All gowned,obs done,cannula in place ready for my TOE and ablation BUT INR still only 1.7 and consultant decided that either procedure was ill advised as I have a prosthetic aortic valve and INR of 1.7 is a dangerous level. We had a good long discussion about ablation for my atrial flutter and ultimately decided as I don't have symptoms and am generally well manager on Digoxin, Bisoprolol, Rampiril Atorvstatin and Warfarin (usually) we would do nothing. I am waiting for the results of the radioactive stress test as it may be the arteries that have caused the couple of episodes of extreme breathlessness but if we exclude corononary artery disease we may look again at ablation .
I believe ablating for atrial flutter sometimes leads to atrial fibriliation and in any event ablation isnt always the answer so am going to wait and see. Hope Ive made the right decision.
Just got to sort out my INR now! Thanks everyone for your support.
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Daisyblu
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I’m obviously sorry to hear that your procedure was aborted but for the best with such a low INR. I’m not medically trained but I’m not sure I agree with your understanding about atrial flutter. As I understand it, an Atrial Flutter ablation is said to be much more likely to be successful than an ablation for Atrial Fibrillation and that a successful flutter ablation does not necessarily increase the risk of developing AF. It will be interesting to hear what others say as they might disagree but it’s clearly something to discuss with your EP……
Thanks Flapjack. It was the cardiac consultant who told me flutter is in the left side of the heart and following ablation fibriliation can start in the right side of the heart, I believe he thinks that while Im not experiencing any symptoms that we could continue to manage my flutter with medication and see how it goes. I think my mechanical valve and my unstable INR is a factor in his decision and maybe because the first ablation didnt work?
Regarding the mention in your previous post of the Roche Coaguchek testing machine for warfarin patients, I bought mine from Roche probably about 15 years ago at a cost of £300. It is over £400 today.
You would need to discuss this with your GP first as you would also require testing strips which are about £90 for a pack of 24. If agreeable your GP should be able to prescribe these for you. The idea is that you would send in your readings at the required interval to the coagulation clinic and they would advise you of your correct warfarin dose for the following period. You do NOT decide on this yourself !
I know the initial outlay is expensive but it really saves such alot of faffing about at surgeries and hospital. You are in control and can test whenever & wherever you like!
Do you have both aflutter and afib? If so, yes, ablating for flutter will most probably not stop the afib and could actually increase the frequency of afib episodes. On the other hand, if you only have flutter, it's kind of a slam dunk, 95% success rate, quick and easy procedure. What about going on a NOAC like eliquis for a while where you don't have to take an INR or am I missing something?
Figured there was a good reason. But if you can figure out the INR, I'd definitely go for an aflutter ablation if you don't have any afib because of the high success rate and minimal procedure.
However, if you have afib and aflutter, then you might want to do both an afib pvi and an aflutter ablation at the same time. This is a more major procedure.
Thanks Jim. I only have atrial flutter. My previous ablationin 2020 was unsuccessful. I do not experience any symptoms with my flutter although every ECG shows it. I do have faith in the Heart Institute in Bristol and am waiting for the results of other heart tests . I think my prosthetic heart valve complicates things.
Bad luck. I had my AF; ablation in 2019 and, yes, within a short time of stopping bisoprolol, I suffered a terrifically bad bout of AF. That did go away for over a year, but I still get occasional bouts of it, along with other troubles - although no flutter at all and not much symptom-wise. Apart from those SOB episodes, as you are generally symptom free, I would think, as you and the doctor said, that you will be fine. Let's hope the scan shows what caused that but also shows nothing much of importance. I find the anxiety of waiting for the test results the worst part of all.
Thanks Steve.I consider myself very fortunate to be under the care of the Bristol Heart Institute and have had most tests available. I know having a prosthetic heart valve complicates things as does Warfarin both things I have lived with for 24 years now!
Both my brother-in-law and close friend have prosthetic valves, and both need them checking or replacing, it seems. My brother-in-law can't have his done though as his aortic arch is over-large (I think I've got that right) and the surgeon thinks it too risky. He continues well, though, at 76. Life can be a trial, that's for sure.
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