My question, how do we define whether an ablation has been a success.
Briefly my back story:
I'm a 51 years male, in New Zealand. Relatively fit farmer, 69kg.
First diagnosed 2020, with AF occurring every 2-3 weeks, reverting to NSR after about 4 hours. Prescribed daily120 Diltiazem, and 100mg Flecainide. Emotional stress due to terminally ill mother in law living with us. Once mother in law passed away, I went 6 months no AF, but still on daily D&F. Then had an episode following a stressful day at work.
Had a cryo ablation Sept 2022.
No AF for 4 months
Jan 2023 advised to stop taking Dilt and Flec. 8 days later went into AF, again stressful day at work.
Back on meds for another 4 months, no AF. May 2023 stopped the Dilt and Flec again. 14 days no AF. Was entering a busy time at work again so went back on the Dilt&Flec as a precaution. No AF during busy time.
June 2023 quiet time at work, stopped taking Dilt & Flec. No AF for 8 days.
Yesterday, stressful day (non work related). Skipped lunch, didn't drink much water, went into AF at 5pm, took Flec & Dilt, reverted back to NSR 4 hours later.
My question is whether the ablation has been a success. I have been referred for a touch up ablation in 6 months time. My QOL has definitely been improved. My AF episodes post ablation have been far less chaotic and reverted within 4 hours PIP flec. Yesterday my HR went to about 160, then every hour dropped back aprrox 20. I was having 6 or 8 rapid beats followed by a skipped beat.
Today NSR, with resting HR 56.
I am really happy that I have only had 2 AF episodes in the last 6 months, which have reverted within a few hours. I would be content with life if next few years continues this way. My main concern with continuing with the Fec is that a 5 day holter test last month showed that although I remained in NSR the whole 5 days, I have been diagnosed borderline first degree heart block. I gather being on Flec long term you can develop other types of arrhythmia. I would be happy to stop the daily Flec, and take as PIP when required.
I'm booked in with my local Dr to discuss on Monday, but would appreciate any thoughts or feedback in the meantime.
Thanks Blake
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KiwiBlake
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It's really subjective. Like yourself, daily Flecainide held afib off pretty well and like yourself I do not want to be on daily Flecainide long term. So, for me a successful ablation would be if I only had a handful of afib episodes a year that I could convert using Flecainide PIP. Anything better would be a bonus. Had my first ablation six weeks ago. I will be weaning off of and then stopping Flecainide shortly. That will be the test. Fingers crossed
Thanks Jim. Yes subjective is the right word. I'd be perfectly happy to go the next few years/decades just having an episode, 2 or 3 times a year, that reverts with PIP. I would call that a sucess. I don't want to be on Flec long term in case it does more damage than good. I keep telling myself AF is not going cause me to cark it.
For me AF is more of a nuisance, when in AF i can continueto function, just feel un comfortabe. Last 6 months I've felt great.
Stress is certainly a well known trigger. I often wonder if an AF attack would have stopped naturally after a period of time and whether the Flec or whatever medication we're given are credited falsely. Just a thought I have after. 18 years of AF.
Thanks Jean. Yes I agree, I wonder if it's the Flec that reverts me to NSR, or whether I calm down, rest on the bed and breath nice and slow (as Bob advises). When I get wound up, which in normal life is only every couple of months or so thankfully (I'm learning how to calm myself down), it takes the body a few hours to eliminate the stress hormones such as cortisol and adrenaline. Now looking at my watch knowing New Zealand is 12 hours ahead of you in the UK, it is way past your bedtime!
I am not on the medication being discussed, but I have wondered the same thing with regard to what I am taking, or in fact any of the prescribed meds to control /alleviate symptoms
So am I 🫤 especially after on being diagnosed having the living daylights scared out of me! My symptoms back then were nothing like the episodes I have experienced since being on the meds. In hindsight (which as we all know is a wonderful thing), I wish I had just accepted the Anticoagulant & waited it out…
I have suffered AF symptoms for the last 6 years. As bloods, ECG checked out as normal-I was diagnosed with anxiety disorder. My episodes lasted a few hours, but were less frequent, probably 5 a year.
Since diagnosis a few months ago and prescribed meds, my episodes have increased to once a month, thereafter once a fortnight.
The episodes are more aggressive and last anything between 12-17 hours.
Since diagnosis, my stress levels have increased tenfold.
Will never know if the frequency of episodes is related to meds, or a natural progression.
I would be happy to remain on anticoagulants and sit out the episode.
My story is similar to yours except I had a follow up touch up ablation (RF) first one was cryoablation. I came off meds after 4 months after 1st ablation (flecanaide) had AF bouts on about 6 occasions and was told I could have a follow up ablation 12 months after the first and was kept on flec until that time. Straight after 2 nd ablation I came off all meds and had 2-3 short bursts of AF, that was 6 mths after the ablation. I have now gone 6 months without any sustained AF bar 2-3 second fast heartbeats. So yes I consider mine a success as like you I could put up with this for the considerable future fingers crossed. I think it would be a good idea to have that follow up ablation has things have certainly improved for you since you had the cryoablation. Hope I made sense good luck 👍
I had an ablation 4 years ago and have had only about 3-4 episodes since. Three 50 gm flecainide and 2 2.5 beta blockers stop it after a few hours. It usually starts for me when I have eaten something which disagrees with me
Thanks Stoneyrosed. Given your username, are you by any chance from Manchester (Madchester)? I'm a big Stone Roses, Inspiral Carpets, Charlatans, Happy Mondays fan.Yes I think I'll go for a touch up, as I say may be 6 months away.
I’m from Leeds, approx 58 miles from Manchester our arch rivals 😁. Yes the indie music of the 90s was a special time, lots of good Liverpool & Northern bands like The Farm, LA’s, The Icicle works, and of course The Stone Roses, and before all these of course they was The Clash maybe the greatest of them all 👌. All the best regards your AF hope everything settles eventually.
maybe a 2nd touch ablation will do the trick? I had cryo ablation 2 years ago but still get Af episodes every month or so. I’m booked in for a 2nd Rf ablation hopefully this year. Nhs in Coventry
same here the 1st was ok for me. No fear now. I’ve been waiting 6 months already for mine and heard nothing. Coventry hospital did say 9 to 10 months though.
Hi Lenlec are you on the waiting list for 2nd ablation.If so it is always worth ringing and asking ever so nicely where you are on the list .Try to get past the stock answer of oh 6- 9 months .I did this every month or so & told them I wasn't pushing but just needed to trying to have my life back.The last time I rang I was asked the girl said 1 -2 months I asked could she just check exactly where I was and supervisor came on & said can you come next week.Of course I said yes please.
You have started on ablations so I would go for a second in the hope...
A success is when AF is stopped.
Lifestyle is important and stress should be reduced in support of pills/ablations. Sounds like you need to improve here.
Discuss Flecainide details with an experienced medic, probably your cardiologist. I share your concerns but I have been taking 200mgs Flecainide for 10 yrs with no known side effects yet....others here for more years. I would have regular checks to test for issues.
What the heart seems to love is stability/moderation in all things, lifestyle, medications, interventions eg In the early days I favoured PIP for Flec but cardio said no 'too much of a roller coaster for the heart'.
I live rurally, need to travel to main city 5 hours drive away to see a cardiologist. At my local small hospital I have 3 monthly appointments with senior nurse at the cardiology dept. I have been discussing Flec dosages in consultation with her. Yes it's learning to identify the stress early to try and alleviate the risk. I agree the heart likes to be stable, not pushed too hard. Looking back 10 years ago I think I may have pushed myself too hard on my mountain bike, thinking that pushing myself was good for my heart. I now wonder if I was over doing it and stressing my heart too much.
I suppose success is when heart returns to NSR - which for you is what happened. The question is for how long?
Second touch up ablations are very common and not surprisingly really when you think of it. I would take that over continuing medication any day.
Having been through similar to what you describe only Flec caused signs of long QT in my case, the second ablation gave me 3 wonderful year completely AF free after the first exacerbated the AF and severity of the episodes.
For me Pacemaker was the most helpful treatment but again not completely stopped all AF all of the time, but made the episodes shorter, much more bearable and recovering time almost instantaneous after NSR restored so I would call that a success, not a cure but a success. There are pacemakers now which can quite successfully help AF - ask your doctor if you might be suitable candidate.
Hi I’m also 51, diagnosed with AFib in March 2021 and Ablation in October 2021, other than frequent etopics I have been AFib free since, I don’t take any medication other than Rivaroxaban as I have a family history of strokes. I would definitely do a follow up ablation if it meant no AFib attacks as life is a lot easier without them 👍
Great to hear you are AF free. I keep telling myself, at 51 we are young! Last 6 months, I've felt great better than ever, although I'm starting to have to hold things at arms length to read. Better get to Spec Savers!
Thanks CDreamer. I know AF is a progressive condition. Hopefully the cryo ablation and touch up RF slows down the progression. The 2 episode I've had in the last 6 months are definitely different, less chaotic, so I think the ablation has had a positive effect.
I think the Flec is lengthening my QT interval. At this stage I've been classified as "borderline ". Do you (or anyone) know if it's reversible if you cut down or stop Flecainide?
Your next ablation is likely to be effective from my reading around this topic and might well be the last you'll need.
To look more negatively, then it must be so that the cardiac conduction issues that led to your AF won't be affected by ablation in the sense of its affecting the root causes, so no one can predict entirely the future for you. Have you been checked for sleep apnoea, for example (mind you, at your weight, although you don't give your height, that seems unlikely)?
If I were you, I would be feeling pretty confident that I could look forward to a long AF free future. Best wishes to my favourite country from the more benighted UK!
Hi KiwiBlakeThis is a question I've pondered, too. I've had PAF for 16 years now. I had 2 ablations in 2008 and decided that they had failed because I had recurring bouts of AF, much more frequently than you but I always reverted to NSR after 3-4 hrs. Part of the reason I felt it had failed was that I was sold the ablations as a possible cure.
Fast forward 15 years and my view has changed. Firstly it was unrealistic to think I'd be cured. A better way to think of it was that my threshold for triggering an event has perhaps been raised. Secondly, cardiologists have repeatedly told me that it is progressive and I may end up in permanent AF. Well, I now have less AF than in earlier years - 2 bouts per year over last 2 years, vs 2 bouts per month (say) 5 years ago (I have a detailed log). I know there's time yet; I'm 'only' 68. But, like you I'm 70kg, very active and do/eat/drink more or less anything I want (but very careful with alcohol when I'm tired). I lead a pretty unstressful life, fortunately.
So, yes everyone is different and you'll not know what's going to happen with your AF in the future but I now view my ablations as a positive.
Thanks Ken. If in the long run I end up with an AF episode only every 6 months give or take, and revert in a reasonable time I would consider that a sucess.
EPs consider ablation a success if no AF after five years. My third ablation in 2008 left me AF free ever since BUT AF is not the only arrhythmia and a different one arrived in 2017 which was abalated in 2019 . Pacemaker in 2022 also.
As others have commented. life style is the most important thing and stress the worst driver for A F as of course is de hydration. It really doesn't take much pre planning to avoid dehydration and learning to relax can be done. Sounds like you caused yourself a perfect storm so once bitten as they say.
That said another ablation ften sorts things out so not a lot to worry about.
Thanks Bob. My boss has installed a water filter at work for that very reason. I have been guilty of not stopping to eat or drink or day, which I know is a big risk. My wife says I'm a slow learner but she is on my case.
Thanks Joy, from the winter-less north.Yes in an ideal world I'd be med free following the ablation, maybe a touch up would bring that. But I've got to be realistic. I also believe I need to continue to address the underlying lifestyle issues, and stress that have lead to this condition in the first place.
I have to say that I am now much better at dealing with the curve balls life throws at me. Life for me is good, in that I only get wound up to the point I get stressed once every few months or so. I also have a very supportive wife, which is important.
Hi JoyI'm on daily dose of 120 Diltiazem, and 100 Flecainide, both as the single controlled release capsule. I have the 50 Flecainide BNM tablet for use as a PIP which I've been advised to take 2 of these. I've only resorted to using these 2 x in the last 6 months. I don't know what BNM stands for, but have been told these are quickly absorbed as opposed to the controlled release capsules.
My HR pre ablation while sitting relaxing was 65. In the month following the ablation HR while sitting increase to about 75. It now however sits at about 55. While sleeping HR drops to about 47. I don't know what my HR was pre Diltiazem as I didn't have a wearable device then.
I've been on the Diltiazem for about 3 years and the Flecainide for about 2 years. I have been advised to try and stop both D and F, to see if it is required post ablation, and use the PIP Flec as required.
I found 51 a bit lightheaded and in the morning I would not
be able to drive.
Heart Foundation was excellent advice and she knew and had worked with Mr Brendon Wong. Diltiazem 180mg too much. Spoke to him and it was reduced to 120mg slow release. But it has been proved that it lessens its strength at 7pm so 12 hrs cover only.
She acknowledged the BB Bisoprolol which did not control H/R was controlling my BP (which stops adrenaline from entering Heart which is what you need). Anxiety raises adrenaline. Do you understand?
Flec .. is a rhythm control med only I understand.
Never been discussed by the three specialists!
Together Diltiazem and Bisoprolol by controlling my H/R and BP is controlling my AF which is straight rhythm. Do you understand ?
I feel that a lot of AFers go for ablation before getting a history and
introducing the full range of meds.
How is your BP?
I'm just trying to help you understand what a CCB Diltiazem does and
what a BB Bisoprolol does.
Ask if you can try a little daily Bisoprolol to see if in stress it prevents you from having AF periods.
Now I don't have any symptoms of heart pounding etc. My length of walking
is improving including some elevation.
You got a personal message through but I don't dear use it because of the two did not send and I lost them by trying to re........ the page.
I just finished this book where a girl with emotional issues took a BB before
her date!
I never imagined to use it in those circumstances but her specialist prescribed it!
Thanks Joy. I didn't know about the bisoprolol anti adrenaline effect on the heart. I've got a Dr appointment on Monday. I'll discuss it then to see if appropriate for my situation.
Hi KiwiBlake. I read your post; I'm approx same age as you, male, I don't come on here often - mostly just to see how people are or offer any support. I guess the reason I don't come on here often is because my ablation for atrial flutter was a success and I've been in NSR since (1 year ago). I get the odd episodes of ectopic beats lasting a few days at a time which I've been told are normal and nothing to worry about. I take 2.5mg Bisoprolol if I find these are troublesome as a PIP which knocks them out pretty much completely and things return to normal within a day. I take the whole kit-caboodle now - statins, lisinopril for hypertension, apixiban - which I was told to remain on for life as I've had the atrial flutter. I consider all these meds to be assurance/insurance. Most of all, I try to keep well-hydrated and practice mindful meditation, take a brisk 30 min walk each day, chill out and enjoy life the best I can.
Thanks I-a-nJust got your message, it's 9:30pm here. The episode I had last week, to be honest I'm not sure if it was AF or just runs of ectopics. My wearable wouldn't give a definite answer apart from Sinus Tachycardia. HR was at 122. I would have 3 quick beats, a slight pause, then 3 normal beats, repeating, for about 3 hours during which the HR slowed back to mid 60's. Then I went back to NSR. I'm not sure if these are ectopics, I'm no expert. It's definitely a different pattern post ablation than before my ablation last Sept. Pre ablation the episodes were really chaotic. Hopefully I am now just getting runs of ectopics, which are as you say, nothing to worry about. I'll discuss with the Dr.
Hi Kiwiblake. I sense you're a bit of a worrier like me.. I know for a fact though own experience that worry amplifies or even makes this stuff worse. Have a word with the doc and see if he can recommend Bisoprolol as a PIP. If it is just ectopics (however I'd not expect HR to be so elevated unless this was a result of you panicking a little) then Bisoprolol may settle it down as and when required - it does for me. Stay calm - you're going to be OK - remember that. It is difficult as you'll be hypersensitive to any slightest sensation in the heart area, like most of us. Maybe give yourself permission for a day or two where you don't keep referring to your wearable or focusing on sensations in your chest. Try distractions - I highly recommend getting out on long walks, being present with the natural world.. Research mindfulness. Sounds a bit hippy but it works mate. All the very best.
Also, if you're worried about your home ecg, let the doc have a look at it. He should be able to say if it's ectopics. I'm lucky in that I can email my device's charts to the cardiology nurse where I got my ablation. They really have been a god send when I've been frantic with worry. Both her and my doc said they're ectopic beats and will feel worse the more anxious you are - take a bisoprolol. So I recon getting a handle on your stress/worry plays a big part in this.
Hi Ian. Thanks for your feedback. I had an appointment at my regular medical centre, but had a locum Dr, as the centre is currently looking for a new GP, since the last one left. Reason for the appointment was to review my latest blood results for my hypotherydism (which can be linked to AF). The locum GP wasn't able to review my AF meds I have to go back to the senior nurse at our local hospital cardiology unit. So I will discuss with her whether I can try Bisoprolol. From what I read, Bisoprol may be more appropriate as it competively blocks adrenaline in the heart, and my AF (or ectopics) are definitely brought on by stress.Thanks for your input. Blake
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