In AF and looking for advice

[Rossdkemp]

looking for guidance. I had my second ablation back in January and have been off any medication since then. Unfortunately tonight whilst exercising I went into AF. I’ve taken 150mg of flecanide around 2 hours ago and whilst rate has come down rhythm is still out. Previously I’ve been told by nhs24 to go to the hospital and usually get the option of cardioversion under sedation or the option to get hooked up to a drip of rhythm control drugs. I’ve always gone for cardioversion why works first time although I get the feeling they don’t like doing it. I suspect it takes resources away from more important patients with the number of people it involves. My question is how long should I leave the flexanide to try and do it’s thing before I phone nhs24 and if I have to go up and get the option how successful is the drip full of rhythm drugs compared to cardio version. I’d rather not be a burden and appreciate AF isn’t life threatening but also I wouldn’t like to feel like crap not get something down and then have to take thinners for a month before they try something else. Any guidance appreciated.

[Hidden]

Hi Ross, as I’m sure you know most of us here are not medically trained therefore we are unable to advise or recommend medication. You need to confirm this with your Doctor but most medics suggest that you should take the maximum allowable daily dose of 300 mg Flecainide but this must NOT be exceeded within any 24 hour period. The reason for this is that it is more likely to give the heart the “jolt” it needs to get back into rhythm and start with a lower dose and then add more later often dilutes the effectiveness. As I say, this MUST be discussed with your Doctor because there may be good medical reasons for limiting you to 150 mg. Before my ablation(s) using a PIP could sometimes take 12 hours or so to work but now I normally revert within an hour.

Talk to your Doctor before making any changes to your prescribed medication....

[bmand]

It depends on your heart Rate if 130 or higher you should probably go to the hospital and let them start a drip.

[Ducky2003]

The one time they tried a drip with me, it did naff all and I ended up self reverting the following day before they were able to cardiovert me. Since then, they have just done elective cardioversions as and when required. Can't advise about Flec as it didn't agree with me.

[Rossdkemp]

Thanks all. I took the 300mg flec and reverted in the waiting room of the hospital.

[Barb1]

Is there a reason that you have come off anti coagulants? My understanding is you should stay on them in case of AF reoccurrence .

[Rossdkemp in reply to Barb1]

Hi Barb, I think that depends on a number of things and potentially a scoring method. But ultimately I’m just going on cardiologists direction. I’ve came off medicine after both my ablations and was only on anticoagulants whilst waiting on my first cardio version 6-7 years ago and 4 weeks ahead of both ablations. I don’t currently have regular bouts of AF The two in the last 2 years have been brought on by exercise (probably time to call it a day with the football). Plus AF aside I’m 35 and pretty healthy. Imagine I’m low risk (fingers crossed).

[LaceyLady]

I’m on Flecainaide, was 50mg x2 consultant has said go to 100mg. I’m keen to keep it as low as possible because then I can increase when in PAF. Also on Bisoprolol 1.25mg, this drug causes me side effects that are becoming intolerable, it is a beta blocker that slows the HR. Due to having an episode last Friday, I now ‘have’ to take the 100mg x2 and he says to keep on 1.25mg of Bisoprolol but when I get high HR in PAF to take a Bisoprolol. I am not happy with Bisoprolol and wish he’d change it.

[The_Lord_is_with_Us]

At your young age ... I'm going to tell you what I would do.

If you're second ablation fails .... and you keep having more frequent episodes of AFIB, then I would save up funds for outlier treatment.

I don't know how you're situated money-wise. But I would source out the world's top EP's who handle complex cases .... and get there. Even if you have to fly to another country.

Now, this advice is not for everyone. If you're one of the many 30-somethings out there who make a good income ... then you know what to do. If you're not, do some research and work within the systems available to you to get the best EP possible who does the rough cases. You will probably do fine ......

I know of many complex cases that resolved nicely after 3 or 4 ablations. It just takes the right EP.