I am 71 years old and am on flecainide after several trips to emergency with a heart rate of 170 to 200. Many drugs were tried and flecainide was the only one that I tolerated. I have no associated heart problems and am very fit. Yesterday I had a consultation with an electrophysiologist he said I border atrial fibrillation and atrial tachycardia and was a contender for ablation. However given the risk of complications, the fact it may not work and that flecainide is working well I may be better to stay on the drugs. He said if I was 40 they would just do it but if I was much older they won't even consider it. I chose not to have it but now I think I made the wrong choice. My doubt is based on if I don't have it now and the flecainide stopped working I'm out of choices but if the ablation didn't work I still have flecainide to fall back on.
Any advice would be very much appreciated as I need to let him know immediately if I have changed my mind.
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Renesch
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That's absurd. I'm older than you, probably not in as good shape and I have been offered an ablation by four electrophysiologists (I shop around ) associated with major teaching hospitals in the US. Seek out the best cardiac hospital in your area and find another electrophysioloigst. I'm not suggesting or not suggesting ablation, but your age should be a non factor.
Thanks for your reply. I live in New Zealand and to see an electrophysiologist is a 10 hour return journey and I saw one of the best in the country. I don't think there is an option to shop around. It sounds like they will do it he just suggested the drugs were a better option and I agreed at the time but now I'm not so sure. Dilemma!
If the flecainide is working and you're content with your quality of life, you can probably by time with it, keeping in mind that for some of us, Flecainide stops working at a certain point and at that point you may be facing the ablation decision at an even older age. So factor that into your decision. There is also a new ablation technology, with a better safety profile, just starting called Pulse Field Ablation. It's being offered in some countries now and still in trial and others. Could be worth a little wait.
Wow ok. I certainly wouldn't want to be in that situation. My heart rate was very high and didn't right itself, the ambulance made the decision to take me to hospital. I was put on diltiazem it worked but i couldn't function went off it bach into fast afib back to hospital and so on and on. My neighbour had the same thing, he flatlined at 200 pm and had to be shocked back. I think it is the very fast heart rate that concerned them.
I sympathise with you Renesch as I was in the same position when I was 70 with exactly the same thoughts as you are having. My advice would be not to rush your decision - why does your EP need an immediate decision? Research as much as you can, ask questions (I pestered my poor EP with 'what if' and 'how likely', even get a second opinion if you feel it is necessary. My EP left the door open when I decided to stay on Flecainide, offering a fast track back to him if I decided on ablation.
At the end of the day it has to be your decision based on what is best for you and your personal circumstances.
I chose the drug route - 2 x 100mg Flecainide daily based on this and I've been AF free for the last 9 years. There is no 'wrong' decision, in my opinion - I worried at the beginning about the moderate dose of a powerful drug but it has been such a boon and I have been very lucky with Flecainide being tolerated so well.
Take your time and think it through - very best wishes for the route you choose.
And that's the problem with flecainide. If your lucky it will just stop working and AF will break through. If you're unlucky it will also leave you with permanent bradycardia requiring pacemaker implantation.
Options do seem to vary from country to individual specialist. I had 2 ablations, 1st made things worse, 2nd gave me 3 years AF free. I then had RST pacemaker implanted in preparation for Ablation of AV node - the Pace & Ablate option - the pacemaker implant on it’s own worked for me and I think I eventually traced back what triggered my AF - but that is a long story. Outcome is that I still suffer the occasional AF episode but without the very high heart rates I used to get and my BP is now stable. At 72 I think it’s as good as it’s going to get.
I had my ablation18 months ago at the age of 69. Interesting that my cardiologist at Barts had no hesitation in recommending a Cryo ablation. Which has worked well. Before the ablation I had PAF and I was told it was better to have an ablation before the AFIB became permanent.
Like yourself I’m fit with no underlying or other heart or health issues . My GP said having the ablation was a “ good use of risk” and I think he was absolutely correct .
Many thanks everyones experience seems so different i ha, ve decided to go on the list and make up my mind while I wait or the 18 month pay covid backlog.
I went through exactly the same situation. Initially I thought I would never have it. The whole procedure was straightforward. I was conscious throughout and it took about two hours which flew by. In fact I was out of the hospital a few hours after the ablation. I went out for a meal and a glass of wine, the same night.
Readers please don’t contact me and say I shouldn’t of done that LOL.
I thought having the ablation was so that I could get back to a normal life which is what I’ve done.
My experience on Flecainide is the same as Finvola, so I have no regrets postponing an offered ablation at 60, now 70. However, your fast HR during episodes is some concern and I would discuss this aspect specifically with a trusted cardio/EP.
Last month I had a regular check up with my cardio and checked with him that there was no extra risk for me as I move into my 70's being just on Fleacinide with no usual companion of a BB or CB. He said the older I get the risk of a dangerously high HR decreases rather than increases 😀.
Thank you for your feedback. I am still undecided so called the EP and asked him to hold fire on my notes and referrals while I give it more thought. At this stage I think I'm going to go on the list for an ablation and as there is currently a post covid wait list of 18 months it gives me some breathing space to see how I go on the flecainide as I've only been on it 2 months. I live in New Zealand and I believe there is only 1 EP in the southern Island who does it whether you go private on on or national health. Or will give me time to think.
hi, I was in your position 16 years ago when my AF caused a TIA. I was offered an ablation but at 59 I said no, didn’t want my heart burning internally haphazardly, the success rate wasn’t great in those days and the cardiologist said at my age he would put me on the drugs (Fleccanide and Bisoprolol) plus warfarin, which he did and all was fine for years until I started getting a faltering beat, he then added a pacemaker to steady my beats and I stopped the Fleccanide, just took the Bisoprolol and warfarin (which is now replaced by Apixaban for less risk.
I function very well am on my 2nd pacemaker now having been paced for 13 years, and with this set up I am so glad I refused an ablation as I heard so many stories of failure. However time has moved on and now results and new techniques have much improved. Read every article you can on the medical advances and don’t rush into this. It’s your heart, be kind to it and talk to those who have experiences to share.
I suggest a rate control is needed for you like Bisoprolol as well as your Fleccanide for stability and of course a thinners.
Thank you, I apparently can't take a beta blocker as they tried it and it lowered my BP and HR so much I collapsed. I am allergic to amiodarone a serious rash that sent the medics into a spin. Diltiazem was prescribed with flecainide in the hospital and i couldn't think and slurred my words and stumbled when I walked. It was very distressing so I refused to take the diltiazem and found the flecainide worked pretty well on its own. The EP said I had made a good choice as I was being over medicated. Really if flecainide decides not to work I'm out of options. I am on blood thinners but as I age and still enjoy high intensity workouts and multi day mountain treks I'm starting to get some old age aches and pains and of course i can't take anti Inflamatory while on blood thinners. I'm complicated.
I’m sorry you had that reaction to the beta blocker, it needs a slow build up and monitor what dosage is best for you. Maybe they started you on a too high a dose.. They do effect everyone differently.
My set up seems to be fine with the pacemaker keeping my heart from going too slow and my Bisoprolol stopping my heart going too fast. Result is I’m always in AF but not felt, and my body is functioning well and active. I treasure my Pacemaker as my guardian angel. So simple an op and constantly checked by the PM team by my remote bedside monitor.
just to add….. Diltiazem does often reduce people to the zombie state. It’s meant to relax you. Not what you need unless you are suffering from anxiety.
My dad was given that in hospital to calm him down and he was slurring his words and couldn’t keep awake.
Thank you, I apparently can't take a beta blocker as they tried it and it lowered my BP and HR so much I collapsed. I am allergic to amiodarone a serious rash that sent the medics into a spin. Diltiazem was prescribed with flecainide in the hospital and i couldn't think and slurred my words and stumbled when I walked. It was very distressing so I refused to take the diltiazem and found the flecainide worked pretty well on its own. The EP said I had made a good choice as I was being over medicated. Really if flecainide decides not to work I'm out of options. I am on blood thinners but as I age and still enjoy high intensity workouts and multi day mountain treks I'm starting to get some old age aches and pains and of course i can't take anti Inflamatory while on blood thinners. I'm complicated.
I can't have an ablation as my Left chamber behind is enlarged.
Read about ablations, the risks, how many ablations you may end up having to have.
You are not 40s!
Statistics is that risk is 2% for death. Also risk of stroke or heart attack. Also it may change to persistent.
But you say Flec.... solves your episodes. I wouldn't take "you could miss out" out of the equation but time is sometimes the essence. A like person I know had 5 pills and he had his episodes finally they did an ablation on him and found he had 2 different AFs in two different places. 1 year 5 months he is off meds and resolved but he is in late 40s.
Only u can make your decision.
Check up on your surgeon though. Done how many, any complications.
I thought age, weight, echo showed no heart defects except the AF. They will need to see the AF perform. Also they get a better look at your heart.
Many thanks which Island do you live in? I'm in Nelson and apparently the EP IN Chch does all the South Island ones. They said they will fly my husband and I diwn and put us up in accommodation fit 3 our 4 nights.
He also solved another Doubtless Bay man's AF who he discovered had sleep Apnea.
So I am further up 2 hours down from Cape Reinga.
He came up to Kerikeri.
I got left after a stroke with aF and 4 days in discovered a shadow on my thyroid - Papailiary Cancer. 4 mths later umderwent thyroidectomy and 12 right lymph nodes removed.
Just had my 3rd year anniversary neck scan.
So with me thyroid problem caused the AF which caused the stroke.
It can revert to normal H/R but hasn't.
Always have a neck scan - Carotid Artery check with thyroid check.
So you are in sunny Nelson and I an in the winterless north with tropical rainfall.
Take care and eat healthy, exercise and sleep well.
Oh boy you have had the works and I thought I was complicated. Good luck. Let me know if you are even headed to Nelson there is always a cuppa from 1 heart to another. ♥️
Good morning from snowy South West UK, I am 78 and developed AF after passing out on the golf course two years ago. I had two ablations which worked for a short time and then on medication to semi control the symptoms. Then took the option to have a pacemaker fitted with the AV node ablated.
Now back to normal and back to golf 3 x per week weather permitting with only a blood thinner tablet. So you still the pace & ablate even if the ablation does not work long term
I had two ablations..Think both in my 70s.First worked but AFib returned Had second few years later..Still AFib returned.Didnt want third..older now...I am on blood thinner.atenolol..heart rate high at times..also slow..pacemaker suggested..so it's all very confusing...and I ever know what to do.who to turn to..identify.
Tough decision that's a given; I have had two ablations ( 63 and 65 ) was down for a 3rd but my heart responded well to a 8 month course of Amiodarone so was cancelled whilst being prepared. I always trust my instinct as to how much faith I have in the consultant , for me I can't see another way as they understand my heart from the real inside visually and not emotionally. I am on Dronedarone and have been for two years with Flecainide as a PIP, which in the main is OK I had a blip last year and was given an Echocardiogram and then 4 months later a 7 day Holter, the cardiologist replied at 16.18 via email to say the Echocardiogram showed know issues to worry about so signed me off for a year, then at 16.21 I had another email to say that my Holter showed issues and he wanted to see me! Not sure if you know how the monitor works but you make a note when you feel anything strange ( does make you wonder with 24 x 7 hours worth of recording everything would be spotted otherwise ) , anyway during one nights sleep I had a few chest pains , nothing heavy, but noticeable, so noted them and he then explained that is why he wanted to see me as I was missing beats and also my heart rate was below 40 BPM, . My real point is that I am very grateful that they didn't rely just on the Echocardigram. Wishing you well.
Ruby really interested in you being on Dronedarone with Flecainide as a PIP take it this was on advice of Cardiologist ? - Do you mind telling me are you on the 2X 400mg Dronedarone and if you get breakthrough AF how much Flecainide do you take - i am on Dronedarone only and get a not of AF bust not at fast heart rates but was really interested in how the Flecainide interacts with the Dronederone ?
Hi, I am a 69 year old male and weigh 80Kg. I previously used Flecainide as a PIP when on Sotalol ( not applicable with Amiodarone as I didn't have any AF episodes whilst on it ) but then it was 100mg on the onset and a further one an hour later. After my first ablation and AF returning I was tested in hospital to see if I could handle 3 x 100mg tablets in one go and it worked. I have had to use it about 9 times and would say 6 worked and the other 3 occasions I had to have an intravenous Amiodarone after going to A & E. The last time it didn't work I was told in hospital and was told it didn't work as it was Tachycardia and not AF, I was given a liquid infusion and after 4 hours was back in normal sinus rhythm, all a bit of a minefield! I was told at hospital NEVER to take more than 300mg Flecainide in a 24 hour cycle. Hope that helps. Kind regards Max
Yes in addition to the Dronedarone . I think if I was due my dosage of Dronedarone I would take that before I took the PIP, but the situation has never really occurred , always a few hours before or after dosage when the AF has happened.
I am sorry. I wonder why the EP thinks there is a risk of more complications for you, can’t just be age? My successful ablation was at age 71. I didn’t have atrial tachycardia however
hi there from a personal point of view I have had two abalations for AF both initially successful but over time the AF has returned- it is not a pleasant operation and not without risk I now have AF that comes and goes and am also on flecanide which seems to more or less keep the AF under control but i nevertheless get periods of breathlessness etc - I have decided not to have another abalation and live with the AF episodes- but will review the position with my consultant later this month - I am 65 - trouble is we all have different scenarios - hope that helps
if the meds your on now have stopped working it is a good chance the meds will not worked after the ablation.I have had the ablation done last September 2022 no more attacks but now I’m dealing with extremely low bp attacks where I pass out. ( which before vin was being treated for high bp. Still in and out of hospital they are trying to come up with a drug treatments program ( Canada 🇨🇦)
Hi, i hope they find an answer for you. So far the drugs are working but I'm told flecainide often stops working and I'm out of choices then. Mind you no one has suggested a pacemaker.
hi I’m 77 and had my ablation six weeks ago. Absolutely no problems with the procedure. The following few days were uncomfortable ( after all your main organ had been under attack !! but as days passed so did the discomfort. No driving for seven days and no heavy lifting either. Still get the odd light Atrial Fibrillation but less as weeks go by. My Apple Watch first notified me of AF and the ECG function is excellent and now accepted by the Cardiologists. I will be contacted after 3 months ( the “ blanking “ period as it’s called ) as this is the considered time span for full recovery. Benefit for me was I could stop my beta blocker “ Bisoprolol “ which was making me very tired and lightheaded so good riddance to it. Ask your Cardio dept to put you back on the list and good luck for the future
Thank you. Yes that is what I'm thinking. As there is an 18 month wait list it at least gives me time to check out the flecainide. I can still change my mind. Thanks for your reply and the best of luck.
oh my Renesch, I’m 74 now but had both Cardioversion and then ablation done at 73. I can’t imagine a physician questioning your age. I also take nie a very small dose of flecanide which I have been weaning down to 25 mg 2x a day. After Ablation my AFIB has improved although will never disappear I am told. Last December my Cardiologist suggested I have a heart tracker inserted which records daily what my heart is doing..
I would question your physician about just taking drugs for your problem. I do reside in the USA so possibly we are using other prerequisites for surgery. Having worked in Germany I am aware that only private patients seem to receive the best medical care.
Hope I gave you some insight. Rethink your decision would be my advice. I’m off for golf .
I was on high dose flecainide I always have a bad side affect with many drugs and this being one of them, I went from walking all over to walking with a frame, they change the drug to Amiodarone after have cardioversion and within two days became thyrotoxic, the tablets I am on now dont really keep the af in control, ablation for me was too dangerous I am 79 and my Prof has decided to do a Pace and ablate which will happen this coming Monday, I have had so much good feedback for this, my heart now is in constant Afib, I dont even get a full nights sleep,,,I hope all goes well for you
I really wish you well for your upcoming procedure. Do you mind telling me what caused you to go from walking to needing a frame? Was it stumbling or pain or tiredness etc. Good luck.
I’m taking Flecainide which works well for me, along with Eliquis and metoprolol. I’m 66. And fit. When I mentioned ablation, my electrophysiologist said no, the meds are working…you don’t want to do something invasive if not necessary. I also did some research and there was no age limit I could find for the procedure. Do your homework, research it and maybe get another opinion. Maybe your doctor knows something else but I can’t find anything that says it can’t be done later if needed.
Many thanks for your reply. I first had AF about 4 years ago it would start at about midnight go on for about 24 hours sometimes a bit more or less then go back into SR on it own. It would only happen 2 or 3 times a year and I didn't have any treatment or see a cardiologist just my gp and took blood thinners. Then in Aug last year I had an episode that didn't revert and 2 days later I went to emergency having used a finger pulse meter and the resting rate was 180bpm. I had an ecg but didn't see a cardiologist just the hospital doc who diagnosed rapid afib gave me some drugs and sent me home. Long story shortened...... I have since been back and forth to the hospital, seen 2 hospital cardiologists who just kept pumping in the drugs and the last ambulance trip they thought I'd had a stroke but I was just over medicated. I am now just on flecainide and blood thinners. A couple of days ago I saw an electrophysiologist, had a stress ecg and an ecocardiogram and the outcome was that I had an unusual condition in that the afib got so out of control it became atrial tachycardia and he suggested the ablation, gave me all the pros and cons of having it or not and said it was up to me.So that is where I'm at. Both staying on the drugs and having the ablation have good and bad attached hence my confusion. Best wishes.
I had my ablation at 73; recovery took longer than most but I don’t regret it. I did end up on flecanide 18 months later but only 100 ml a day - and don’t feel like a zombie…
I think I'm at the same place as you - ablation in 21 but have had to go back to flecainide and still on dilimiazem and edoxaban. I haven't had any more af episodes with the flex but I'm wondering whether or not to have another anblation as it took a year to get over.
I don't know about the age part. I have had two ablations a cryo one and an RF one both improved my condition but did not cure it. I follow a pill in the pocket routine. If I have an instance of AF i take 200Mg and it usually goes away in 2-4 hours. I am 56 now and my AF is very variable. I can go weeks with nothing or go through a period of it going off daily and flec not resolving it fully. I get very tired and cant sleep well when its off all teh time. I am over weight and need to lose 3-4 stone and have decided that unless I lose that weight i wont consider another ablation. The consultant has suggested that if i were to lose the weight it could be as affective as an ablation at reducing or stopping my AF. I think every one of us with this "embuggerence" has to look at out lifestyle, how it affects us and if its stopping us doing anything we want to do. I am still working full time and generally live with it. You need to think about the impact on you. If your AF is getting in teh way of living your life then have the ablation, if its not and you can manage it then you have made the right decision in my opinion. I wish you good health.
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) associated with major teaching hospitals in the US. Seek out the best cardiac hospital in your area and find another electrophysioloigst. I'm not suggesting or not suggesting ablation, but your age should be a non factor.
According to EP JOHN MANDROLA, MD "AF-rhythm drugs (propafenone, flecainide for example) often make atrial flutter worse." 
Flecainide and Metoprolol Combo Have Stopped Working
Ablation 
Confused after Ablation today
