Appointment to discuss Ablation Procedure

[Blugene]

Hi, l’ve been referred for an ablation and will be attending the consultation appointment in a few days. I’m thinking what advice people could offer with regards of what questions to ask etc. I was diagnosed with PAF in November 2020 following a lengthy episode.

I’m female age 71 slightly over weight, have coeliac disease, and a under active thyroid. Meds are Apixiban 5mg twice a day and Flecainide 50mg twice a day. Thyroxine 125mcg once a day. Otherwise l’m generally quite healthy.

The AF episodes gradually increased from two major episodes in 2020 becoming more frequent, usually monthly, the episodes on average lasted 48 - 72 hr, pulse rate 130. This continued over the next two years. I saw a Cardiologist in October 2022, who prescribed Flecainide, since then the AF episodes have decreased considérable, l’ve had four episodes, three quite close together in April , l increase the Flecanide dosage which does shorten the episodes.( l had pneumonia due to a viral respiratory infection , during this period).

I feel that the Flecacanide has stabilised the AF . MyEcho Cardiogram was ok l have no structural heart damage. I’m reading through other peoples post and just wondering if l should put myself through the procedure when things are stable.

Would appreciate your views on this and thanks for reading.

[BobD Volunteer]

AF is known to be a progressive condition, the old saying being "AF begets AF". If your EP has recommended ablation then they must think it will be helpful but do undestand that it is not a magic bullet and may need to be repeated. IF you do decide to go ahead then do read the following two fact sheets which will be most helpful. (may take a few moments to appear).

healthunlocked.com/redirect...

healthunlocked.com/redirect...

[Hidden]

Hello Blugene, the situation you describe is a fairly common one regarding the way in which AF can evolve. You say that your current condition feels stable but you need to consider why this might be. Flecainide is an effective but potent rhythm control drug and 100 mg per day represents 1/3 of the maximum daily dose permitted and whilst it maybe keeping AF at bay, it is not necessarily the best way to do it for the long term. It’s not unusual for its effectiveness to reduce over time so doses may have to be increased to compensate. This is certainly something you should discuss at your appointment, The other important thing to discuss is your thyroid. An overactive thyroid can certainly cause or contribute to AF as can an under active one so it is important to discuss this as well.

If the Ablation has been offered under the NHS, this is not something which is done lightly and from what you have told us, you would seem to be an ideal candidate for a successful procedure. I’m not medically trained so cannot comment on the impact of coeliac disease but I assume you will raise this anyway. The waiting list is likely to be quite lengthy so you will have plenty of time to consider your position but personally, I am in favour of having an ablation rather than taking rhythm for the longer term. Hope this helps……

[Lakky12]

Ask if it will be done under general anaesthetic or local. If local, ask for confirmation that you’ll be given enough sedative not to be aware of very much - I’m convinced to this day that I wasn’t given any sedative whatsoever, and it wasn’t pleasant! However, if you get the appropriate amount if sedation it’ll be fine. Good luck!

[wilsond in reply to Lakky12]

Me too,and when I asked that question on review I had only been given 1mg of sedative,could have had 10mg. Now written in my notes and I will double check if need it touching up.Awful at times

[secondtry]

My vote is to get yourself on the ablation list and ask whether you can take 200mgs/day Flecainide as those episodes need to be stopped. I would also read up on lifestyle changes which will help.

There is likely to be several months before the actual ablation day and you can take a final decision whether to go ahead or not when you have seen the impact of the proposed changes.

Lastly you need to do some research on whether the Covid/flu booster jab is a good idea as it could 'irritate' the heart and from I have also read it provides insufficient protection.

[CDreamer]

The questions I would ask:- who will be doing the procedure; how many do they perform a year; what type of ablation - cryo or RF; what sort of success rate for someone like me; if I choose ‘not at this time’ can I change my mind later down the line & if so would that decrease the efficacy of the procedure; what alternative treatments;

Above all read the links that Bob posted and know that everyone’s recovery is very different. I have 2 neighbours who had ablations recently and recovered very quickly - although both in their mid 80’s recovered within 2 weeks, out playing golf and back walking - but both were also ex-athletes.

There is a theme here - the fitter you are the more likely you are to make a full and quick recovery so use the waiting time to hat as fit as possible!

[lizzieloo2]

Hi. I have had PAF for about 10 years now. Once diagnosed and medication altered (on 300mg Diltiazem daily, 20mg Rivaroxaban daily and 100mg Flecainide as PIP), my episodes were between 9 months to a year apart. However, this is a progressive disease and my episodes began coming more frequently to the point where, 2 years ago, they were weekly. My cardiologist suggested ablation again (offered it originally but I declined then) as he didn't want me on Flecainide long term as he said it could kill me. I was sent a big booklet on ablation by the arrhythmia nurse and given a telephone appointment a couple of months later giving me plenty of time to digest the information and write down all my queries (it was a long list!) The nurse answered everything to my satisfaction and I decided to go ahead as the condition will only get worse and it seems that ablation is more successful for people with PAF rather than persistent AF. I had to wait about 18 months and had the catheter RF procedure in August this year. Apart from the day after the procedure, I have now been AF free for 5 weeks so there is definitely an improvement so far. By the way, I'm 69 next week and also have no structural heart damage and my feeling was it was better to have the procedure whilst still relatively fit rather than put it off and maybe suffering with something else down the line. I had a GA and am not sure why others have only had sedation as my anaesthestist told me that he would be putting me under deeply as the EP didn't want me moving whilst he was zapping. Good luck with whatever you decide but it's worth going on the waiting list until you have more info as the lists are long and you can drop out at any time. Let us know how you get on x

[Sixtychick]

I’ve got my catheter ablation next Wednesday. I’m obviously scared, but I have all the info sheets from this site, that Bob goes on about, which are very useful and I wrote a list of questions when I has my pre-assessment appointment. They are doing mine under a local with sedation and as I’ve never had sedation before, I’m worried about that, as well as being worried about stopping my Sotalol tablets for 2 days, as it says in block capitals, do not stop this medication, as it can cause heart attacks and other problems.I decided to have it done, as PAF can develop into continuous AF eventually and I’m hoping it’ll work, as I only get it occasionally, although I had it in Jan and Feb this year. In Feb, I tested positive for Covid when I went to A&E and they said that was probably what started it that time. I’ve been told by Doctors to go to A&E when I get it, as my BP soars and my heart rate goes very high and it feels so horrible,I’m too scared to stay at home with it anyway. Fortunately, it doesn’t happen very often. It took me ages to decide to go for it, so hope it’ll be worth going through with it. 🙏🤞

[Foulplay]

My husband had the ablation in May . He is 62. He was I Afib for over a year before being diagnosed. He started it after contracting the original strain of Covid in early 2020. His Afib was controlled with the medicine with a few episodes a year. On the medicine even though it was controlling it he was short of breath walking up stairs, and had no stamina . He never really felt well. A few months after the ablation he felt like a new person and could do the things he used to do like repairing our deck. Our neighbor who had Afib saw the difference in my husband . He was afraid he would not be able to walk around San Fransisco for to his sons wedding. He was short of breath a lot too. His Dr wanted him to have an ablation and he kept refusing . He just had an ablation 2 months ago and the shortness of breath with activity is gone. He is at the wedding this week.It really made a difference .

[Morzine]

I get what you’re saying, I’m about to choose my date for my. Second ablation. My kids said why not wait as I’ve on,y just got afib back a few weeks back after beung free four years…saw cardio two days after it was back, and I’ve already had the email to choose my date , ….I did lie in bed thinking last night, should I do this? But I’ve always said I’d do a second one as for me those four free years gave me peace of mind and i never thought much about my heart….so I will do it and hope I get a few more years freedom.

My last one I worried beforehand and after I told myself it was unnecessary….now I’ve got to listen to my old words and get on with it!

Sue