Post Ablation advice please??

[Jonboggs]

I underwent an RFA for Afib and Aflutter in late last year (coming up on end of blanking period) for paroxysmal afib/flutter first diagnosed 5 years ago. I have been on Flecainide and Diltiazem for several years. Prior to the ablation, I would experience episodes about 2x a week for about 12-24 hours with a heart rate in the 100-120 range. An echo done 18 months ago showed mild LAE and following my recent ablation, my EP said she observed a moderate enlarged LAE but it was not “worrisome” and that things had gone well.

I had no symptoms for the first 3 weeks following the ablation and then the Afib began to return. While the duration of the episodes is now shorter (2 - 8 hours) my heart rate is significantly higher 140-170 during the episodes and my quality of life is worse. I am having 2-3 episodes weekly

My EP seems less confident now in possible long term success, citing now the challenges associated with a “really big left atrium” and my choices now look like either going in for a second ablation (quoted 50/50 success opportunity) or pursuing the dofetilide route. I have also been advised in the meantime to stop Flecainide (maybe causing issues?) but stay on the Diltizem.

As many other posters here have experienced also, I am pretty discouraged and not sure what to do.

Would really appreciate any advice on the following:

1. Should I give things a little more time since I am not totally through the blanking period?

2, Has anyone actually improved after discontinuing Flecainide?

3, Any thoughts about second ablation v. Dofetilide route? Would a second EP opinion make sense?

Thanks very much - this forum has been extremely helpful to me.

[jeanjeannie50]

I had been on Flecainide alongside Metoprolol for many years, then I visited a cardiologist (hadn't seen any medical heart person for quite a few years). He looked at my ECG and immediately said that I should stop taking the Flec as it looked as though it was causing more problems than helping. I did and felt so much better almost immediately. Suddenly I had a lot more energy and instead of mowing my back lawn in 4-5 separate sessions, with rests in between each one, I could do it in one.

Jean

[Nan1]

Hi, sorry to read your post and that you are having a rough time. I cannot help with your questions as I have just had the ablation so early on in my recovery but I’m sure you will get a lot of advice from people on this amazing Forum. Can you tell me how you cope when your heart rate is up at 140-170?

[Jonboggs in reply to Nan1]

Thanks Nan1 -in all honesty it is pretty difficult to cope when it is really racing - and the most disruptive symptom is feeling very lightheaded. Unfortunately, it has happened at work in meetings, which is tough. One small positive is that I can usually tell it is coming on - the ectopic beats get more frequent - and while it starts off very, very high, it will gradually decrease “down” to the low 140s Breathing exercises have helped a little and I try to remain calm and remind myself that it will pass and that - as we all here know - living through/improving our Afib is a journey.

Best of luck recovering from your ablation - will wish good thoughts!

[Nan1 in reply to Jonboggs]

I can relate what you say as on Friday I had ectopics all day then AF started and HR up to 140. Felt rough so can’t image how you deal with 170. Thanks for reply.

[absolutepatsy]

I can relate to what your saying. I have had AF for 10 years, 2 ablations, first worked for 2 years, second for 3 months. Been on a lot of different drugs which helped for a bit then was back in AF and ended up on donederode which is quite toxic. It has caused me to have a red face and I burn't my skin, even with high sun block and subsequently ended with Basal Cell Carcinoma, small cancer spots x 2 on my face which I have had cut off. (They do not spread so I am clear of Cancer) I have had enough of AF and losing weeks out of my life as I am so symptomatic, high heart rate, breathlessness but mostly fatigue and not being able to go out, like walking through treacle.

I asked for informaton on a pacemaker and while it is a scary decision the EP was happy to fit one. , I had it fitted 2 weeks ago and now await an AV Node ablation which will make my heart totally rely on pacemaker. I have joined a couple of groups and found that although the heart still goes into AF with a pacemaker, you shouldn't feel any symptoms as the PM kicks in. I will report back on here when I have the ablation in 2 weeks. You may want to consider discussing this with your Cardiologist. Hope this helps a bit.

[Jonboggs in reply to absolutepatsy]

Thanks for the information about your history. Very helpful to hear and will definitely discuss with my cardio. Look forward to hearing more about your coming ablation. Best of luck!