I had a phone consultation with a cardiologist (hope I get to keep this one) who treated me like an intelligent person and answered lots of questions, including ones I hadn’t asked. I hope this post may be helpful to others.
The information that came out of this was as follows:
I can’t take a higher dose of my present medication (Zemtard 180) because my heart tends to go too slowly sometimes and occasionally pauses, unless I have a pacemaker.
I can’t take Flecainide in any form, including IV in A&E, because it might slow my heart too much (without pacemaker).
Bisoprolol is a 3rd generation beta blocker which would be good because it helps to prevent AF as well as slowing the heart but is not suitable for me because of my asthma.
Nebivolol is a 4th generation beta blocker, more cardio selective, but likely to ‘unmask’ my Sick Sinus Syndrome - tendency to go too slow.
Amiodarone would be helpful if symptoms are very distressing but has ‘interesting side effects’.
The only option to get me back in NSR is a cardioversion (not a good option for me because of my spinal fusion). So going to A&E only useful if I am having extreme symptoms.
Angina is caused by lack of capacity in my arteries, not by clogging up, as angiogram showed main arteries to be clear (this one for Goldenheart ).
I could think about another ablation but entirely up to me.
As I am on an anticoagulant to prevent stroke this is a QOL issue not a survival issue. (My concern, not discussed, is worry about stopping Apixaban for surgical procedure, eg complex tooth extraction, which will certainly send me into AF!)
What all this means for me is that I either have to put up with frequency, extremity and duration of PAF or opt for a pacemaker but it is not a matter of urgency.
I’m thinking I’ll go for the pacemaker next year when things (hopefully) have settled. I could still have an ablation but as things are I don’t feel it’s my first option.
Bearing in mind I’m 76 next month, had PAF for at least 20 years, one ablation in Dec 2015 which lasted 2 years, has anyone had any thoughts they’d like to share?
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Buffafly
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Doesn’t it make a big difference when you find someone you have confidence in! As you know more about AF than most of us I’m not sure how we can help....😉
I know some here take amiodarone and manage quite well, but like you, it’s a drug I would prefer to avoid if at all possible. Because drug solutions are limited, I guess ablation/pacemakers provide a route forward but as far as ablation is concern, (with the greatest respect 😉) age might become an issue. With waiting lists as they are currently you could be 77+ and although it might not be a problem, I guess it could increase the risk. I would try not to worry too much about Apixaban and dental work. NICE say that several extractions can be undertaken without stopping a dose, but even missing a single or even a days dose is not deemed to be a major problem but you need to check that out for yourself because I’m not medically trained.
Click on management and then scenario Apixaban and scroll down
As far as other procedures are concerned, if these are carried out in a General Hospital environment they will have the facilities and the knowledge to deal with the kind of problems you are naturally concerned about.
I’m a youthful and relatively fit 74 and at the moment, I would not hesitate in having another ablation should it be necessary, but that could all change in 2/3 years time. Maybe best to wait a while then have another chat with your new best friend 😉.........
Hmm. You would not hesitate to have an ablation at 74, but probably at 76/77.
Well, I was on target at 74, because I had two at that age. Now at 76, I did have my third. There was neither a problem nor a risk, so that should shoot your age theory. Luckily, I am in sinus, but would not hesitate for a fourth regardless of my age (within the boundaries of my health , of course.)
In my opinion, in a socialistic system like UK and Canada, age becomes a factor due to the cost to the system for an elderly patient, money that the system would prefer to spend elsewhere. In B.C. Canada, private clinics are banned so that the elderly can't even spend their own money to get an ablation.
I recall that some years back there was a video at one of the January AF conferences of a man in his nineties having an ablation. 🤸♀️
I think you are misquoting me and the health system here has nothing to do with it. There are many people around who have ablations late in life. For the same reasons you mention ie (within the boundaries of health) all I was suggesting was that if an ablation was deemed to be the best route forward, better to have it done sooner rather than later which seems reasonable advice to me.
I have been down the ‘have an ablation to avoid a pacemaker’ route but it turned out to be temporary fix because now my AF is worse than before and I still have little episodes of presyncope. I won’t die of AF but I remember my mother was never the same again after falling off a chair while hanging a curtain. So to me it makes sense to do it the other way round if necessary this time. I’m pretty healthy for 75 so I don’t think my age is a big factor.
Definitely you should do what is best for you. And, you have analyzed what is best for you. I was not trying to advocate that the ablation route is better than the pacemaker route. Each one has its benefits curtailed to the patient. I was merely trying to emphasize that age should not be a deterrent for an ablation. It appears that Flapjack and I were still on the same page because health does come into the equation. I read his post as health deterioration guaranteed. From my own experience, healthy elderly patients should not deny themselves from having an ablation, if they choose to, simply because they are in the elderly category.
Just had a thought, not sure if I’m right, but I think CDreamer may have had similar issues to consider so I have taken the liberty of making her aware of your post.....hope no one minds........
I opted for pacemaker as I can’t take any heart meds and sedation or GA is very risky now. Best thing I ever did, no AF, that I am aware of, I’ve had 2 very short episodes, 1 about 6 weeks after implant & 2nd when I had a serious chest infection - viral pneumonia.
Regular rate & rhythm, stable BP - not had either for most of my life. My HR started to drop in 2017 which triggered AF which started a downward spiral. My options came down to Amiodarone, not advisable or compatible with other condition or PM which didn’t require sedation or GA. Went in at 1.00pm, home by 8pm. No regrets.
Thanks, though I suspect I’ll get a standard one and you have a three lead superwhizzgizmo if I remember rightly, not sure how much difference that makes. Cardiologist seemed to say the only advantage would be that I could safely stuff myself with meds, which isn’t generally my aim, but it would be good not to feel helpless when my heart is batting it out at 160. We didn’t get around to discussing the little preblackouts I have occasionally but I’m sure they’re connected. Your story is definitely encouraging.
My husband had the 2 lead implanted 2014 for SSS and exactly the reason you describe - so he could take the meds because he was experiencing pre-syncope, immediately he was diagnosed he was banned from driving until the PM was inserted. After implant and once everything settled his meds were changed so he took more meds but at much lower doses and the mix of meds combined with the PM worked and he was AF free and steady pulse until late 2018 when persistent AF kicked in. Because of the PM he could take the drugs and after Amiodarone, which he is now tailing off, no AF and no aortic stenosis. It was a path he was very reluctant to start down but I am so glad he did and he is so much better and 87 in Jan and still pretty fit and active.
PS - just to be clear - taking meds was not an option for me so that’s why I got the fancy pants PM but my EP had to fight hard for me to get the funding because the 3 lead is more than x3 the cost AND not every cardiologist is competent to position the 3rd lead in the correct place. My heart issues impacted badly on my Myasthenia and vice versa so I had a few blue light episodes.
All I can add Buffafly is that I'm glad you found a good un who was able to take you through all the information,and that a pacemaker certainly helped my mum get QOL for many years.
She was much happier and able to do so much more.
If it means you can have the option of taking AF meds instead of an ablation ( with the concerns you have on that ) it seems a reasonable idea to me and I'd probably go for it in your shoes .
It was interesting to read that bisoprolol protects against AF as well as slowing rate. I didn't know that .
Thank you, the cardiologist was quite pleased when I thanked him and said he’d answered all my questions including some I didn’t ask! Nobody had ever explained why I couldn’t take Flecainide. Also good in a way to know I no longer need to dither over whether to go to A&E or not - only go if it’s so bad I need a cardioversion.
I started passing out when reverting to NSR so had a two lead pacemaker fitted and now my HR does not go below 60. It has not made any difference to the frequency and length of my AF attacks which occur every 12-14 days and last for 36-48 hours.
Thank you, I’m not expecting the PM to reduce my episodes but would like the option of upping my meds when my heart goes into overdrive occasionally. However I’ve noticed my AF is now quite often below 90 because I have frequent long gaps between beats so clearly the dose of diltiazem I’m on is slightly too much. Thank you for sharing your experience 💜
Hi Buffafly, only just seen your highlighted point for me. Thankyou for being kind enough to point that out. Knowledge truly is power ,any insight is a huge reasurance,especially when awaiting a confirmed diagnosis,still,which i am. Im glad you have this cardiologist. My new cardio is also proving helpful. Theres a ? around tge reliability of my cat scan, as my heart rate soared sky high,and a low rate is essential for a clear image,.....the radiologist informed me of this. Hence scheduled for a stress test with echo, my cardio says to check for heart disease. Bearing in mind coronary artery spasm,or,and,micro spasms could still be playing a role. Im very happy hes also acknowledged my a fib,via my alive cor readings. Best wishes for the help you need . X
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