About 1 year ago I suffered with recurrent AF episodes usually overnight and they lasted from 1 hour to 5 hours. On two occasions I went to A&E and was kept in A&E overnight. I got a consultant appointment and he prescribed Flecainide 100mg twice per day and a spot on the NHS ablation waiting list. The Flecainide seems
To have worked and I have reduced the dose to 50mg twice a day without any adverse consequences.
. I am worried about having an ablation and if a low dose of Flecainide is working I am inclined to wit and see and not to take up an Ablation if offered. Am I being short sighted?
I have my consultation next week and seek your kind advices
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Jazzguitar22
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If you are ok with your tablets I wouldn't consider an ablation now. Procedures are improving all the time and when you really need one they may be more successful. I've had three, last one in June 2016, and still have permanent AF but at a low rate between 60-90bpm.
Changing my diet and not eating foods containing artificial additives helped me more than anything else.
Having had AF for 18 years, three ablations (where they go up through your groin to burn or freeze the inside of the heart where the rogue pulses often come from) and numerous cardioversions (electric shock to put the heart back into it's correct rhythm) my advice to everyone diagnosed with AF is the following:
1. Be Aware you are most unlikely to die from Atrial Fibrillation (AF). I used to think that the way my heart bounced around I would surely be found dead next day. Still here though!
2. Changing your diet to a more plant based one, avoiding any foods containing artificial additives, not allowing yourself to become dehydrated, cutting back on sugar, alcohol and caffeine, also losing weight (if it's needed) will all have a beneficial effect on your AF. Artificial sweeteners were a sure trigger for my attacks. How I wish I'd known all of this before having any of my ablations. Would I have listened if anyone had told me? Probably not, because I believed ablations would cure me - three didn't! They have helped some people though and my AF now is not so severe.
3. This is a hard one, but looking at gadgets that show your pulse and AF will make you anxious and anxiety feeds AF. I was obsessed with what my heart was doing for about the first ten+ years of my AF journey and my attacks were so debilitating I'd end up in a hospital ward, it has taken me a long time to take my mind off this subject and get on with living. The less I think about it, the better I feel. Now I used to feel cross with people who suggested I stop looking at my pulse rate machines, I thought that their AF couldn't be as bad as mine and they didn't understand how poorly attacks made some of us feel. I would get cross with anyone who said they could still go on holiday and carry on life as normal. They made me feel evil, by not understanding how ill I felt! In our minds AF is only as bad as we have experienced, for some attacks are mild for others they're more severe.
4. Make sure you don't slouch, or unwittingly do shallow breathing while watching tv or if you're online. If you do your heart will protest. Also avoid tight clothing around your waist.
5. Try supplementing with magnesium, any type except oxide (I use glycinate from YourSupplements and also take taurine, zinc, vitamin B complex, D3, K2 & C). I feel fine and there's little I can't do now, despite being in constant low rate AF. Or at least I think I am, I don't check these days.
6. If over 60 I would make sure that you’re taking an anticoagulant to prevent blood clots forming and causing a stroke. Note that they do not thin the blood in any way, just stop it from clotting so quickly. You should not notice any major difference in the way you bleed.
I would have done anything to not take the meds so I would say investigate ablation & if you have been offered a slot and there is high chance of success then the earlier in the process the better. Flecainide is a toxic drug, as a PIP it worked well for me - for a short while, daily dose it held AF for about 12 months & I started showing early signs of long QT. Many people can take it without consequences but my reasoning was why take a drug with known toxicity when you a procedure could mean you don’t need to. I chose ablation to be drug free.
Lifestyle adaptations whatever you do will help and if you go for Ablate- the fitter you are the more likely you will be to have sustained NSR. Similarly if you stick with the drugs if you eat well & avoid alcohol it will help your body metabolise the drugs and be a lesser burden in your liver & kidneys.
Do all the research you can around ablation, what type, who would do it, how many per year does the EP do, what are their success rates - ask lots of questions and remember that you accept being in the waiting list and know you could pull out at any time. How long were you quoted for the waiting list?
How can we help ease your concerns about the ablation process?
Thank you C Dreamer for your reply. I was quoted a 1 year wait for an ablation and that time is almost up. I will definitely look into statistics around an EP once selected. I will see what my cardiologist advises on Tuesday
I've had paroxysmal AF for about 10 years now and up until about 6 weeks ago, took 100mg Flecainide as a pill in the pocket for when I experienced AF episodes which were coming every 2-3 weeks. I was offered ablation when I was first diagnosed with PAF but didn't fancy it and my cardiologist at the time didn't push it. However, as the episodes became more frequent (every 9 months to a year to begin with) and knowing that this condition is progressive, I asked my new cardiologist about it. He said he didn't want me on Flecainide for any longer than necessary as it could kill me. He explained the catheter RF ablation fully and I found it less daunting than I had thought, so about 2 years ago, I decided to go for it and went on the waiting list. I was sent a big booklet about ablation and scared myself after reading it but made a note of all the queries I had and discussed these with the arrhythmia nurse and was put at ease. I finally had my ablation 6 weeks ago and was immediately told not to take the Flecainide PIP or the Diltiazem I took daily. I had an AF episode the day after the ablation but wasn't surprised as I had all the usual triggers (overtired from not sleeping the night before, dehydration from not being able to drink for 14 hrs and did too much as I felt OK). My cardiologist then put me back on the Diltiazem until I see him in 3 months but told me not to take the Flecainide unless absolutely necessary. It is now nearly 6 weeks since I had an episode so I am hopeful of success and certainly don't want to go back to the Flecainide. I'm sure your cardiologist will discuss this in more detail when you see him. Good luck
Tbh I don’t know why ablations are not offered sooner. Once the electrical rhythm gets out of sync it will get progressively worse.
Look up Dr Sanjay Gupta on YouTube talking to the consultant who trained him. It is extremely informative. It explains it all. It seems those who have PAF would benefit from n ablation sooner rather than later.
My cardiologist consultant has never mentioned one 😳 He’s recently changed my tablet to Dronedarone and now I have to have regular blood tests on my liver! And. Have a liver disorder 😳
I waited about a year and I think it caused damage. When dr did ablation it took longer because of damage. Make sure experienced dr. Been in rhythm for 6 months and no meds. Good luck with your decision.
If your AF is controlled with the lower dose of Flecainide then perhaps an ablation is not the right time. But it is clearly an individual choice. Flecainide wasn't working for me and my AF episodes were becoming more frequent and for longer periods. I chose to accept the offer of ablation and after 5 years still consider it a success ( I don't take anything for granted!). I have rare episodes of AF and some eptopics but that doesn't worry me. Bristol Heart Institute looked after me very well. Good luck to you.
I think the whole purpose of an ablation is as a prophylactic- ie stop the PAF from becoming persistent AF.
I am in the same situation in that I'm65 now and have had PAF for about 10 years now and treated it with 50mg Flecainide twice a day. If I have an episode I take a big dose of 300mg Flecainide and 50mg Metoprolol.-My AF episodes are about once every 5-6 months lasting about 6-8 hours. I am also taking Rivaroxaban.
I am due to have a Pulsed Field Ablation in the UK in October as a prophylactic measure to stop my PAF from becoming persistent as I get older.I am also hoping to come off the flecainide but understand I will still have to take the Rivaroxaban.
Get on the ablation list first and re-assess the overall situation when your number comes up, maybe having a private cardiologist appointment just before the date to conclude on your options. In the meantime reduce all forms of stress and address better lifestyle choices generally.
If circumstances remain the same, I would not go ahead with an ablation as procedures will improve. I was offered an ablation by both cardiologist and EP but the success rate quoted and possible complications was not sufficiently convincing.
Latest data is confirming that the earlier the ablations are done the greater chances of success are more likely.
I understand your concerns completely. I tried everything, diet, yoga, meditation, HRV training... and we all know that we are each different in how AF manifests, in my case I regret not having gone in sooner. Nonetheless it was important for me to know that I had tried everything possible first . I waited 4 years with AFib RVR and it was too long!
I am 6 ablations in and awaiting my 7th in October!
I started with Flecainide and a few different BBs and although they will reduce the duration of an episode and reduce the pace from 180 to 150, they still last 4-6 hours and they are every 2-3 days. IF I don't take the meds, an episode lasts 15-18 hours. I also tried many other medications and various combinations.
Follow your instincts with your evolution... but if I were you I would put my name on that waiting list! You can always say no, and you will make another patient very happy by being moved up!
Having reread my post, must not be very encouraging! I will explain so as to not dissuade others from ablations.
The second ablation was interrupted so aborted. The EP preferred under ablating and repeating than over doing. The fourth worked for two years. My EPs were highly qualified and experienced.
The fifth did not succeed and the sixth was done by a referred Professor, again a highly qualified and respected EP and applied a different procedure as it was a retrograde aortic approach.
My 7th will be PFA.
As I've mentioned to the EPs, " repeating the same thing and expecting a different outcome.....🙃🤪" Vive Einstein.
Daily meds make me unable to work and the PIP is less and less effective. I have been classified as Persistant as the PIP every two days seem to give me a break of 24-36 hours and I guess it is their half-life that buys me a bit more time... even with the meds it takes 4-6 hours to convert. The ablations took me down from episodes of 18-35 hours and rates of 180-210, and now 4-6 hours in duration every 1-2 days, and HR is, with meds, reduced to to 140-150bpm. So there is improvement!
I seem to be an exception with multiple resistant foci points, but there was still a positive effect which changed my quality of life, which is the only reason I'd be willing to have a go, yet again.
I've tried all the meds available as well,
Perhaps with these details it will make it seem a wee bit less insane to try, yet again!
The goal of this is to say, ablations are doable, and in my experience better sooner than later!
At the end of the day it is all so personal, and none of us have the same AF, so I wish you the best in your choices and for successful outcomes!
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