Hi
I'm on Flecanide & Bisoperol & I've not had a AF episode in over 9 Months. I'm on the waiting list for an Ablation but I feel my medication is working that well that I don't need the operation.
Has this situation happened to any of you & how long have you been on the meds for?
Hello Finlay, I see this is your first post so welcome to the forum. This is something which crops up frequently and there is no easy solution. It’s a case of weighing up the pros and cons and coming to a conclusion. I ought to declare that I am pro ablation so you may detect a degree of bias.
To get to where you are now, I guess it’s reasonable to assume you have undergone some tests and discussed your situation with an EP or cardiologist and he/she has recommended that an ablation is the best route forward for you. Assuming also, that this is being done on the NHS as opposed to privately, this is unlikely to be a recommendation taken lightly by your specialist, especially at this time with Covid. AF is generally a progressive condition, in other words it tends to progress over time to permanent AF and whilst that is still manageable, it does mean taking fairly potent drugs for life, which in your case could be another 40 years. Personally, that’s not a route I would choose to take. Although I’m not aware of any major developments in AF treatment, I’m sure at some time they will come but it’s anyone’s guess as to how long, if at all, anything changes any time soon.
On the downside, an ablation is not a guaranteed cure for AF and it may need to be repeated before it gets your symptoms under control. The only other thing I would add is that at a guess, 8000+ ablations are performed in the UK per annum. Bearing in mind most forums tend to attract bad news, we rarely hear from anyone saying they wished they hadn’t had their ablation. Just in case you decide to have an ablation, please check out these two factsheets.......
heartrhythmalliance.org/res...
heartrhythmalliance.org/res...
It will be interesting to hear what others say, best wishes.
Hi Flapjack
Thanks for your answer. The last thing my specialist said to me was "these tablets may work that well that you may not want the Ablation" that was last May. I've got another telephone consultation with him on 23rd March. I really don't know what to do mate. All I know is that I'm feeling really Good at minute & don't want to ruin that.
Further to what Flapjack has said why take some really nasty chemicals for life and both flecainide and bisoprolol fall into that category, if you can find a different way to control your symptoms. Sounds like your cardiologist is only such and not an electrophysiologist so prabably has little incentive to urge you in that direction.
Hello Finlay and welcome to the forum.
I was started on Flecainide and Bisoprolol 7 years ago after diagnosis with PAF - Bisoprolol was changed to Nebivolol 3 years ago. In that time, I've had no AF episodes. In the beginning of my AF journey, I couldn't decide whether to seek ablation or not - so I had two long sessions with my EP and the outcome was to wait and see how I fared on the drugs but to keep the option open.
Obviously, we are all different in our symptoms, reaction to drugs and ablation, so it is difficult to compare my experiences with others. I have had short runs of AFlutter from the Flecainide - my dose is 200mg daily - but my life is good, I can do most things I want to and, since changing from Bisoprolol, I have much more energy.
Do lots of talking to your docs, especially your EP about the consequences of delaying - eg a condition which is usually progressive, your age, circumstances and general health.
Best wishes with your decision.
Welcome to the forum.
I'm a Flecanide fan. Two years now and still afib free (just a few hippcups). Some people on here have been on it much longer and are still doing fine.
However 9 months is not very long - your afib could return. My personal view ? Have the abaltion as you can always go back on flec if it doesn't work (there's every chance it will).
I understand your dilemma completely.
Paul
Hi Paulbounce
Thanks for your reply mate. What you say makes loads of sense & that maybe the route I go down.
Are there other things which might influence your decision such as
Losing weight
A healthy diet
Avoiding strenuous exercise
Caffeine
Alcohol
Magnesium supplements
Plenty of good quality sleep
Ruling out obstructive sleep apnoea
Dealing with stress in your life
Arguably the first and last of these are the most important, but all can influence recurrence of AFib. You can always defer your ablation in the light of developments, though you might have to go to the back of the queue unless your EP intervenes.
Your EP has probably discussed all these things with you. None of mine did, but I found lots of good advice here.
Just my opinion, but it could be you don’t need an ablation just yet if there are changes you can make. Bear in mind that we hear lots of stories from people who don’t get away with just one ablation. The procedure itself can cause problems which can be tough, though these are very rare according to the statistics.
The old argument was that if you don’t get too many symptoms, ablation won’t help you. The new argument is that early ablation is the way to go. I think the jury is still out on that one.
You might ask your EP the most important question of all. When does she think you will be starting anticoagulants? Using risk scoring, that wouldn’t be in the near future, but some cardiologists are beginning to question that apparently. I can’t give you a reference on that.
Hi Badger
I've recently lost 2 stone & I've not drunk alcohol for 13 months now but I do Mountain Biking which is really strenuous but I really feel that this had helped me a lot. If I go a couple of days off my bike I start to feel a little fluttery but I definitely agree with everything else you've said. 👍
Sorry Finlay, I’m not too sharp with the technical side and I often carry on editing after posting to avoid losing my post/reply. I added a few extra points above which might be worth a look.
Hi Badger
That really is a good point about when I'll have to start anticoagulants. I've got a telephone appointment with my specialist on 23rd March & will definitely ask that question. 👍
Id add chocolate to the list of things to avoid. It's a definite trigger for me.
That’s unlucky. I really like Lindt 90% chocolate and can indulge, but then I’m permanent AFib. For some it apparently reduces frequency of paroxysmal AFib
bhf.org.uk/informationsuppo...
Oh I wish I was one of those people! I break out now and then and have some of my favourite organic dairy free trouffles called Booja Booja! OMG....they are to die for. I always get away with them. The Hazelnut Trouffles and the Champagne Trouffles sre THE Best. It's all about quality isn't it!! 😛
I went on Flec in 2016 and haven't had an afib event to date. My cardiologist told me the ablation procedures are still improving so the longer I can remain afib free and put off having an alblation the better.
Hi jwsonoma
That's brilliant news, I'm really happy for you & That's exactly the sort of answer I was hoping someone would say. 👍
I am of the understanding that the more cumulative AFib a person has the less likely their ablation will be sucessful and there is also a similar correlation with weight. My cardiologist also told me to loose the belly fat with a BMI of 23. So I lost 20 lbs and he said that combined with no drinking and I may never have another aFib.
I had recurrent episodes of af every 3 weeks for 3 months when meds were changed and havnt had an episode for a yearI'm 67 and in pretty good shape
Had the stress test etcetera and nothing obviously wrong.
Feel pretty Good most of time so not bothering with an ablation for the moment
Cardiologist reckons nothing I'm on will kill me so not necessary.
Digoxin, flecainide and apaxiban.
It's such a flukey thing and varies so much from person to person.
Do a lot of brisk walking,dieting, don't smoke and drink very moderately.
Dear Roger, had a look to see what is Digoxin and found this ? Does the article make sense?Good wishes.
Well ...... there could be a problem. The longer you're on medication, even if it's successful, the more doctors say your heart negatively remodels; therefore, making a future ablation less successful.
Often times the medications lose their efficacy just when you feel your best down the road. Then, you have the added problem of reaching a dead end in treatment where nothing is working for your best interest.
Of course, I'm sure there are patients here who have been on these medications for years ... and still relatively AFIB free.
Have a long talk with a good EP and see what they recommend.
Watching replies with interest as I'm in the same boat!It's a true dilemma,"if it ain't broke why fix it " versus "fix it and do without meds"
I've been on and off waiting list for double ablation , currently back on it after a tricky few months last summer. I have an EP with a good reputation and asked if it could be guaranteed that he would do it. Longer waiting list of course but feel better about the prospect. Might help you too if you decide to go that route.
I'm stable 98%of the time now again as I was before the episodes last year.
As I am now ,with lifestyle changes etc since diagnosis in 2013 I don't feel completely convinced still about ablation but when I'm in extended Afib and Flutter I want to go for ablation ..and NOW!! All the best for your decision.
Talk to EP and have a good think.
Hi wilsond
It really is exactly as you say, should I or shouldn't I. I honestly think that there is no black & white & everyone responds to medication differently. I've got a telephone appointment on 23rd & I'm really gonna have a good talk to my specialist, I just hope it helps me make a decision 👍
Hi Finlay... my situation was the other way around. Cardiologist opted for ablation first as apposes to drugs as I was on a lot for another condition. 6 mths after the procedure I started to get episodes again which were pretty debilitating. This time they suggested meds first as they couldn’t guarantee that the ablation will be successful long time. Given that it was an unpleasant experience for me I chose the meds! Been on Flecainide now for around 5 mths and pleased to say no episodes so far 🤞Good luck in whatever you chose.... your cardiologist may help with your decision later this month!
Hi Finlay.About 4 hours ago i came out of a 30 hour AF episode, similar to 6 others i have had over a 16 month period. (There was a 10 month gap between the 3rd and the 4th.)
I take Bisoporol 2.5mg and Apixaban and like you am awaiting an appointment for an ablation.
During the 10 month gap I thought do I need this ablation given that I seemed to be doing okay and so cancelled a previous ablation appointment (August 2020 ).
My EP at the Queen Elizabeth hospital Birmingham is of the opinion that my AF will progress and long term, although I am 65, I will be better off with an ablation rather than taking meds.
It is a personal choice to some extent but I have chosen to listen to the experts on this occasion.
Good luck whatever you decide.
Hi Sir
Thanks for your response mate. There's a lot to consider & I will definitely listen to my specialist on my next telephone meeting. Good luck with your op mate 👍
Always controversial & only a personal decision this dilemma. Unfortunately I would have to say not one you can leave to the medics as there are many unmeasurable aspects e.g. future improvements in procedures, complications, effectiveness & side effects of drugs, your own general health. In my case both the cardiologist & EP offered an ablation but talk of only 70% chance of success, and another one likely to get it right, put me off. In addition as you will learn here many are still on drugs after an ablation.
So my decision was postpone ablation and take Flecainide (medium dose 200mgs/day) which has worked fine for 7 years and equally important has bought time to make many beneficial Lifestyle changes. The snag is my QOL is so good now I dare not rock the boat by weaning off the drug.......or topically have the Covid jab until more info is available. Oh well life is never perfect!
Hi -- I was on those 2 meds for years and they worked well, but then they didn't. My doc says the body gets used to medication and they eventually lose their effectiveness over time.
Hi Snowgirl
Have you changed meds or had an Ablation with them not working anymore?
Yes, I changed meds to metoprolol succinate, digoxin and dofetilide. They worked for a couple years, when again lost their effectiveness and I had an ablation in 2019. The ablation lasted about a year, but I'm now considering another one and have an appointment at Cleveland Clinic for a second opinion. Note that everyone is different. My first ablation revealed a vein dangerously close to my diaphragm; another one nearly wrapped around my esophagus. If you're doing well, then don't fix it, is my philosophy!
Hi Snowgirl
I wish you all the best for the future & hope 1 day you get proper fixed 👍
Thank you, Finlay007 -- hope you continue to feel good!
Totally agree... why fix it if it hasn’t broken!
I have had AF for 20 years, and it had increased in length and frequency to 24+ hours every week or ten days. I am 87 next week, so did not want to go the ablation route, so EP put me on flecainide 50 2x day and 50 mg digoxin 1x. Haven not had an episode in one year, but am feeling horrible: unstable on my feet, totally exhausted all day. But no AF so I put up with it. Six weeks ago I cut my pills in half, and still no AF. But I feel no different. So maybe it is just old age!
Hi Weldon
I would perhaps go back & see your doc to see if he will change your meds. When I was on Flecanide on its own before the Bisoperol I felf awful to mate. I wish you well for the future mate
You might want to read: a-fib.com/in-your-80s-are-y...
and,
a-fib.com/faqs-a-fib-ablati...
I am trailing behind you in age. I do not subscribe to "putting up with it." The trick is to have a discussion with an EP that specializes in doing ablations in the 80 + category.
Hi Finlay, I'm 53 and have had 3 AF episodes over the past 1.5 years. All were stopped in their tracks within 2 hours using Flecainide Pill in Pocket. Otherwise I'm on Atenolol at very low dose, for ectopics. My EP has recommended ablation but also supported a wait and see approach. With a Kardia or iWatch ECG to confirm when it's AF and a pill in pocket approach, and relatively young age the thinking is that I can stall off for a while to see when chronic meds or ablation become the lesser of two evils. Good luck with your decision. When pressed it seemed my EP thought any more than 1-2 AF episodes per year on or off Flecainide would be reason for an ablation. I might have already pulled the trigger except for the efficacy of the 'take as needed' approach and the uncertainty/potential around increased ectopics which sometimes makes me more symptomatic than the AF.
Hi Benn
You sound so similar to me mate, I'm also 53 next month & I would just like flec to be a pill in the pocket, this is something I'm gonna discuss with my specialist on 23rd. Thanks for the answer & I wish you well mate 👍
There is one guarantee: once you have AF, you have AF with the corollary "AF begets AF."
So, at 53, I would safely say that to contemplate a life on meds is not a desirable route considering the side effects that will do some number on your body. Thus, how does one look at the problem?
You do not state how frequent your episodes were prior to going on meds. You state that the meds have kept AF at bay for nine months. Since meds are working well now, you might want to ask your EP when Pulsed Field Ablation becomes the norm for ablation since it is a more advanced technique that destroys the source of electrical signals rather than create a scar. In other words, the goal would still to be off meds but with this advanced technique to get you there.
Hi cuore
I've never even heard of Pulsed Field but I'll definitely be looking into it now mate. Thanks for the answer 👍
Here is a site of the actual top EPs giving a discussion as to how it works to other EPs. Dr. Jais gives a six minute explanation. He is the one who did my ablations.
Flecanide
Flecanide 
Intravenous flecanide
