getting more frequent despite the drugs. I just kept going back and making a nuisance of myself until they put me on the list and I finally had an ablation in May 2016. It was a success but a much bigger procedure that the previous one for the PAT. I had a couple of post op hiccups mainly due to me not wanting to take the drugs but my cardiologist let me wean myself off them after about a year (last one being Apixaban) and to date the AF has not returned. I’ve lost weight, made the lifestyle changes, and although it was tough at the time, have no regrets about having the ablation.

Good luck with whatever you decide to do but personally I found the drugs more of a problem than the actual AF and I’m very, very pleased to be off them! Long may it last!!!!

P.S. I still get runs of ectopics but not massively concerned about that.