6 weeks ago I had a successful cardioversion but sadly it lasted just 20 days before I went back into AF. Yesterday I had a follow up appointment at the hospital where they said that the results of my echo cardiogram had come back normal but that they felt that the best option for me, based on my age, 50, and history was not to try another cardiogram but to go straight to an ablation.
I'm okay with that, I always thought I'd end up having one anyway and it makes sense to me to have one now. However they have said that by the time I have a consultation to decide what type of ablation I need and the waiting times for it, it's going to be around a year before I have it.
The problem is though that I am in constant AF. I never come out of it, it's there 24hrs a day but my rate is controlled (average heart rate is 80bpm) and I'm on blood thinners.
I know there is nothing I can do about the waiting times but doesn't being in constant AF for a long time mean there is less chance of things like cardioversions and ablations working?
Other than losing weight, which I'm determined to do, is there anything else I can do whilst I wait to hopefully improve the chances of a successful ablation?
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Peakoverload
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Good that you are trying to loose weight as this is the no 1 best thing you can do. Aiming for a BMI of better than 26 often drastically reduces AF burden.
Provided your rate is well controlled and kept under 100 there should be minimal risk in any delays since you are anticoagulated for stroke prevention . Keep working on that weight and stay well hydrated at all times.
Unfortunately, papers suggest that success rates of people in long-term persistent afib (longer than one year) are significantly lower than those not in long term persistent.
I would therefore try and push for an earlier ablation if possible and/or talk to your doctor about anti-arrythmic's to keep you in sinus rhythm while waiting for an abation. Assuming you haven't tried them already.
As to losing weight, arguably the single most important thing you can do lifestyle wise. Studies show significant improvements in ablation outcomes with a 10% weight loss.
Jim
The good news is that you are in a much better place than many. Unfortunately, unlike in the US, where health care is predominantly insurance driven and money can move mountains, here in the UK especially at the moment, any treatment whether it’s consultations or treatment, it’s virtually impossible to short cut waiting times so doing everything thing you can to keep your heart rate below 80 bpm will pay dividends. Although my cardioversion lasted around a year, when it started to falter, I was prescribed a daily maintenance dose of Flecainide which helped to keep me in NSR for another 8/9 months whilst I waited for my ablation and that was back in 2016!!
If it’s possible, and you are in a position to respond at short notice, it’s worth making the hospital aware that you could be available for a cancellation at short notice but to be honest, they will probably have a pretty long list of patients on that list too!
Keep the heart rate below 80 bpm and any worsening of your current situation should be minimal…..
just had a thought, not wishing to pry but at 50, unless you have some other health issues, it’s not usual for someone to be taking anticoagulants. They offer tremendous benefits, but can also carry risks, is this something which has been discussed with your GP/cardiologist or is it a short term precaution due to having the cardioversion?
As stated. success rates are affected by persistent afib but you have somewhat of a counter with your young age (50).
You may be an ideal candidate for the minimaze procedure. May want to consult with your doctor and get second opinions. If you are not familiar with the minimaze, use search function above as it has been discussed on the forum.
I'm surprised they haven't mentioned putting you on Amiodarone for a couple of months, then trying the cardioversion again as that is worked for me.In my case, the previous prolonged bouts of AF have caused my left atrium to dilate and now I'm waiting for ohs for a valve repair, so I would have a chat with your EP about the above........ I was 49 when my AF kicked off.
As someone else suggested, look into the mini maze. MummyLuv is the expert so have a look for her posts in the search bar. They are supposed to be doing a Cox IV Maze when I have my valve repair but that is only done if you have ohs. Tbe mini maze is not as invasive.
I was in a similar situation until recently and even toying with idea of taking equity release and paying privately. Fortunately my EP dissuaded me from such a mega life choice and not long after the waiting times for ablation were cut through NHS buying in to the private sector.
I have twice paid for a private consultation with an EP who also works with NHS. This did not allow me to skip queues. However it did give me good long appointments and the opportunity for the EP to get to know me, offer reassurance, think realistically, understand the risks, explore all the options. And he headed the team doing my ablation just a week ago, one year after being diagnosed with persistent.
If it was me, and as others have suggested, I would look into the mini maze procedure. Here's a recent video on YouTube by Dr Wolf (Houston USA) who invented one version of the procedure. l learned a lot from this video and so highly recommend it.
You should be offered another cardioversion - usually the second cardioversion is offered with a short course of amiodorone before and after and should last longer because of that. I had this and had blood tests every month to make sure the amiodorone was not causing serious side effects. At the end of the course my thyroid count was about 3 points higher than it should be but within 3 months was back to normal and I had no other side effects.
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