Flecainide or ablation for atrial fibrillation?

[TnJns]

My partner has recently been diagnosed with atrial fibrillation. He has been offered either medication or ablation and he has opted for ablation as he does not want to be on medication for the rest of his life (he is early 40s). The consultant said it is a complicated procedure with risks and 1 in 200 will have a stroke due to the procedure. I am very worried and think medication would be best. Any thoughts or experiences anyone is willing to share?

[BobD Volunteer]

Remember that these sad days doctors have tell you all the bad thing that might possibly happen so that you can't sue them! I've had three AF ablations with zero issues. Nothing is risk free and AF is always a progressive condition so best get on top of it now before it becomes drug resistant would be my view. At 40 something that is a lot of time left to take some really nasty drugs for.

[TnJns in reply to BobD]

Thank you for your reply and your view on this. Great to have some reassurance. When you say nasty drugs? How do you mean?

[BobD Volunteer in reply to TnJns]

Most drugs used to treat AF have some potentially nasty side effects.

For example flecainide needs to be paired with a beta blocker to prevent potentially causing flutter. Most beta blockers slow a person down, reduce exercise tolerance , can cause weight gain and sleep problems etc and calcium channel blockers can promote fluid retention causing swollen ankles and feet.

Why would you want that for the next forty or fifty years?

To my mind the only expection would be anticoagulants for stroke prevention where appropriate.

[oscarfox49]

Of course there is no guarantee of success with ablation either, either immediately or permanently and the University of Michigan Health Centre says in a report that for those in permanent AF for any time, the success rate is only 50% with the danger of atrial flutter occurring subsequently. If the procedure is repeated two or three times, the success rate goes up to maybe 80%. The real question cardiologists should be asking is 'Is ablation a 'cure'?' It may stop the AF but AF may be a symptom of atrial myopathy, and various surveys have shown a similar number of people dying from subsequent strokes amongst those 'cured' and those continuing to control AF with medication. This is what I have read, although I am just an educated layman not a doctor.

[secondtry]

Probably need more detail to reply to you. However, assuming he has an open mind on the subject and he has Lone PAF my vote would be to go on the ablation waiting list but try the medication for 6 months (assuming not a maximum dose is required); when he is called he can always decline or ask for a postponement.

I think it is unduly pessimistic to think he might have to remain on meds for 40/50 years as advances in knowledge/treatment of AF in that time should be substantial.

Lastly, aside from some genetic involvement, I believe the majority of AF is caused by the body's early warning of accumulating poor lifestyle choices. So whether he goes for ablation or not, possibly the biggest decision(s) is to make changes, which of course take time to implement and take effect.

[Hidden]

Initially he could try the medication to see how effective it is in addressing the problem. I was told by a cardiologist that the stroke risk of the procedure varies according to factors like age, weight, whether the heart is diseased etc.

[SuzieA]

Hello, I took Flecanide for a while but was offered an ablation which I had. I was so glad that I had it, I didn’t like taking medication, I always felt tired whilst on tablets. My quality of life improved after the ablation but it’s your decision as to which way you go. Good Luck

[seasicksurf]

I resisted ablation for years because of the perceived risk and the hope things would get better, yet the flecainide was a terrible way to go. Hands down the worst drug for me (albeit PIP). Get the ablation.

[jondeanp]

I was diagnosed initially with AF and then Flutter. I was on medication while waiting for an ablation. Not only was I tied to the meds, I was also restricted to the things I could do ie tolerate exercise. I was offered a procedure to deal with AF and flutter at the same time. It was a tough decision for me. I spoke to the EP and the AF nurse a couple of times while on the waiting list to discuss my concerns.

In the end I elected to treat the flutter and have been In NSR (bar a few minor blips) for 4 years so far 🤞

[Davo59]

I had a ablation 7 years ago was off work for 4 weeks when back at work occupational health wouldn't let me work nights for 3 months first couple of months were a bit rough then all settled down still had occasional ectopics for a few years but last 3 years nothing at all so my advice take the ablation up to now has worked for me

[mjames1]

How often does he have episodes and how long do they last?

If the episodes aren't that frequent, then using Flecainde as a pill-in-pocket (PIP) could greatly enhance his quality of life while waiting to decide on current ablation technology or perhaps newer technologies down the road.

When Flecainde is used as a PIP he would not have to be on daily beta blockers or calcium channel blockers. He would just take one or the other prior to taking the PIP per the protocol of his doctor.

As long as he has a structurally sound heart, Flecainide as PIP should be quite safe and might be worth a try. He can always change his mind later, not an option after you have an ablation.

In order to make sure he has a structurally sound heart, many doctors will do some sort of stress test or echo.

If on the other hand, his episodes are very frequent, then taking Flecainde daily may be required. That's what I am doing at age 75. And yes, that will require a daily nodal blocker such as a beta blocker or a calcium channel blocker such as diltiazem.

I do agree with one poster that he may not want to do that for the rest of his life, but it will again buy him time to decide about an ablation and/or wait for potential newer technologies. And everyone reacts differently to the drugs. Some people have a lot of side effects on these drugs and some don't mind them at all.

Jumping from a diagnosis of afib to an ablation is one way to go. Another is to try a medical approach first, such as Flecainide either daily or PIP, depending on what is required. Another medical approach is to simply treat the rate (no Flecainde) when he goes into afib, assuming his episodes aren't that frequent and don't last that long. That is what I did for the past 30 years until my episodes became longer and more frequent.

It's not a clear cut decision. Pro's and con's both ways as it often is in medicine.

Jim