Confused (like a lot of us!)

[Montsauton]

After an Afib episode when I ended up calling an ambulance, the cardio put me on Flecainide 2x50mg daily, without actually seeing me. It has worked (touch wood) and I no longer have Afib episodes. A friend who also discovered he had Afib was immediately sent for an ablation. My question is what makes the diffference between being put on a drug as I was or being sent for a surgical intervention. How does the cardio choose which to do? Why isn't everybody put on a drug? Sorry if this sounds naive but with zero chance of ever seeing a doctor face to face I'm putting my trust in you out there.

[BobD Volunteer]

Any and all treatment for AF is ony ever for quality of life (QOL) so what treatment is given of not really relevant. It is not generally a life threatening condition. merely life changing. For many people changes to life style and diet can drastically reduce AF burden but for others the three options are rate control (normally first line) using a beta blocker, rhythm control using an anti arrhythmic drug such as flecainide, or a non surgical intervention such as ablation. In a very few cases a surgical ablation may be offered.

I am surprised that you have never seen a cardiologist nor apparently had any tests since flecainide is a dangerous drug which should only be given if the patient's heart is sound with no sign of cardiac artery disease. It is also usually given alongside a beta blocker as it has the potential to cause flutter.

Ablation is a costly procedure and not normally offered here in UK and Europe as a first line treatment, only after drug regimes have failed.

Hope that helps.

[Montsauton in reply to BobD]

Many thanks. Just to be clear, I did see the cardio once and had initial tests and measurements but didn't see him when he prescribed Flecainide. I was initially put on a beta blocker but because my normal heart rate is so slow (resting 55) on beta blockers it became uncomfortably slow. I think I have misunderstood what ablation is. I thought it was a surgical intervention - electrode being put into the heart? Also I have never quite got hold of the difference between ablation and cardioversion. Are they the same? Sorry for my ignorance.

[Buffafly in reply to Montsauton]

Cardioversion is a shock administered by paddles (as used in resuscitation) and is usually offered only if the patient has a dangerously high/prolonged arrhythmia when all other methods of restoring sinus rhythm or at least slowing the heart rate have failed.

Ablation is generally referred to as a procedure and involves freezing (cryoablation) or burning (radio frequency ablation) areas inside the heart to ‘kill’ the rogue signals (Ladybird explanation!) Also traditionally used when all other methods have failed but modern thinking is that early intervention is better.

Hope that helps ❤️‍🩹

[BobD Volunteer in reply to Montsauton]

Ablation is done via catheter in femoral vein so not surgical ie no incision , just a small puncture.

[etheral in reply to BobD]

As an isolated condition you are of course correct that afib is not life threatening. Combined with other problems such as reduced cardiac output from previous MI it can cause heart failure and death.

[mjames1]

Different doctors have different approaches and ep's tend to be more aggressive in terms of ablations than cardiologists. But in the end, it's your decision, a lot of people miss that point. That said, no two patients are alike, so your friend's situation may have been different.

Jim

[healingharpist]

Hi Montsauton, I'm also on flec but only as what we call "Pill in Pocket" (PIP), which means I take 150 mg of flecainide at the start of an AF episode (maybe once every 1-2 months), instead of taking it daily. Re your drugs question, yes, most cardiologists or GP's would suggest trying drugs first, and most consider ablation a "later or last resort" if quality of life isn't good enough on drugs. Also, there are many lifestyle changes and "alternative" methods for treating AF, from therapeutic music to breathing techniques, exercises, walking, meditation, supplements--many others.

There are different kinds of arrhythmias, also, and your friend being taken straight to ablation would not be the norm, in my experience with cardiologists, including EP's (an electrophysiologist, who is a cardiologist who specializes in ablations). But it depends on his history & the condition of his heart, which we don't know.

As you will learn on this site, every one of our cases is so unique, depending on our genetic inheritance as well as our symptoms, our lifestyle, our medical history, the health of our heart, risks and comfort levels, that there's no easy way to compare one person's treatment to another. Drugs may have side effects & diff. ones have to be tried out, while ablations have risks, don't always work, and often have to be repeated 1, 2, or more times. So all the options should be explored with one's cardiologist/s and the best choice made for each person's needs and desires.

Just keep reading and asking questions! May you stay always in NSR!! Cheers, Diane S.

[Montsauton in reply to healingharpist]

Many thanks for all those replies. Very helpful. I'm a lot clearer now.

[A_fi_bR]

I’d agree with the point about drugs being a first port of call. I was told that any decision will be based on your symptoms. So you could be having episodes and not be aware, in which case it’s not really affecting your QoL.

Keep taking the tablets, and I would assume you’ll get an annual check up as a bare minimum. I started on Flecainide and I described as ‘turning the volume down’ on my AF but still got daily issues.

I waited about 18 months for an ablation for that but then assumed that the SVT I was getting was a part of AF. Next stop is an EP study to see where it’s coming from and then possibly more ablation(s). I ONLY got the EP study because I captured my SVT episodes on my watch and made a point of telling the doctors, which they paid attention to and asked for PDF files – so I would say start gathering some evidence if it’s causing you problems. Also, I’ve been banging on about my AF/heart arrythmia problems for about 8 years now. That’s how long it’s been, from first feeling symptoms to ablation last year. Not quick. And on-going.

[OldJane]

do not put your faith in us. In an overstretched system keep pressing for answers. Work at it until you are seen! Old advice was medication (usually Bisoprolol) and if that fails, ablation. Now, rhythm control best - rather than Bisoprolol which is a rate control - and early ablation. As Bob days you should have been assessed before being given flecainide but contrary to what Bob said the NHS team I was referred to fast track early AF to ablation, the meds only used until that is possible in an overstretched service.