Meds vs ablation

[Glb1948]

I am on flecainide now for about two weeks and beta blockers. Most of the time I do pretty good with controlling a-fib but the combo of beta blockers and flecainide seems to be knocking my heart rate down lower than usual. Before taking the flecainide my heart rate was around 58-60, now it’s in the mid 50’s and sometimes lower. My Ep is recommending ablation but i’m afraid it will just lead to more problems. Does anyone else have low heart rate with this med?

[jeanjeannie50]

What beta blocker and dose are you taking? Do you feel well at that rate, it's not abnormally low, some people go below 40bpm.

[Glb1948 in reply to jeanjeannie50]

I take nadalol... for 30 years. 40 mg I the morning and 40 at night. When it drops to 50 or 51 I feel a lightheaded and and dizzy.

[Hidden]

I’m not medically trained Glb but as far as I know, Flecainide, being a rhythm control drug, is less likely to reduce your pulse rate whereas the beta blocker will. Although your pulse rate is almost in range, you should only take daily doses of Flecainide if you take a beta blocker as well, but maybe there is an opportunity to reduce the beta blocker after consulting your Doctor.

Regarding Meds v ablation, that is a question which features regularly on this forum and is very difficult to answer for a variety of different reasons. Below is a link to an earlier post which you may find helpful. Please bear in mind, the majority of responses are from folk in the UK. Due to our health system, being offered an ablation is not easy on the NHS system, the general rule is that the EP must be confident of a good result. I believe the situation is different in the USA which may make it even more important to do your homework.

healthunlocked.com/afassoci...

Hope this helps your thought process.......

[Glb1948 in reply to Hidden]

Thank you! I will do some more research . Thanks for the link.

[Lovetheoutdoors in reply to Hidden]

Morning FlapJack. I was diagnosed with AF last January. Taking a calcium channel blocker as heart paused too long on beta blockers. Also anticoagulant. Only had 2 episodes since. I keep seeing references to EP on here. Does everyone get to see one in UK. Or is it done on request. Got my check up August. I'm 72 and doing v well. But I was told by the consultant that he didn't like prescribing the ccb to older people as it can make the heart stiffen. I'd like to come off it !!

[SuziElley in reply to Lovetheoutdoors]

Hi Lovetheoutdoors! I’m 71 and on cub Diltiazem. Also on Apixaban and Flecainide. Between them all, my heart rate has slowed and most of the time more regular. I’m waiting to see cardiologist having seen an EP a few weeks ago. I only saw the EP because they thought I should have an ablation. However, my ectopics are from so many different points he decided it would be too risky so monitoring me on meds instead. He has also said that after five years they’d probably have to stop the flecainide and put me onto amioderone. But that’s because it can hit the kidneys after long term. Diltiazem should be OK for long term use.

[Hidden in reply to Lovetheoutdoors]

Interesting.....I’m on a calcium channel blocker and have been since 2015 and I’m 74 so it will be interesting to see if others have heard about the possibility of it stiffening the heart. It isn’t anything I’m aware of but others here are much better informed. I expect you know, but an EP (Electrophysiologist) is a cardiologist who specialises in Arrhythmias and if you are aware of one that you would like to see, your GP can refer you. However, most GP’s who offer a referral, generally refer you to a cardiologist at your local hospital and sometimes, the Cardiologist might subsequently refer you to see an EP. It’s all a bit of a lottery but if you politely but firmly pursue your request, GP’s will normally co-operate but it can be a challenge for some.

To see an EP first generally means a long wait if for no other reason, there are far fewer EP’s than cardiologists so many patients opt for a private consultation. This should cost £200/£300 but it is important to make it clear that any ongoing treatment needs to be done by the NHS unless you have medical insurance or are very wealthy. Also, you need to be careful of tests. They are likely to want to do an Echocardiogram which is expensive and even a 12 lead ECG can add a fair bit to the bill.

Generally medics prescribe beta blockers rather than calcium channel blockers so it would be interesting to know why your consultant opted for a ccb. Bisoprolol is the usual beta blocker of choice which can be very effective but for many, it does have side effects. A popular alternative from what we see on the forum is Nebivolol but there may be reasons why they prefer you to take a ccb. Hope this helps.......

[Lovetheoutdoors in reply to Hidden]

when I was admitted to hospital with my first known episode of AF following myocarditis a couple of months before, they gave me beta blocker but said that during the night my heart paused for too long! Then I went onto ccb. who I have my appt in August I will query what I was first told about ccb. however I haven't found anything online to support this. Im also on a diuretic which I was already taking before I had AF. Just like to come off some pills unless they are all necessary which might well be the case. thanks for your reply.

[Karendeena in reply to Lovetheoutdoors]

Hi Livetheoutdoors ref EP , if you are not lucky enough to be referred to one you may have to go privately like I did. If it is decided you need a ablation most EPs will add you to their NHS list. At the moment I see my EP every 4 months and it costs me £170, worth it for me as I would rather be in the safest of hands

[Glb1948 in reply to Karendeena]

I live in the USA so it’s pretty easy to get an ablation at any time. My EP had three time slots available the 1st week of June so i’m not sure I should be in such a hurry. I was just diagnosed in April when I had my first episode. Started on flecainide in may and seems to be doing well except I can’t push myself to hard or I’ll start feeling weak.

[Chrissy7 in reply to Glb1948]

You are so lucky! I live in Canada- where we have “Free Health are only” - have to wait 1-2 years to get to see an EP ..and longer for alblation. It’s been almost a year since my last AF episode (possibly my first) and I do not feel well on Meds .. cardiologist says he doesn’t know what’s wrong with me...

Comforting....

waiting to hear from EP‘s office… Not a great quality of life in the meantime.

[Glb1948 in reply to Chrissy7]

I hope we are able to keep our health care system . The liberal” progressive “ party in our country are trying their best to push socialized healthcare on us.

[jeanjeannie50]

Flapjack has beaten me to it and with a good response! Once we know what medication you're on we can give a more apt answer.

Hope you soon feel better.

[secondtry]

I have a similar HR. My cardiologist gave me 200mgs Flecainide (a medium dose) without a BB as he said the latter would make me feel unwell - I took this to mean it would reduce my HR too much so I couldn't function properly. Although a rhythm drug Flec did reduce my HR by around 5 points. The outcome has been fine for 7+ years.

The priority is to stop your AF completely but I agree I would only consider an ablation if QOL demanded it after full consideration of med options and giving Lifestyle changes some time to be come effective.

Important notes: I am currently an active 67yo, diagnosed with Lone PAF and no comorbidities. The above meds are not appropriate to everyone presenting differently and you need to discuss with your cardiologist BEFORE making any changes.

[The_Lord_is_with_Us]

If AFIB gets worse .... I would certainly consider an ablation. My EP does patients into their 90's.

If you get a top EP (don't just go with local EP for convenience) ... you could possibly get a cure or at least 10+ years out of an ablation. Nowadays, they're a couple hour, overnight, in and out thing. I just had one, so I know.

Also read THE AFIB CURE book by EP John Day. It will help you chart a path forward (and it comes in audio).

[Hidden]

I take a beta blocker (Sotalol) and my heart rate is typically in the mid-fifties when at rest. I can even go into the forties at night. I’ve asked various doctors about this and they told me that whilst this rate is technically a bradycardia, it’s not a problem unless I feel dizzy, unsteady etc. at this rate - which I don’t. They are reluctant to reduce the dose as this would make it more likely that I would ave more frequent episodes of PAF.

I don’t see why an ablation would necessarily be a problem regarding heart rate; you might be able to come off the beta blockers which would probably increase your heart rate I would think.

[Snookersteve]

Hi, I'm on 2 x 1.25 mg of Bisoprolol (ie just another beta blocker) and 2 x 50mg of Flecainide and my heart rate is around 55 bpm. I started off on a higher dose of Bisoprolol and my heart rate was going below 50 so I arranged with my doctor to decrease the dosage. I notice that you are taking 2 doses of Nadolol ie 2 x 40mg although the dosage instructions for arrhythmias is 1 x 40mg daily. I would ask your doctor if you can reduce the dosage to 1 x 40mg daily (or 2 x 20mg daily). Provided your Blood Pressure remains at a suitable level then the reduced dose will allow your Heart Rate to increase a little and you may feel that you have more energy.

[TracyAdmin Partner]

Hello there, you may benefit from visiting the AF Association website, you will find our online resources helpful re the medication, for instance a factsheet on Flecainide or the AF - Drug Info booklet. Kind regards Tracy heartrhythmalliance.org/afa...

[Superms]

Definitely. I am experiencing that now. I take 100 Flec morning and night and was taking 75 Toprol morning and night. My heart rate was in the 40s. My cardiologist lowered the Toprol to 50 morning and night and heart rate was 51 yesterday. We will see.

[Glb1948 in reply to Superms]

Thank you! If my heart rate was any lower I wouldn’t be able to function.

[KipperJohn]

Personally I don’t subscribe to an argument which pits one form of treatment for AF against another., particularly with such a wide range of symptoms and responses to particular treatments. It’s far to broad a subject to narrow down to that extent. My own treatment for PAF has included 2 ablations, several cardioversions early on and a beta blocker combined with an anticoagulant. My ablation eventually improved and extended my quality of life, but my PAF is definitely on the way back now. That’s the nature of the disease and recognising that and how to deal with it with good advice is key to coping with it and all it’s vagaries.

[wilsond]

Mine hovers around 55 . Maybe ask if you can take a slightly lower dose?Works well for me .

I take 1.25 biso and 250 Flec,reducing back to 200 soon.

Best wishes

[Glb1948 in reply to wilsond]

Thank you.