I'm fairly new to the afib club. I've started experiencing episodes of afib or atrial flutter in August 2022. Since then, I've experienced an episode fairly infrequently (about one or two a month and the majority of them last for less than 2 hours). I've been hospitalized twice, once in January 2023 where they used medication to cardiovert me, and again around April 2023, where I went to the emergency room and ended up cardioverting back to normal rhythm on my own.
Since January, I've been taking metroprolol 50mg twice a day and its been keeping my heart rate pretty consistenly low (66 to 76 bpm) at rest compared to what I used to be without medication (86 to 96 bpm). I've been able to recognize when my heart rate is going too fast or if I'm about to have an afib or atrial flutter episode, and have been taking an extra dose of metoprolol as a pip method, which usually works.
My triggers are usually alcohol (I've cut down considerably from two drinks a night to about one to zero drinks a week). I've quit smoking, which has helped my blood pressure and reduced spikes in my heart rate. But at times, I feel anxiety around being able to go out and enjoy life because something might trigger an episode. For example, I enjoyed some time in a hot tub with friends and it seemed to have triggered an afib episode. I went to Costa Rica and the extreme heat and humidity made me vulnerable (ie. fast heart rate) and I had to basically take an extra dose of metoprolol to reduce it to somewhat normal levels for the day for fear of it spiking too high and triggering an episode.
I FINALLY was able to see an electrophysiologist today for an official treatment plan. He presented flecanaide pip method or an ablation. I'm fairly young (42 year old woman) and I'm social and active. I'm not asking for medical advice, but I'm wondering what others may have done when presented with these choices. I took the flecenaid for now... but am wondering if I should call my EP back and go for the ablation for a better chance at living life normally. Thanks for reading!
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Auriga321
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If I was you and offered an ablation at this early stage I would go for it - but that's me. I waited far too long before being referred to see an EP and then by the time I had seen him and had a couple of successful cardioversions Covid hit and I missed out on my ablation as by the time after deaths in the family and the cardiology unit at the hospital being closed due to an outbreak of Covid I had to have new scans and tests and the tests showed further treatment would be unlikely to work as the heart had remodelled itself. So now in permanent but low rate AF. Possibly the question to ask is: Do you want to go on taking medication for life for AF with the AF likely becoming more frequent and lasting longer. ask your EP if you were their wife/daughter what would they advise. Waiting Longer until the AF becomes life changing (though it sounds like it already has).
In the meantime cur out everything you know to be triggers and other possible triggers such as caffeinated tea and coffee and artificial sweetners. If you are over weight then start losing weight and eat as a natural a diet as you can with generally less meat and processed foods with meals cooked from scratch - a little and often is better than 2 large meals a day and drink plenty of water - even if this doesn't help your AF it is likely to make you feel better and healthier in general. Try your best to avoid anxiety and stress - easier said than done but that is also a trigger for AF and Af itself can induce stress. I always try Yoga breathing and find this helps.
There is no doubt that early intervention by ablation stands the best chance of a good outcome before too many rogue pathways have been formed. OK there is no guarantee that it would not need repeating but why sentence yourself to a life time of drugs ar your age.
Hi, I was diagnosed with Afib in Jan19 (53 then) after a heart attack. Since then I have been on daily Flecainide (150mg) and ‘Afib free’ for 3+ years now. I also have the option of an ‘emergency PiP’ (extra dose of Flecainide and a beta blocker), should I have an episode; thankfully never had to use this. The current trend is to move me from daily medication(chemical cardio version ) to PiP only. This is up for discussion at my next review.
The treatments for this condition have been described to me as a ‘arsenal of weapons’ to use against it. My cardiologist (and me 😀) has been happy with my stability, the condition appears to be kept in-check, just with medication (plus lifestyle and exercise). No one knows if or when it will progress but he (and I) is content with the current position and wants to ‘save’ the ‘heavier weapons’, the more invasive treatments should I need them later.
My Afib episodes, so far, always auto revert to NSR. Since starting treatment, I had one more episode mid 2020, which auto reverted again and since then nothing!
I am very happy with the status quo. I feel I don’t have any limitations currently, my meds are tolerated very well and I live a very social and active life. The choice I have is whether to move to PiP only. It is a risk, I might not be able to maintain NSR and what are the implications if I have more episodes, that are subsequently stopped with medication. Will this aid the progression of the condition?
I am not anti medication or treatment and I will do what is required and advised by my cardiologist. Over the last years, daily medication has been removed. An anticoagulant was removed as I am under the threshold for it and the beta blocker was dropped as my HR is low ( unless in Afib). I do generally feel ‘less is more’, so if there is the possibility that I might be able maintain NSR without daily medication (with a PiP backup) then I should give it a try.
As always, discuss any change to treatment or medication throughly with a doctor.
Hi, I would probably go for the ablation and give it a go. I know your frustration though. I am 68 and was diagnosed 3 yrs ago in A&E and fast tracked to my local cardiac unit. Well it took almost 6 months and was offered ablation by the EP... after tests, echo etc. There was Two year waiting list, but I was seen about 12 months in. ...Consultant said there is a 50/50 chance of success, and it out me back in NSR for a week!!!...Now diagnosed with long standing persistent AF...By the way approx 50% of AF patients have permanent AF. My pulse was a little high, so they have increased my bisoprolol to 7.5 mg daily and I am on Edoxaban and Flecainide...I am listed for a cardioversion, so another wait, at least here in the UK.....I am philosophical about mefication, as I could well progress to permanent. I have no problems taking tablets, and you want to avoid complications and Afi b is progressive....I get totally stressed and was a keen runner. I walk now frequently and go to the gym, don't drink caffine, reduced my alcohol intake to an occasional drink, watch my weight and don't eat cra p foods!!....However, keep positive and follow the advice of you Cardiac consultant
If it were me, with so much life ahead I would have an ablation. Prevent or at least slow the progression of AF (it tends to be progressive) before it remodels the heart or becomes persistent or permanent. My EP would say the same. However you couple of course spend a year or two to see how it goes and then decide. It is a much mess scary procedure than it sounds
No harm in getting in the queue for an ablation and then taking a final decision when you are called up. In the meantime, there are a lot of lifestyle changes (often discussed here) that may help and I would consider asking your EP the pros and cons of taking Flecainide daily.
My EP told me that the sooner you get the ablation the more effective it will be, that the longer afib goes on the harder it is for an ablation to correct it. I chose to have the ablation because:
1) If I had the ablation I could get off of some troublesome medications and, more importantly, I could always go back on those medications if my afib returned.
2) If I declined the ablation and my afib got worse, my options would be to increase the dosage (how long could I tolerate that?) or go on more troublesome medications, or I could finally try a belated ablation and hope it would still work for me.
I seem to be a contrarian. If possible I want to stay away from invasive procedures is medications can help. PIP is something you don't take regularly but only when needed . If it stops working you can always have the ablation which is not a guaranteed permanent solution. However get advice from a cardiologist, preferably two.
You are absolutely right to consider all the options. Regrettably, all the indications are that AF gets worse over time and therefore medication has to get stronger to try and control symptoms. As has been said, the earlier an ablation is carried out, the more successful it is likely to be but sometimes more than one is required to get optimum results. At 42, you have many years left and from what you tell us, you enjoy life to the full, almost all AF medication have side effects which are not too dissimilar to the symptoms of AF.
Only you can make the final decision and I’m in agreement with Secondtry, get on the list because you will have plenty of time to change your mind ……which you won’t 😉
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