Meds post ablation.

[Jafib53]

Hello. I am 52 and in discussions to have an ablation, probably, in a few months. My Afib was spurred by an overactive thyroid and as far as I can tell I am in pretty much constant Afib. I don't have any major symptoms but if I check my heart rate / rhythm they are always irregular. When I have had EKGs they show Afib. Anyway, had a meeting with doctor earlier this week and he recommended an ablation and set up a meeting with a specialist in a couple of weeks. One thing I asked the doctor was if I would need to continue with meds (currently on bisoprolol and anti-coagulant) after an ablation if it is successful. He said I would be able to come off meds. Is this normal, or do most people continue on anti-coagulants at least?

[mjames1]

AC's are a hot topic on forums like this with some strong opinions, but of course I favor my own opinion Undisputed is that some continue with AC's (thinners) and some don't.

My opinion is that it's not a black and white issue, but depends on both your CHADS2VASC score (risk factor score) and also how you as an individual weigh the risks versus the rewards of being on thinners. A sedetanarian (is that a word?) may look at it differently than someone who rides motorcycles off road, for example.

A bit beyond my pay grade, but have they thought about treating your overactive thyroid, because maybe that is all you may need to stay out of afib?

The other thing, being in afib continuously for several months, may start to remodel your heart, making interventions like ablation less successful.

However, there are drugs available, anti-arithmetic's like Flecainide, that can be taken daily to keep you in normal rhythm. That could buy you time until you end up having an ablation. The person you should be having this discussion with is an electrophysiologist (ep). They are cardiologists who specialize in arrhythmia's like afib and are far more knowledgeable in these matters.

Jim

[Jafib53 in reply to mjames1]

Thank you for the reply. I have been being treated for the hyperthyroidism since it was diagnosed last October. It seems to be almost better now but the heart is still not right. I have read that Afib can revert after thyroid is back to normal but it seems that is unlikely now. I am worried about the fact that I have been (I think) in continuous Afib for a few months already, but I am meeting a specialist (I think he is an ep as he is the person who does the ablation) in two weeks so I guess I will just need to find out more then.

[KiwiBlake in reply to Jafib53]

Hi. I'm at 51 Yr old male, periodic AF for last 3 years. I had a cryo ablation last September. Pre ablation I was on daily Diltiazem (120) and daily Flecanide (100). For 4 weeks pre ablation I was put on dibigatran blood thinner, which I took for a further 4 weeks post ablation. I was advised to continue on both the Diltiazem and Flecanide after the Ablation for 3 months as a precaution while the heart heals itself and the scar tissue forms. They refer to this as the blanking period. I believe this is common practice.

At my three month post ablation follow up at cardiology I was told to stop the Flecanide slow release, but given quick release Flecanide PIP if I need them. During the first 4 months I have had 3 AF episodes lasting approx 2 hours. For the last 4 weeks I have had no AF, so hopefully it's been a success. I've had a few skipped beats (ectopics) and a bit of flutter (only 4 or 5 times) so I think the ablation is holding.

I have an under active thyroid so am on medication for that (hypotherydism) .

In terms of the ablation itself, I found it to be painless, I was nervous going into Theatre, but didn't need to be.

Hope that helps you.

Blake

[JaneChapple in reply to KiwiBlake]

Sorry to hear what you are going through. The heart and thyroid are closely linked. Undertreated hypo and hyper can cause heart problems.

Have you had any recent bloods done to include TSh, FT4, FT3, TPO antibodies, Tgab and Trab anti odies for hyper? If not this could well be causing your palpitations also.

if not it would be worth checking with your GP but I suspect they only check the TSH, in which case your other option would be to do a home finger prick test through MonitorMyHealth which is a fully accredited NHS Lab so dr shouod take note of these. The other company is Medichecks who do other vitaminsand mineral tests also. Thyroid UK offer discount on these tests and there is also lots of other useful thyroid into.

Tests needed are TSH, FT4, FT3, TPO, Tgab and Trab antibodies (the last one being for Graves/hyper)! Ferritin(iron), full iron panel, Vitamin B12, Vitamin D, folate, magnesium, selenium, zinc, copper.

Sadly drs/Cardiologists dont know much about this which is surprising as T3 (the active thyroid hormone) isused in heart ops.

Janexxx😩❤️

[Jafib53 in reply to JaneChapple]

Thanks. I have been well treated for thyroid - all the tests and ultrasounds uptake scans etc and managed to rule our Graves and nodules. So was probably thyroiditis and levels are now basically back in range. I originally saw a cardiologist as my first signs of an issue were palpitations and so saw a cardio before I had any notion that it could be thyroid. In fairness he was onto the possibility of it being thyroid related straight away and immediately had my T3 and T4 tested and that’s how we knew it was thyroid related. Sent to endocrinologist for thyroid treatment. It was hoped heart would revert with successful thyroid treatment but unfortunately that hasn’t happened so now have to take alternative measures.

[KiwiBlake in reply to Jafib53]

Hi. I'm at 51 Yr old male, periodic AF for last 3 years. I had a cryo ablation last September. Pre ablation I was on daily Diltiazem (120) and daily Flecanide (100). For 4 weeks pre ablation I was put on dibigatran blood thinner, which I took for a further 4 weeks post ablation. I was advised to continue on both the Diltiazem and Flecanide after the Ablation for 3 months as a precaution while the heart heals itself and the scar tissue forms. They refer to this as the blanking period. I believe this is common practice.

At my three month post ablation follow up at cardiology I was told to stop the Flecanide slow release, but given quick release Flecanide PIP if I need them. During the first 4 months I have had 3 AF episodes lasting approx 2 hours. For the last 4 weeks I have had no AF, so hopefully it's been a success. I've had a few skipped beats (ectopics) and a bit of flutter (only 4 or 5 times) so I think the ablation is holding.

I have an under active thyroid so am on medication for that (hypotherydism) .

In terms of the ablation itself, I found it to be painless, I was nervous going into Theatre, but didn't need to be.

Hope that helps you.

Blake

[Jafib53 in reply to KiwiBlake]

Thank you! No way to know if it will be a success unless we do it! Hope yours holds.

[Dovewings in reply to Jafib53]

hi J

I had the Hybrid Ablation 4/14/22 and never took heart meds again. I feel great at 66! No Post problems. I'm on a Woman’s Multi Vitamin, Vitamin D3 2000eu, and a daily Probiotic. God’s BEST for you in your ablation!♥️🕊️

[KiwiBlake]

And because we are in our early 50's i know there is a good chance it will return, I've got to be realistic about that. If I need a 2nd touch up ablation then I won't hesitate in getting it done. Still got a lot of good years ahead of ourselves!Cheers

Blake

[Jafib53]

Do you know you are in Afib because of symptoms or just from readings on a device? I had a feeling of beating heart for a few weeks when first diagnosed for my thyroid issues but now would have no idea I even had AF if not for devices. I am not sure if that is good or bad!

[KiwiBlake]

I often get pulsatile tinnitus, so when sitting quietly I "hear" my pulse, so when I go into AF I find it quite disconcerting. I think too when you go through something like AF you are much more aware of your heart. Other than that, I can function quite normally when in AF.

[CDreamer]

It really depends upon your CHADS score but with Thyroid dysfunction I would continue on A/Cs for life.

I came off A/C 12 months following what I thought was a successful ablation - then had a TIA. I was told that because the AF was treated that the stroke risk didn’t diminish. I had to argue to come off A/Cs as my EP was not happy. That was back in 2016 ish and thankfully I wan’t affected long term but a good lesson so I couldn’t get back onto A/Cs quick enough. I just heard from my son that an old friend of mine who was a great believer in everything ‘natural’ had a really bad stroke and is now in a nursing home.

As for Bisoprolol - I’m not the person to ask as I couldn’t tolerate Bisoprolol but took me a long time to realise that.

We make choices based on our fears - I’m afraid of having a disabling stroke. My AF burden is now less than 1%.

Hope your ablation goes well.

[wilsond]

It is important to remain on anticoagulation,as AF can return unexpectedly,or occur during sleep,and thus we are unprotected. I would be concerned to come off AC,in fact would insist otherwise!It seems to vary as to other medication. I had a double ablation in June,and told to remain on all until follow up appointment,which was a bit later than expected.

I was told that they prefer the heart to retrain itself in nsr before reducing gradually off flecanide and bisoprolol,rather than cold turkey.

Perfect so far,except for one episode with a clear indication of cause.

Others on here stopped straight away.

Best of luck

[Singwell in reply to wilsond]

So glad you're doing well! I've been AF free since May and just having a few issues as we get my thyroid sorted - few short runs of tachy and the odd PVC.

[BobD Volunteer]

The best intelligence is that succesful ablation does not remove stroke risk. As one leading doctor once said, it is not the AF but the company it keeps.

So if you are only on antcioagulation for the purpose of ablation and recovery (i e your chads score is zero) then it may be that you could stop the anticoagulant after a perod of time (three to six months maybe). Most of us old gits are on them for ,life.

[Jafib53]

Thank you all for replies. Lots of good information.

[Rainfern]

Thank you for your post Jafib, I'm saving all these brilliant responses for when (hopefully) I'm offered an ablation. Wishing you a successful and speedy outcome. Don't forget those lifestyle factors (sleep, exercise, healthy diet, relaxation etc) while you're waiting!

[Jafib53 in reply to Rainfern]

Thank you!

[Mugsy15]

I'm surprised you haven't been offered Cardioversion, which is the usual first step, both to see if you are likely to have a successful ablation and with the hope of restoring normal sinus rhythm, at least temporarily.

[Jafib53 in reply to Mugsy15]

They did mention a cardioversion but I think it was to get me into NSR before ablation. I could have misunderstood as I hadn’t been expecting to see the cardiologist that day ( I was seeing thyroid doctor and they squeezed me in) and it was a lot to take in and was all being conducted in Japanese ( I live in Japan). But I am having a consultation soon so will ask about that then.

[carrs]

Hi had an ablation at the end of October. I have continued to take 5m bisop and apixaban a small dose of thyroxine has been added to compensate for some damage amdeoderon earlier. So far perfect I'm back playing golf and feeling OK. My review is in April with the specialist. I wish you well. I have to thank people on this site for their help and encouragement.

[Sozo]

You should be able to go off on anticoagulants if the ablation is successful! Of course there is always a chance for anyone to have a stroke even those who do not have afib. But the chances of stroke shoot up when you are in afib. So if you have had a successful ablation and your basically healthy then I think there is consideration of the benefits of going off of them... IMO

[Magson]

Both my Cardiologist and EP told me I would be on an anticoagulant after ablation. This was 2018. Not sure if it is your GP advising you. My experience is "listen to the experts". I dropped all other meds. Good luck.

[Jafib53 in reply to Magson]

it was the cardiologist who said it, but I will so EP when we meet.

[Zozzy]

I had a successful cryoablation for vagal AF about 5 years ago. My CHADSVASC score was low, which I think is the reason my consultant said I didn't need to continue meds after the 3 month blanking period.

[Jafib53]

Just looked at the CHADSVASC test thing and as far as I can tell I would be.

a 0.

[Coco51]

To answer your question, I am still on meds after ablation. There was never any talk of coming off anticoagulants by my EP. I was 64 when I had my first ablation after being in continuous AF for nearly 5 months - paroxysmal AF before that for 10 years. I probably had "re-modelled" heart circuits so I needed a second ablation.

However I still take Flecainide, Bisoprolol and Apixaban. When I tried to stop Flecainide a few years ago the AF started again. But now, seven years on, my AF burden over the last six months has been virtually zero. Funnily enough before the ablations the Flecainide moderated the AF but didn't stop it. Now it does.

We'd all love to stop tablets. I see them as a daily reminder of my mortality. But I'm grateful for the relief they bring.

PS:There are different opinions about measuring the success rate of ablations. It would be worth asking your EP how he defines success, just so you have realistic expectations. Good luck!