Had a Cryoablation 9 weeks ago . After a conversation with the cardiologist/ EP we’ve decided to stop my Apixaban and also Carvedilol.
I will gradually reduce the carvedilol over a few weeks before stopping completely . I will be monitoring my heart rhythm and BP etc.
Anyone done similar and what’s been your experience. I understand CHADS-VASC2 score etc.
We are all different obviously but it was nine months before I weaned myself off my rhythm control drugs and fortunately for me never did the anticoagulants as I understood that ablation did not remove stroke risk. When a different arrhythmia found me I was well anticoagulated so DCCV was avaiable at once rather than waiting.
Why 9 months?
That is how long it took before my heart settled down after my third ablation.
Can you go into a bit more detail Bob? When you say it took that long to settle down what do you mean exactly? Mines taking its bloody time as well so interested in what you consider settling down to be in detail if you don’t mind 👍
My arrythmia nurse is talking about taking me off my meds after our chat on the 30th which will be 15 weeks post ablation at that point. I’m not sure if that’s the right decision or not. I really can’t make my mind up and don’t want to be pushed into a decision.
I’m not sure if I should just come off to see if ablation has worked or stay on for as long as possible to hopefully keep in NSR for as long as possible in hope that that will also give heart time to heal itself properly.
What’s your thoughts?
I was still getting high numbers of ectopic events. One particular which lasted for several weeks had a rhythm all of its own. I would miss every 2nd 3rd 4th 5th etc up to eleven and then start back at 2nd. Every time I tried to stop propafanone these ecctopic events started up. Eventually I dropped from 3x 150 mg per day to 2x 150 to 1x 150 to 1x 150 every two days etc until finally drug free (apart from anticoag (warfarin) which they will drag from my cold dead hand). I was then AF and drug free for nine years before developing a different arrhythmia but that is a different story. Still AF free though!
Thanks for explanation Bob. So in terms of af events your heart was settled after 3rd ablation straight away? You just had the bad ectopic events on their own?
Outside of the ectopics, did your heart physically feel any different? Any aching etc?
Thanks again 👍
Oh no Elli it took a long time to settle down and like all my ablations needed a DCCV around three months due to tachycardia along with all (or most ) of the things I wrote about in the fact sheet. It takes TIME. You are not fixed in a moment the way it was sold to me by doctors. That is why I joined the charity to spread the word to others less fortunate than I. Like I say though NO AF since 2008 so well worth it.
So the tachy wouldn’t correct with meds then? Therefore cardiovert was needed?
I just can’t make my mind up if coming off meds is a good idea or not 🤔😫 feels like a catch 22
Since that is one very good reason to have ablation you need to at least try if your EP has suggested it. Not anticoagulation of course.
Oh in the long term I definitely want to come off meds. That’s the main reason I had ablation. I’m just not sure if coming off them too soon may do more harm than good. Especially after my af episode 2 weeks ago. I’m already off the anti coags as I was getting some bleeding into my eye and nasal passage. My Chad vasc score is zero though.
Not able to comment on your medication kalgs but it’s really good to hear that things are beginning to settle for you much like was suggested after the ablation. Like many folk here, regardless of my CHADs score, I would be very nervous about stopping my anticoagulant and weaning off the Carvedilol could always be reversed if you are not happy. All in all, great news eh!
I was keen to come off the anti cogs . Life style etc. They don’t give the protection for alleventualities as some people think. With AFIB it’s more certain about their benefit .
I had my cryo in mid August and have only had 1 vagal hearburn induced AF episode which lasted 6 hours (normally before ablation vagus induced heartburn episode use to last 12/14 hrs) , however my cardiologist said because of the 1 episode of AF I will be reviewed in 12-18 months and discuss reducing meds??
Good to hear. I’m about 9 weeks post ablation also. Fingers crossed for you all goes well. I’ve halved my apixaban dose to 2.5mg twice a day. Not sure why tbh.
On doctors advice?
No. In 8 yrs of having af my ep never said for me to take Apixaban. So why take it after a successful ablation?
I’ve just read your history and I see 2 months ago your CHADs score was then zero and all the arguments for and against taking it after an ablation were comprehensively discussed. Looks like it’s your way of making a compromise…….
Yeah I think your right. I’m waiting on my ep follow up appointment so I can can discuss this. Hope it’s before Xmas.
I was on 2.5 apaxiban because of my bleeding disorder (on advice of EP), but then told 2.5 was giving me all the disadvantages (is increased bleeds) but none of the advantages (ie reduced risk of clot) so put back on 5. However the whole before and after first ablation was done on 2.5!!!I read somewhere that reduced dose of anticoagulants works nearly as well as full dose though.
So different EPs different advice.
Best wishes
It will be different for different individuals. The one size fits all dosing is bound to be too much for some people. I have read the clinical trials for the DOACs. The lower dose of Pradaxa was not much different in it's stroke preventing than the full dose. I can't remember whether they tried the 2.5 mg dose of Apixaban . I think the people who have side effects from anticoagulants should be able to choose whether they take a lower dose if that helps reduce side effects in the knowledge that they are running a slightly increased risk . It should be their choice not the EP's.
I had an ablation in September which 🤞🤞 has been successful. Other than a reaction to Letrozole I have had no AF or palps/ectopics until I started to reduce 75mg Flecainide to 50mg twice a day then they were very mild but just went back to 75mg and now nothing. I’ll wait until my heart is ready. My EP has said I’ll be on Apixaban for another year in case I needed a Cardioversion and he could then do it straight away. Don’t rush this its better to be AF free than to rid yourself too quickly of the medication. Good luck.
Good sense .
I think everyone is different. After my first ablation I came straight off my meds after me ep follow up. I was told that weaning would be more for mental reassurance than anything else. But then I wasn’t on a huge dosage of flecanide. After another couple of Af episodes a year or two later I didn’t didn’t even go back on any rhythm drugs before my second ablation. So nothing to come off other than thinners second time round.
I had my ablation in may. I stopped flecanide one month later and 3 months later the beta blocker….cold turkey both times with minor side effects but no problems. Was advised to stay in apixiban for life just in case the AF came back. We are all different
One doctor said taking anti cogs if you don’t need to is akin to having your appendix removed in case you get appendicitis. Crude I guess . It certainly depends on circumstances.
What is interesting is the background to CHADS-VASc. Quite a limited trial before it was adopted.
One issue is how AFIB may remodel the heart and the theory there is greater risk of clots. One school of thought is those with an higher CHADS-VASc score are at greater risk of bleeding from anti cogs.
Life is a risk
CHADS-VASc put far more people on anticoags than the previous scoring systems. It also came out just before the DOACc came on stream . Convenient ? Coincidence?
Yes makes you wonder
I had my ablation in October and they stopped bisoprolol immediately but kept me on Rivaroxaban. I’ve spoken to my arrhythmia nurse this week and she has put me back on the bisoprolol due to the amount of etopics I’m currently getting
Had my ablation for paroxysmal AF back in 2018 and still Afib free afaik (I monitor my heart). I came off Rivaroxaban 3 months post ablation. Low CHADs score and both EP and cardiologist happy with decision to stop. IMHO there are no risk free options.
Kalgs, I had a catheter ablation on October 26th. As of 24th Nov I will be stopping taking my beta blockers, Bisoprolol & Flecanaide.
I'm going to start monitoring my heart rate and BP from tomorrow until a week after. Just for comparison.
Be interesting to see results of both.
Rob
See, that's interesting. I've been told to just stop them, no staging!!
Are you talking about beta blockers?
Very frustrated with cardiologist
Coming off Amiodarone and INR
Coming off meds
Coming off Sotalol
Coming Off Flecainide.
