AF and heart failiure

[Flippy1]

Hi,

I am 56 and new to this community, I have had AF since 2019, I don't have symptoms. It was discovered when I was knocked of my motorbike as the paramedic noticed my heart rate hadn't gone down,

Initially I was in and out of AF.

I had a review in September 2023 and the tests highlighted thast I am now in AF all the time and I have 31% ventricular ejection fraction which is heart failure. I have no symptoms and am pretty fit, running and playing football.

The cardiologist is suggesting an Ablation for the AF and that it might also improve the heart function, when I saw the GP they didn't see how the Ablation could improve the heart function

I am also now on bisoprolol meds,

Its all a bit of a shock, any advice, similar experiences to share, tips would be welcome and appreciated,

many thanks,

[BobsBeat]

The Bisoprolol is a beta blocker, which will keep your heart rate down while in AF, preferably between 60 - 100 BPM at rest. An active HR would be higher.

Have they tried you on any AADs (Antiarrhythmic) drugs, such as Amiodarone, Flecainide, etc. to try and convert you and maintain NSR? You could do an AAD in combination with a Cardioversion (to convert you) if necessary.

If drugs fail to keep you in NSR, then Ablation or Mini Maze would be something to consider to stop the errant signals causing the AF.

There is strong evidence that your heart and EF will improve if you can get into and maintain NSR. I wouldn't even bother with the GP after his comment and would look for a great Cardiologist or preferably an EP (Electrophysiologist) who specializes in Arrhythmia issues.

[Flippy1 in reply to BobsBeat]

Hi BobsBeat, thank you that all sounds really useful, they had talked about a cardioversion when I had just the AF, now with the discovery of VEF at 31%, they are now suggesting the Ablation, though they are saying I am not a priority so likely to be end Feb/March - they haven't mentioned Amiodarone, Flecainide, maybe I should ask about it?

[BobD Volunteer]

Generally the first thing to do would be try a cardioversion to see if you can attain NSR. Little point in going for an ablation if you can't though I think your GP wrong.

If AF can be stopped then the ventricle will not be working so hard and EF may improve over time. .

[mav7]

I have 31% ventricular ejection fraction which is heart failure. I have no symptoms and am pr

etty fit, running and playing football.

Was the ejection fraction discovered during an echocardiogram ? And did the echo reveal any other issues ?

[Flippy1 in reply to mav7]

Hi mav7 yes it was discovered during an echo cardiographer, no other issues were discovered

[Rainfern]

Welcome to the forum Flippy. You’ll find a lot of support and good advice here. GPs have to know a huge amount about everything so no matter how brilliant they are they won’t be as up to date as a specialist cardiologist - preferably an electrophysiologist (EP) who will be experienced and up to date with all the latest advances in practice and guidelines.

You may want to consider getting an independent opinion from a private EP (this was my initial route) as ablation is not the only procedure available. For instance when I enquired about mini maze my EP said that might be a first line of treatment if I had signs of heart failure, which I didn’t.

The GP would have been content to take a purely medical route for my low level persistent Afib. However, after attending a talk given by an EP and joining this forum I went the ablation route. Learn all you can, be pro active and let us know how it goes!

[Flippy1 in reply to Rainfern]

Thank you I was thinking about the value of paying to get some independent advice, I live in London and am with Barts Hospital whocb has a good reputation, but speaking to anyone is very hard and I have only had a telephone appointment, any recommendations would be welcome

[opal11uk in reply to Flippy1]

There is a very good Cardiologist at Barts and I am desperately trying to remember his name, he is world renowned for his work and especially with A/F, perhaps someone else can recall his name, it sounds German.

[Rainfern]

Great, you are lucky to have Barts. You might be best to post a separate question for EP recommendations. It’s not my area. The advantage of a private consultation is you get time to ask all the questions you want and establish a good working relationship with a consultant. Hopefully you’ll find someone who works across both private and NHS sectors. That way you’ll know the consultant if and when you’re offered any procedures. I wish you luck. It’s such a shock and worry when first diagnosed but does get easier once you’ve clarified a way ahead. Keep asking questions here. The good people on this forum were a life saver for me. Good luck!

[Fullofheart]

I'm 48, had 3 ablations last year and achieved nsr 5 months after the last. First time in normal rhythm for 20 years. My ejection fraction is lowered too and I was due to start heart failure meds just before going into NSR. Now not on any meds.

Had an MRI last week and I'm hoping/ expecting that the EF will have improved from 7 months of NSR.

There are lots of treatments options. Being under Barts is a real advantage but if you can't get to speak to someone one option is to pay for a private consult (around £200 ish usually). Plan being to stay on the NHS list for any procedures (which as Bob says might well be cardioversion first, then ablation) but to talk to someone sooner. That might feel helpful. You can also discuss rhythm control meds then too.

[Ppiman]

I think the term "heart failure" is a broad one and can apply both to a reversible state caused by an arrhythmia, and a less reversible state caused by physical changes in the heart.

My EF feel thanks to my persistent atrial flutter and tachycardia, but it returned to normal after my ablation.

Steve

[wilsond]

In my experience GPs often have limited knowledge of heart conditions,especially AF and flutter.Listen to your cardiologist, they are the people with the knowledge and yes I've seen on here several comments on improved HF after ablation

Best wishes

[Glendafellows]

hi your ejection fraction is low. I would ask to be referred to heart failure clinic to see if it can be improved and get more details from them and your cardiologist about what are the consequences to your heart if you do not proceed with the ablation at this time. Afib is a progressive condition. Best of luck.

[opal11uk]

I have remembered the name of the Cardiologist, it is Schilling and I believe he is at Barts, last I heard he was definitely in London. He has an excellent reputation and I personally would not hesitate in going to him.

[Flippy1 in reply to opal11uk]

That's brilliant thank you, I will follow up and ask about him