Cardiology appointment

I had a very thorough NHS appointment with consultant (45 minutes), following an ECG and health check (much more useful than the brief private consultation in June), he explained everything about AF and my situation.

His main message - the new cluster of episodes (4 since June, following a four year gap after 2 in 2016) may indicate an ageing (I am 71) deterioration of the heart muscle, leaving me vulnerable to AF.

There are two types of AF, and “mine” is vagal, triggered by depressants such as alcohol, deep sleep, heavy meals rather than stimulants such as coffee or exercise, but once it gets the habit it can have many triggers, and become persistent. “Vagal” triggers such as mine are not helped by ongoing use of beta blockers (the reverse in fact). He also said that I shouldn’t take Flecainide (prescribed as PIP by private consultant) until an ultrasound checked the condition of my heart, I am referred for that, it may take a couple of months. If OK, I can use as a PIP. If episodes increase, I may need to take Flecainide daily to attempt to reduce / prevent them.

He said that every episode stretches the heart muscle so better not to have them, and to shorten them. Because of that this, he fast forwards AF referrals over many other heart issues. Also he says depending on the ultrasound he would recommend ablation day surgery sooner rather than later, before the heart is stretched leading to other heart disease. It is also a more successful procedure if done before the heart is too affected.

I am minded to accept his recommendation however if the ultrasound shows my heart is good and there are no more episodes I am disinclined, I do not have a good track record with surgery, and there is a 20% chance it will be unsuccessful in some way. He said there is a 12 month wait for most heart interventions but 5-6 months for ablations.

He also explained that the likelihood is that the heart was - or is now - slightly stretched and this alone increases the likelihood of impaired pumping so I should be on anticoagulants. I accepted his prescription of Apixaban. I have resisted anticoagulants up to now.

Does this fit with advice others have received?

[BobD Volunteer]

Your EP sound very sensible. I am relieved that you have started anticoagulants as you would need to be on them for some time prior to any ablation in any case and your stroke risk is high.

May I reccomend that you go to AF Association and read all you can abaout ablations and tehn download the two fact sheets on Preparing for and Recovering from Ablation. Read then till they are impressed into your soul.

heartrhythmalliance.org/res...

heartrhythmalliance.org/res...

[Hidden in reply to BobD]

Thank you

[Buffafly]

I’ve never really had any advice so that made very interesting reading, thank you 🦋

[Hidden in reply to Buffafly]

Thank you! He gave me even more than I wrote, talked me through the entire ablation procedure

[Janey1955]

Yesterday I had a telephone appointment with my EP. He told me to discontinue Flecainide as it isn't working and suggested an ablation. I have no blood pressure, my heart is perfectly healthy, but I am on Apixiban. When I get AF it is only every few weeks for maybe 12/16 hours but I can continue a normal life when I get it. He said any decision to have an ablation was my own. What a decision. In the end I decided to leave it for now, obviously if the attacks are more frequent and causing symptoms I will reassess. He did say that ablation worked better on a healthy heart where the Afib wasn't too bad. Difficult decision to make and not sure I am right or not but it does seem very invasive.

[Hidden in reply to Janey1955]

Yes, so hard. Were you using Flecainide every day?

[Janey1955 in reply to Hidden]

No because it seemed to increase the number of attacks, so I was taking as a pill in the pocket, but he said there was no point as it wasn't having any effect. I have just read the two informative sheets on ablation posted by BobD. Having read them it made me think I had made the right decision for now anyway.

[Hidden]

What decided you??

[dizzielizzie1]

What an excellent consultation you had . I've never had any advice in the almost 7 years I've had Afib--I'm very envious. I take Apixaban and have done so for four years. I do think you should take your cardiologist's advice and take the Apixaban to be on the safe side.

[Hidden]

Hiya Maddiegran,

Now that was a very interesting read. Thanks.

I recall, time and time again BobD ( and others) saying AF begets AF .... and whilst I can understand this I have always felt my understanding was - 'something missing'. Your post seems to hit it on the head when you discuss on a couple of occasions - heart muscle and heart being slightly stretched.

So, back in the day I found my AF kicked in after an evening meal. Once my GP had blood tests done which removed Coeliac Disease and IBS from the equation, I then consulted an nutritionist.

From this came a course of Probiotics and a food diet/plan. I have had only one AF event since April 2015 (in February 2018). However since then this little insidious demon AF has been playing around with my heart electronics ..... that said I am nowhere near meltdown/flashpoint but underlying electronic issues are at play and becoming more frequent which my GP and I are currently addressing ( very slowly in this current climate).

In answer to your question, I think the advice you have received amounts, pretty much, to quality advice. By the way, right from the outset ...I have always rejected any thought of an ablation for no other reason other than the nonsensical emotion of .......... I don't want anyone BBQ ing my heart.

I might add, that my AF was first identified, classified and treatment started in around 9 hours from the first symptoms ....... something that has always kept it at arms length and given me an easy ride compared to many on this forum, that was over 10 and half years ago.

Anyway, good luck during your future 'joyride'.

John

[Hidden in reply to Hidden]

I am terrified by thought of ablation! I would have the “freezing” one, that is how they start here.

[Yourflowergirl]

I went into a fib in May for the first time at least the first time I know about it and I went to the ER because I was in Afib my heart rate was at 177 and I was having a major panic attack. It’s a long story but a few weeks later I was put on a heart monitor for three weeks and found out my heart was going into a fib multiple times a day. I just had a catheter ablation July 14 and it wasn’t that bad. it sounds scary but it wasn’t that bad. I’m recovering well and I haven’t had any any arrhythmias I’m doing normal things again, back to exercising and feeling good. It was an outpatient procedure, I rested for a week after the procedure and everything started getting better. it’s not as bad as it sounds. I am so glad I did it I’m hoping I’m in that 70% that I won’t go into a fib in the future and I won’t need to do a second one.

[Hidden in reply to Yourflowergirl]

That is so encouraging! Dare I ask how old you are? Was a cryo ablation or a heat?

[Yourflowergirl in reply to Hidden]

I’m 51 almost 52.

[Yourflowergirl in reply to Yourflowergirl]

I had a catheter ablation. It was heat. I was pretty healthy prior to my episode in the ER. The cardiologist said it was probably a one time thing since I had been partying the night before and binging. But that was not the case. I have since stopped cold turkey all alcohol, caffeine and THC. It’s hard but I don’t want to trigger afib ever again. I’m eating very healthy too but I was eating healthy and exercising prior to the procedure. I had felt my heart palpitations other times prior to this big episode but I shrugged it off. I also learned that my mom, her brother my uncle and her mom my grandma also had/have afib so it runs in my family. A few weeks later after learning I was in afib all the time my cardiologist said “ I unleashed the beast” and told me an ablation should help. After the procedure in recovery it was difficult to lay still for the 4 hours it takes and very hard on the lower back. Very achy and uncomfortable. The first few days after coming home my chest felt heavy and a some discomfort. No pain and I was tired. It went away after the first week. My inner thighs were tender for about three weeks and a bit bruised from the catheter but all that was normal. I feel so much better now pretty much back to normal. I am grateful and highly recommend a catheter ablation if that is what your doctor suggests.