All Change and on List for Ablation - a post-cardiologist update

[Apple88]

Hello again.

Thought I’d update on my previous posts and again, ask for any thoughts or advice from anyone with experiences to share.

Went for my cardiologist appointment yesterday, armed with all of my paperwork, including ECGs, Kardia readings & hospital discharge notes.

He was brilliant and listened to all my concerns & questions. He said my bradycardia was in sinus rhythm so although it was clearly making me feel unwell, it wasn’t AF. I explained about what happened with the digoxin and he’s said - which I was kind of expecting- that as my HR runs low anyway, then maybe I’m not the best candidate for trying to control my AF with meds.

He has put me on the list for a catheter ablation (in 3-4 months) and has taken me off bisoprolol. He has prescribed 2 x daily 50mg of flecainide to start on Tuesday, and an EGC after 7 days to check how the flecainide affects me.

I felt this was a lot to take in, but I was sort of relieved that he seemed to have a plan. As I was only diagnosed a year ago, at 45, I was a bit concerned that things seem to have gone downhill so quickly to the point where I’m now off work and needing surgery.

I’m hoping that the flecainide suits me and will help in the meantime, but mainly I’m looking forward to trying to pick myself up a bit again. It’s been a rough month.

Thank you all for your previous advice and replies, but it seems I really need advice again about this next step.

Does this seem like a normal pathway, or course of action to be taking? I do trust my cardiologist but it just seems to have escalated quickly. I will look at the ablation info from the links on this site to try and prepare myself.

This forum has kept me sane recently!😊

[Hidden]

All sounds good. A daily maintenance dose of Flecainide will help to keep you in sinus rhythm but normally, this is taken in conjunction with either a betablocker or calcium channel blocker. If you haven’t seen them already, I am sure you will find the following two AF Association factsheets on preparing for and recovering from an ablation helpful. They were written by patients, for patients therefore they include a lot of information not normally covered by hospitals or clinics.

heartrhythmalliance.org/res...

heartrhythmalliance.org/res...

One other thing, it’s a procedure rather than surgery, no scalpels and no zips after the event!!

[Apple88 in reply to Hidden]

Thank you. Yes, you’re right - procedure definitely sounds better!

I will definitely be reading the fact sheets, probably several times!

I have been told to only take flecainide - and nothing else. I’ve seen somewhere that it’s normally taken with other medication but that’s not what the cardiologist said. Hopefully it’ll still be okay.

Thank you for taking the time to reply.

[Hidden in reply to Apple88]

as you already have bradycardia a beta blocker would only slow down your HR more which is probably not a great idea.

I was on bisoprolol for a long time and my HR went in to the low 30's before I was taken off it. I did feel like crap with HR that low!

[Apple88 in reply to Hidden]

I can definitely relate to that! Low 30s must’ve been awful.

Start the flecainide tomorrow, so here’s hoping! 🤞🏼

[cpalmermn in reply to Apple88]

I would argue that Flec is ‘sometimes’ taken with BB, but not ‘normally’....BB can lower heart rate, and sounds like yours is low enough at times.

I’ve been on the same exact path, and the approach sounds reasonable, except I took Flec (with no BB) as a possible alternative to ablation, to see if it would stop further episodes of Afib. It didn’t, but it made them much shorter. So then we ablated. Hanging In so far with just 30 mins of Afib in 3 months...good luck.

[Apple88 in reply to cpalmermn]

That’s great! Thank you for that. I start tomorrow so will see how things go. HR has already started to feel a bit jittery after stopping the bisoprolol so 🤞🏼.

Maybe, if it works well I might not need the ablation. I’m not usually great with medication in general though so I’ll see.

Thanks for your reply. 😊

[jennydog]

I do hope that flecainide works well for you. I honestly think that I would have a miserable existence without it. Pre-ablation I was prescribed 2 X 100 per day but now only use it as a p-i-p. I have it with me at all times as it gives me confidence knowing that it works so I am in control. It's an old, relatively inexpensive drug. Maximum intake is 300/day.

[Apple88 in reply to jennydog]

Thank you for replying. I’m due to start it tomorrow so I will hope for the best. It’s weird because I feel jittery already since stopping the bisoprolol, even though it was only a low dose.

I think I need to try and take my mind off things, but it’s hard when I’m still off work.

Looking forward to getting back to normal - or as close as!

[Hidden]

sounds good, and quite similar to me.

Could not tolerate drugs to keep me in rhythm so EP suggested an ablation.

Had this almost 3 years ago and still in NSR. I do have the odd blip of fast heart rate or periods of palpations but that is still preferable to being in AF

[Apple88 in reply to Hidden]

This definitely gives me hope! Thank you. I’m having a check up ECG a week after I start the flecainide to see if it’s doing okay I guess.

Ideally I’d just like to think that there will be a time in the future that I don’t have to take them!

Thanks for replying.

[wilsond]

Echo Flapjack,don't want to alarm you but please check about taking a betablockers ie bisoprolol alongside daily dose of flecanide. It is recommended ,as it can cause flutter to occur as well

It did that to me .

Best wishes x

[Apple88 in reply to wilsond]

Thank you. I think the main issue is that the beta blockers are just dropping my rate too much & making me unwell.

My EP is pretty experienced so I’m going to hope he’s right in what he has told me.

If I have problems this info will be useful for when I next see him though - I can say that it’s normally taken alongside.

[buddy2blue]

Hi it sounds like you have a very good cardiologist and he is on the ball with things. Try not to worry that things are happening fast I know it can seam scary but getting it sorted is the main thing. I’m on 160mg of sotalol for my AF. And have also had a failed ablation but that’s because I’m a very complex CHD patient and my heart really dose not behave. I now have a duel lead pacemaker and two stents in my pulmonary artery, and going for an appointment at Newcastle freeman hospital at the end of this month to start the transplant Journey xxxx

[Apple88 in reply to buddy2blue]

Oh my goodness!

Thank for replying. You certainly have put things in perspective. Yes, I feel happy with my consultant and I think I have to just trust him to know what’s best.

You sound like you’ve definitely had a lot to deal with. I wish you all the best with your journey. 😊

[buddy2blue in reply to Apple88]

Thank you I don’t do things by half lol

[cuore]

Yes, I agree, you certainly have a brillant cardiologist. He is taking the path of not having you live in AF. A beta blocker is for rate -- to keep the rate low, not to try and get you into sinus rhythm and stay there like Flecainide. Look up digoxin and note all it does, and you will not how wise your cardiologist was not to go the digoxin. Putting you on the list for an ablation while you are still paroxysmal is breath-taking. Some cardiologists are complacent to let you fall into persistent AF. If only I had had a cardiologist like yours whereas mine was an #@*#, and he was comfortable in keeping me persistent.

[Apple88 in reply to cuore]

Thank you.

Yes I feel very reassured. He really seemed to want to help me get my life back. 😊

All the best.