2 weeks post ablation

[Hammerboy]

I was sitting in the garden yesterday relaxing and chatting to my wife. I happened to mention I felt really good and so far no AF and as I said it I felt it start . How about that for talking it up 🤔

As advised I took a Kardia reading and phoned the arrhythmia nurse who told me to email the reading over to her. The episode lasted about an hour and a half and self resolved , nothing since

The nurse went on to say if further episodes occurred they would probably prescribe Flecanide for the remainder of th e blanking period and then review .

I'm aware that AF can occur during this period and I'm not overly concerned but after 2 weeks of feeling so well it was a bit of a downer .

I've done nothing to go against all the good advice about taking it easy and will continue to do so but I'm in the hands of my heart now so can't do anything more but wait it out.

Just a quick question on rate control drugs. I've never been prescribed them and have read mixed messages about tolerance and safety etc .

I have mild stenosis of the atrial valve and have an echo annually to monitor any changes . So far its fine with no progression and my LA is normal size . The arrythmia nurse said its not a problem but I remember years ago when I first got AF my cardiologist said using rate control drugs would require tests to ascertain if I was able to take them .Is that still the case or should I be comfortable with the advice of the nurse if I do have further episodes.

[CDreamer]

Hi - good to read your report. Sounds as though you are doing really well and taking all the advice and support available. It is really early days so I know it’s easy to get down when you get a bout, but many people do and all turns out well in the end so patience and be prepared for a few bumps along the road but keep the faith.

Regarding rate/rhythm control - a very hotly debated subject amongst cardiologists with a somewhat 50/50 split. My EP told me some years ago that heart rate wasn’t important per se but could do some damage if left to too high for too long but took the view that converting back to NSR was more important. I know that seems to go against many but I went with his advice simply because I hated the rate control drugs and couldn’t tolerate them at all. (My views on beta blockers are somewhat stronger than expressed here but I don’t want to get censored 🙃).

[Hammerboy in reply to CDreamer]

My cardiologist prescribed Bisoprolol 1.25 mg as soon as he diagnosed my AF.I have a lowish HR mid 50's at rest and bouts of short bradycardia during sleep .

I stopped them after a week because of feeling so tired and my HR went down to the 40's

As my AF is paroxysmal I then tried the drug as a PIP but it made no difference so I just stopped using them

I know the nurse only mentioned Flecanide for this blanking period but I'll still look for advice and more information before I accept they are safe and appropriate for me .

Thanks for the reply 👍

[rosyG]

I hope all goes well for you- very early days as you know. Flecanide is not used if there is structural heart disease so I would get a proper assessment of your heart and whether mild mitral stenosis rules using flecanide out . If they decide it's Ok for you I would take the first lot in A and E just to see if it suits you! I was actually told I could go and be monitored there if I wished.The guidance used to be that it should always be started in hospital but this doesn't seem to be followed in practice! I took my first and only very small dose in ITU when going into AF after total knee replacements (both knees at once) I actually saw stars on the ceiling for a while but of course there would have been other drugs from the op circulating too!!

[Hammerboy in reply to rosyG]

Good advice thank you 😊

[Moonriver in reply to Hammerboy]

As Rosy says, be careful with flecanide. I used to take it as pill in pocket and it was effective but was later told by a cardiologist that you need to check out heart structure before using it. I did try it again when I went into fast AF last winter in A and E and it put me into atrial flutter not sinus, so it was stopped. I had ablation four months ago and had a few blips but seems to have settled. Well, I hope it has. Good luck with yours.

[Hammerboy in reply to Moonriver]

Many thanks

[Moonriver in reply to Hammerboy]

My first ablation lasted seven years! So there’s hope for all of us.

[Hammerboy in reply to Moonriver]

I'd take that, did you avoid all triggers in that time ?

[Moonriver in reply to Hammerboy]

tried to avoid triggers. Food poisoning, dehydration and upset over friend’s stroke did set of AF but it settled quickly until respiratory infection last year.

[Samazeuilh2]

I don't think this is as bad as it sounds. An article at stopafib.org states: "Atrial fibrillation recurrences during the first 3 months after ablation are rather common. It is generally believed that the mechanisms of afib in this setting are different from that of the patient’s clinical arrhythmia. Acute inflammatory changes owing to energy delivery; modification of the autonomic nervous system with consecutive changes in the atrial substrate; or delayed effect of radiofrequency ablation due to lesion consolidation have been considered. It is also suggested that afib might resolve completely upon resolution of the transient factors promoting early afib recurrences. Accordingly, suppressive antiarrhythmic agents are frequently prescribed for patients with atrial fibrillation recurrences during the first 1–3 months following ablation." In other words, post procedure AF is due to inflammation etc. which should resolve itself. So I would say there is still everything to play for.

[Hammerboy in reply to Samazeuilh2]

Great info thanks👍

[stoneyrosed]

Since my second ablation on jun 7 this year I have had 3 episodes of AF. My cardio nurse told me to take flecanaide if AF becomes “ troublesome” but if I can get through it then do so. From his tone I take it he would prefer I try to get through it without. I have followed his advice and now my follow up appointment is only a couple of weeks away so can get more info from the EP. Hopefully you won’t get any more episodes but if you do perhaps try ride them out until your follow up appointment.

[Hammerboy in reply to stoneyrosed]

Good advice thanks 👍

[seasicksurf]

Flecainide works very well for most people. It’s a well-documented, reliable drug. In my experience, it worked well for my PAF but was horrible in terms of side effects. Like a 10-pint hangover. I had an ablation 16 months ago. I had 3 brief AF episodes in the first two weeks followed later on by variable rhythm (fast HR then slow then fast—all in a minute or two). It all subsided and eventually ended about 8 weeks post ablation as my heart healed and my electrical system remodeled itself.

Give yourself the time to heal. Be well!

[Hammerboy in reply to seasicksurf]

Interesting side effect , I haven't had a hangover in 5 years 😅 .Thanks for replying👍

[Singwell]

Hi, sensible attitude though I understand your disappointment too! I was kind of 'Lucky' in getting my AF outbreaks earlier post ablation, though I did have one towards the end of the blanking period. None since... Flecainide is a rhythm control medication and as far as I know, if you've structural problems with your heart it's not normally recommended. But your arrhythmia nurse would have to take advice from the EP on that anyway. Don't know if that answers your question...

[Hammerboy in reply to Singwell]

It's definitely a decision I'd only make after a proper discussion with my EP .I had never been offered anything other than Bisoprolol in the 2 years prior to my first ablation in 2019 . I'm told its more usual to offer rate control drugs before considering surgical intervention so I seem to have skipped a step and in the 18 months or so between ablations Flecanide was not considered so I guess I'm a bit confused its now being considered in the blanking period this time .As I've previously mentioned I have atrial stenosis so would need to be completely sure it's safe in my situation and comfortable with side effects as mist pills have an effect on my digestion and I seem to have a very sensitive vagus nerve .

[Sozo]

They are black box label drugs and can be very dangerous unfortunately! They made me so very sick!

[Hammerboy in reply to Sozo]

Can you state what evidence you have for making this statement .

[Sozo in reply to Hammerboy]

Hi Hammerboy, This was approx eight months ago, when I went on a deep dive research on these meds. You will have to do your own research. I commented to the NP after I said "no more" on why I was not informed that they are black box warning meds. She basically said that all these arrhythmia meds are bb labeled and I guess anymore they do not have to inform the patient of the dangers.

[Hammerboy]

I’m not saying your views aren’t accurate based on your research but I wouldn’t like to think others would be put off taking medications that could benefit their health after reading comments that don’t have any back up facts to substantiate them.

[Sozo in reply to Hammerboy]

Absolutely! For some people they work a miracle!!