Antiarrhthmic drugs working great, but scheduled for ablation

[Waverly1]

Thank you to everyone for this wonderful forum. My husband, 56, started getting more and more out of breath and fatigued in November and December of last year. Finally he went to the ER (we are in the US) on January 2. He was in AF and his heart rate was 180 but they got it down to between 130 and 150 after meds. He was diagnosed with heart failure and AF. They started him on the antiarrhythmic drug Dofetilide (Tikosyn) , in the hope that his heart would convert to NSR but it didn't, so after three days he had a cardioversion which worked, and he continued on the Dofetilide.

It's now been eight months and he feels great, staying in NSR, and he tolerates all the medications just fine. Which are: Dofetilide, metoprolol, Lisinopril, apixaban, fuorsemide, and atorvastatin. After a few months he had an Echo which showed his heart failure had greatly improved (ejection fraction went from 28% to 62%.). He exercises by biking to work, and significantly cut down alcohol, usually only drinking on weekends. Before all this, he was a pretty heavy drinker, about 3-4 drinks a night. It seems likely that the drinking was a main contributing factor in his onset of AF.

My husband's EP has suggested that he either stay on the Dofetilide indefinitely, or have an ablation. The EP has actually indicated that my husband is a good candidate for ablation (and we have heard that he is generally conservative regarding suggesting ablation). Interesting that there is no consideration of going off of the Dofetilide and seeing how it goes. I'm guessing it's because afib invariably recurs. And maybe also that he was very symptomatic with afib.

My husband has decided to get the ablation on Sept 27. (It's a cryoablation). The doctor plans on keeping him on the antiarrhythmic Dofetilide for 6 months following. I guess my main question is -- if the meds, including antiarrhthmics, are working so well for him right now, is he crazy to get an ablation? And for those of you for whom ablation has not been successful, have you tried antiarrhthmics? Thanks everyone!

[Hidden]

Hello Waverley, drugs versus ablation is always a difficult decision to make and I can only relate my thinking which prompted me to go down the ablation route. I was reluctant to take fairly potent medication for the rest of my life particularly as we often heard that the effectiveness of medication could reduce over time. Also, AF is a progressive condition and this could mean doses might have to be increased and this could result in stronger side effects which for some, can match or be even worse than the effects of AF. I had a cryoablation in 2016 which was followed by an RF ablation last year to “touch up” the areas the balloon missed (which is not unusual) because tissue around one of my pulmonary veins was irregular.

I certainly have no regrets and would have a third if necessary but it is not a decision to take lightly as there are risks. You rarely, if ever, hear of anyone saying that they wish they had NOT had their ablation. Good luck in your deliberations, hope this helps.....

[Waverly1 in reply to Hidden]

Thank you for your reply! Was the 2nd ablation prompted by a return of afib? And also curious if you stayed on antiarrhythmics for a period of time after the first ablation. Thanks! And yes, it's true that you rarely hear of anyone saying they wish they had not had their ablation.

[Hidden in reply to Waverly1]

Yes, but the episodes were far less severe and were stopped quickly using Flecainide as a pill in the pocket. I still take a lowish dose of Diltiazem as it also helps to control blood pressure. I knew that a second attempt was likely because of the difficulty the EP had in a ablating one of my pulmonary veins. You need to bear in mind that ablation is not a cure for AF and episodes can, in some cases return, but the symptoms generally are significantly reduced.

[KMRobbo]

Was on flecainide antiarrhythmic and diltiazem for rate. I had side effects with the diltiazem. Had a PVI cryo ablation and it stopped the AF. 9 days later I developed 're entrant atrial flutter possible promoted by the flecainide so I had a second ablation a month after for this. RF ablation. That stopped the flutter. I stopped taking drugs 3 months after. The ablations were 18 months ago. However I did not have any other co morbitities- my heart was sound except for the A fib. I was 57 when I had the ablations.

[Waverly1 in reply to KMRobbo]

Interesting, thanks!

[Hidden]

With all those meds, who knows how his body is working any more. But you might like to try cutting out nearly ALL sugars for 4 or 5 days, just to see if his heart gets better. Here is what worked for me ...

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After 9 years of trying different foods and logging EVERYTHING I ate, I found sugar (and to a lesser degree, salt – i.e. dehydration) was triggering my Afib. Doctors don't want to hear this - there is no money in telling patients to eat less sugar. Each person has a different sugar threshold - and it changes as you get older, so you need to count every gram of sugar you eat every day (including natural sugars in fruits, etc.). My tolerance level was 190 grams of sugar per day 8 years ago, 85 grams a year and a half ago, and 60 grams today, so AFIB episodes are more frequent and last longer. If you keep your intake of sugar below your threshold level your AFIB will not happen again (easier said than done of course). It's not the food - it's the sugar (or salt - see below) IN the food that's causing your problems. Try it and you will see - should only take you 1 or 2 months of trial-and-error to find your threshold level. And for the record - ALL sugars are treated the same (honey, refined, agave, natural sugars in fruits, etc.). I successfully triggered AFIB by eating a bunch of plums and peaches one day just to test it out. In addition, I have noticed that moderate exercise (7-mile bike ride or 5-mile hike in the park) often puts my Afib heart back in to normal rhythm a couple hours later. Don’t know why – perhaps you burn off the excess sugars in your blood/muscles or sweat out excess salt??

Also, in addition to sugar, if you are dehydrated - this will trigger AFIB as well. It seems (but I have no proof of this) that a little uptick of salt in your blood is being treated the same as an uptick of sugar - both cause AFIB episodes. (I’m not a doctor – it may be the sugar in your muscles/organs and not in your blood, don’t know). In any case you have to keep hydrated, and not eat too much salt. The root problem is that our bodies are not processing sugar/salt properly and no doctor knows why, but the AFIB seems to be a symptom of this and not the primary problem, but medicine is not advanced enough to know the core reason that causes AFIB at this time. You can have a healthy heart and still have Afib – something inside us is triggering it when we eat too much sugar or get (even a little) dehydrated. Find out the core reason for this and you will be a millionaire and make the cover of Time Magazine! Good luck! - Rick Hyer

PS – there is a new study out backing up the above observations. You can see it at

cardiab.biomedcentral.com/a...

[Waverly1 in reply to Hidden]

Very interesting, thanks!