Things to do to hopefully stave off having an ablation?

[Doggiemomma]

I want to avoid ablation for as long as I can, not the least which is that often, it's not a "one and done" thing. After this last episode of SVT‘s, my EP increased my flecainide to the maximum dose per day. If I should have another episode of SVTs or a-fib or flutter etc, and the emergency room gets me back into NSR and discharges me, am I looking at perhaps a change in medication?

I've read that Flecainide can often work for years, and beta blockers, too. I take them both and a blood thinner. At this point, I don't seem to have any "side effects" of taking these meds.

My EP has suggested ablation of course, not only because he wants to help me, but that’s also because ablations are what he does.

I think there are other meds I can try if the Flecainide doesn't help, but I don't know what meds those are....and I don’t want to feel pressured into an ablation for a lot of different reasons. I'm pushing 70 years old, and I am focused on losing weight as I'm obese and came by it honestly--I overate a lot to compensate for things missing in my personal and emotional life. I appreciate your help, input and suggestions please. Thank you!!!

[BobD Volunteer]

Loosing weight WILL help. If you google Legacy trials in Australia they found that getting back to a BMI of 26 or less often removed the need for ablation. That said mine is now 25 and I still have arrhythmias even if I do feel better in myself.

Flecainide is the most commonly used anti arrhyuthmic drug but there are others such a Propafanone which works in a similar way. Avoid amiodarone as it doesn't have side effects it has effects most of which are unpleasant long term

[Doggiemomma in reply to BobD]

Hi, BobD, and thank you so much for your helpful & encouraging words! After I post this reply, I'll go look up the Legacy trials you mentioned, & special thanks for sharing about amiodarone & it's long term unpleasantness.

[Davidtol in reply to BobD]

I've been on amiodarone for years, as nothing else seems to help (my heartrate is normally 45-50) . Are there any new meds that can be a substitute?

[jeanjeannie50]

Eating is so satisfyingly isn't it and I certainly know it's one of my loves! I really admire your honesty and know that a lot of us carry a little more weight than we should.

Imagine losing some of that and feeling so much better! As an extra bonus we could reduce our AF burden.

Well I'm with you. Let's start reducing our food intake from next Monday (got to eat up all those goodies and not buy anymore). We'll call it the AF diet experiment and report back here every so often. Hopefully to tell others how much better we feel.

Who's going to join us?

Jean

[Doggiemomma in reply to jeanjeannie50]

Hi, Jeanjeannie, yes, eating so so satisfying--such a comfort on so many levels!

I am looking forward to reducing my weight and reducing my AF burden and while the weight always comes off slower as we age, it will come off.

Because of my lack of skin elasticity & where I carry my excess poundage -- my lower abdomen "stomach/gut" where I already have skin overhang called an "apron"--I'll need surgery to remove that skin else it hangs down to my knees once I reduce my weight. I wouldn't mind doing the AF Diet Experiment with anyone else who is interested!

[Bambi65 in reply to jeanjeannie50]

That is a grand idea! Count me in too.

[jeanjeannie50 in reply to Bambi65]

Right so the first one to lose some weight and notice a difference in their AF will write about it on this forum. Jean

[Doggiemomma in reply to jeanjeannie50]

Sounds like a plan....just remember I have a loooooong way to go, and may not see results as quick as I'd like!

[Hidden in reply to jeanjeannie50]

Just to get you started. I have lost 1.5 stone and today walked 8 miles and I’m 76! Take Pradaxa, 1.25 Nebivolol and 2x 100 Flecainide a day. Last AF episode 6/3 and that was caused by a white wine spritzer!

[jeanjeannie50 in reply to Hidden]

So you've noticed a great improvement since losing weight?

Jean

[Hidden in reply to jeanjeannie50]

I used to have 2 days in AF one off for months and Flecainide didn’t really work. EP said AF would become permanent but it didn’t. Turned down an ablation. Since losing weight Flecainide is working and at the moment all is good.

[HiloHairy]

I wondered why the meds side effects weren't crushing you and then realized that it's because the extra weight is already taking your energy away.

I've been overweight for a significant parts of my life though never quite obese. Currently my BMI is about 25 and I work out vigorously at a gym five mornings a week. When I'm not trying to please still one more cardiologist by trying still one more med my energy level and enthusiasm for life is pretty close to the way it was when I was in my 40s and yes, I've already hit 70.

While the prospect of an ablation scared and depressed me for quite some time I'm now impatiently looking for the end of the pandemic so I can have mine done. They do take in more than half the cases the first time and most of these people never come back to the forum. If I need a second one, so be it. If that's not enough I'm willing to haunt them at the hospital until they get it effing right!

[Doggiemomma in reply to HiloHairy]

HiloHairy, perhaps I misunderstood, but I don't recall my post saying anything about my energy levels, which I feel are quite good, although I do, and have usually, enjoyed a little nap after dinner.

Glad to "meet" another person who has hit 70 before me!

[secondtry]

I don't know whether you are in a position emotionally to do lots of homework research on lifestyle changes but that is what many here agree will help. Food, exercise & breathing are probably the best places to start. One small step at a time and keep going.

[Doggiemomma in reply to secondtry]

Thanks for ringing in here, secondtry! I've taken a lot of nutrition classes, and do breathing exercises and meditation.

Exercise scares me because I think even gentle walking might start a run of AF. I've noticed three times now, that when I become hot or overheated, from either the temperature of the day or when I've walked from my parked car to enter the market and it's a hot day, !bam! I can feel my heart do it's wonky things and then I'm in some kind of AF. Sometimes, not related to walking or heat, the AF happens anyway!

My lifestyle is fairly "clean" - I don't drink coffee or tea or alcohol, or smoke or smoke "other" things, I only drink water--not even carbonated water-- and I try to have a mostly plant based diet with a bit of protein daily, usually chicken, turkey or fish--seldom red meat--and sometimes cheese and Irish butter from contented cows. :O)

I do enjoy yogurt once a day with probiotics, my fruit intake is limited. I've given up chocolate and candy and biscuits and my beloved ice cream.

[secondtry in reply to Doggiemomma]

Wow you are doing very well already! Exercise without AF can improve, in my early AF days I can recall feeling not right about a slight incline and taking it very slowly. I would read up here and elsewhere on taking Magnesium Taurate (or other compound incl Potassium e.g. Nutri Mega Muscleze) plus CoQ10 after checking with your medic of course.

[Doggiemomma in reply to secondtry]

Awwww, shucks, thanks for the compliment! I am taking Magnesium Glycinate which was recommended by a friend after I mentioned that the high absorption chelated magnesium I tried had me running for the bathroom, no matter how I took it. Thanks for telling me about your taking things slowly, and encouraging me to do more research about the supplements! I don't know enough about CoQ10.

[secondtry in reply to Doggiemomma]

CoQ10: All I know is that my hi profile London Naturopath said he treats all his AF patients with the Nutri Mg compound & partners it with CoQ10; Mg relaxes, CoQ10 strengthens the heart as well as doing other good stuff for the body. But do check with your medical advisers first.

[Doggiemomma in reply to secondtry]

Thanks, secondtry, for the extra info! I'll run it by my EP!

[GrannyE in reply to Doggiemomma]

I am in my 70s, have had 1 ablation, and am thin but I have noticed that when I do too much I can trigger A/Fib and breathlessness and I have to sit down to recover and the A/Fib can lasts for days. I therefore try very hard not to overdo things but am active a lot of the day but never do anything too strenuous I find that it does not suit me to ‘work out’ but I can usually get away with gardening and golf (with a buggy on a hilly course) but even then too much can trigger A/Fib. Anyone else found that exercise triggers A/Fib and breathlessness?

[doodle68]

Hi Doggymomma I decide when diagnosed with P-AF over 3 years ago to try to slow down the progression of my condition with lifestyle changes and to avoid ablation if possible in the hope that a better treatment will be found.

It is only in the last few months that my episodes have increased .

I followed the recommendation of the Legacy study with regard to weight loss a concept now widely accepted by many doctors and I adopted a permanent lifestyle of eating healthy foods/daily exercise//no alcohol/plenty of sleep/avoiding stressful situation and things like arguments that increase hormone levels. I lost 21 lb and have managed to maintain the weight loss . I am going to lose a little more weight to see if that slows things down again. I have not quite reached my goal of a BMI of 25 .

I developed a whole new way of looking at food, rather than saying what would I like to eat I said what can I eat in moderation that will be good for me . Luckily I love many healthy foods like vegetables/fruit/nuts and have never eaten 'convenience' foods , I also love cooking so that made things easier.

I have my main meal at lunch time so I am active and not sitting around in the evening having eaten a large meal. It really hasn't been that difficult to stick to my lifestyle changes when I consider that by doing so I stand to improve my condition .

Good luck with your ablation avoidance 😊

[Doggiemomma in reply to doodle68]

Doodle, thank you for sharing a bit of your own journey! Keep working on that BMI goal!

[secondtry in reply to Doggiemomma]

Totally agree with Doodle's approach, I am down to BMI 22 and in part I attribute this to a brisk 1 mile walk before breakfast (increases the metabolic rate) and again before my last meal of the day...when you can manage that.

[Doggiemomma in reply to secondtry]

Thanks for letting me know that a brisk 1 mile walk works for you! I've read that "weights" also increase the metabolic rate (but don't overdo!).

[Coco51]

I tòo am pushing 70 and love my food. I have lost weight and kept it off for 2 years now -134lbs down to 114lbs (61kg -52kg). My BMI is now 22. I eat a mainly plant based diet with fish . I rarely eat meat or chicken. I take more exercise, no caffeine or alcohol. All great, but the bad news is I still get AF episodes😣😕. Sometimes it feels you just can't win. But I do really feel a lot better generally!

I too felt fearful about ablation. It sounded scary. But of all the things I have done it has been the most beneficial. But bear in mind my AF had suddenly became persistent - 24/7, night and day with no relief. Unlike you I did feel lethargic on high doses of Flecainide and Bisoprolol so I became keener on Ablation. I've had two ablations and now the AF episodes are less severe, almost muffled, and much slower. Only 80-90 bpm usually. They are more bearable and sometimes i have none for months.

I wish I had had the Ablations earlier because the longer certain people have AF the more likely it becomes persistent . That's because the heart remodels and finds lots more rogue channels for electrical impulses to make it fibrillate.

I refused Amiderone having heard from someone here that it left them with life long thyroid problems.

I wish you good luck and hope the weight loss works for you.❤

[Doggiemomma in reply to Coco51]

Coco51, thanks for sharing your input!!!! I've read where people can stave off episodes for more than a decade, but there's no secret to doing that. We're all so different in terms of our bodies and what works for us. I agree with the Amiderone and the issues it brings with it.

[Coco51 in reply to Doggiemomma]

That's very encouraging.

[RiderontheStorm]

One and done worked for me. Eventually the pills and especially something as potent as Flecanide will have it's way with you eventually - but maybe not as you are of significant age now and other drugs are available. Good luck.

[Doggiemomma in reply to RiderontheStorm]

Hi, Rider, so glad to hear one and done did it for you! You're the exception from what I understand, to needing a followup ablation or two. What kinds of things do you know of, regarding Flecainide having it's way with people? I'd like to know more, especially if from personal experience or from what has been posted. Thanks!

[RiderontheStorm in reply to Doggiemomma]

I carry and use it in emergency known as the PIP, pill in pocket. It works well but I feel like I have a 3 day hangover after using it. Just so tired and washed out feeling. I guess some get use to it but I am pretty physical still and feel the drag on my system when using. I try and use as minimal drugs as possible. Just last week was in hospital 2 days for another bi lateral PE but never suffered a moment of AFib which shows how well the Dr. hit his target when doing my ablation 4 years ago.

[cuore in reply to Doggiemomma]

The key to having hopefully one ablation is to have it done when one is paroxysmal, especially if the episodes are not too frequent or too long. Once a person becomes persistent, especially if one is persistent for a long time during a one year persistent stage, then the probability of needing more than one ablation is increased.

[Doggiemomma in reply to cuore]

I'm not sure I understand what "persistent" means... being in AF for over 6 hours once a week & then it self corrects, or ??? Please remember I'm rather at the beginning of this journey and believed -- at the time -- meds would take care of everything. Surprise, surprise, surprise!

[cuore in reply to Doggiemomma]

Persistent is defined as continuous AF beyond 7 days. You are at a very early stage with your episodes lasting 6 hours.

[Doggiemomma in reply to cuore]

Thank you, cuore!

[David1958]

Some people tolerate meds better than others. I did not tolerate them much at all. I was on both Flecanide and Metoprolol. My wife used to wake up in the middle of the night to check if I was still breathing. The FAA required me to wear a Holter Monitor once a year for 24 hours. My heart rate got down to 40 in the early morning hours. I felt like a run down toy. I was 52 at the time and did not want to increase the dosage of the drugs since the side effects were bad enough already. So far, I am 9 years 8 months post ablation (Feb 2011). I too keep Flecanide and Metoprolol on standby to use as a PIP if the need ever arose. Otherwise no meds. Like most everyone else here on this forum I too made lifestyle changes to a more plant based diet along with regular exercise. No caffeine and hardly any alcohol. I have been a BMI of 25 for a long time. I used fasting to get down to that BMI and I discovered something interesting. For the first time in my life I was in control of the food I ate instead of food being in control of me. I certainly hope you find what works for you. I am not sure why anyone is afraid of the procedure. I know any surgery carries risk just from the anesthesia itself. Mine was a 4 hour operation. I slept through the entire thing. All of the incisions were small. I did not have to do anything to care for them. The sutures degraded by themselves. I did stay in a hotel close to the hospital an extra day just in case I needed to return to the hospital. It turned out to not be necessary. My AF was definitely triggered by dehydration and exhaustion. As long as I avoid those two things I pretty much keep AF away.