Heart function team suggest course of amiodarone combined with further CV after a few months of this medication.
They have left it with me to consider what I would prefer to do.
Either proceed with the above ( with a list of potential side effects which are impossible to predict ahead of treatment) or put up with persistent AF of the normal HR variety. Mildly symptomatic. Hills are difficult and slight dizziness.
Previously consultant suggested straight to ablation if CV fails.
Also …should I be asking for an EP study. How do you “qualify” for this?
Thanks as always Forum friends
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Hallane
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You probably know that if it's long-term persistent ( over a year) no guarantees, other than this would probably not be your only ablation.
Keeping that in mind, you might consider a surgical ablation like the mini maze. Some here, who were persistent have had good success with it.
Without knowing your history, hard to say, if a cardioversion with amiodarone makes any sense. But you're still relatively young, so better to ablate now then when you get older.
These days EP study is generally done at time of ablation, in other words, they go in and if cryo ablate round the pulmonary veins and then see if AF can be generated and from where. On the other hand if your rate is well controlled and you are anticoagulated it would depend largely on your quality of life if ablation was advised.
i had one cardioversion and they got me on the 3rd and last try, no medications prior. The next one 4 months down the track they gave me Flecinade for a week and BB metropolol and the Cardioversion worked the first time.
I've had several cardioversions and the last one, in conjunction with the Amiodarone has lasted nearly 2 years 🙏. Currently waiting for a valve repair, rather than another ablation, but with a Cox IV Maze at the same time.
Hi after a CV that lasted for 10 days I pushed for ep consultation to discuss ablation as unhappy to try amioderone.I had been in persistent AF for 2 years when I had the telephone consultation.He decided that due to length of time in persistent and that Amioderone has many unwanted side effects to go straight to ablation.He gave me 50% of it working but could do another if needed.Now 12 months in NSR.
Do push but nicely .I am grateful for all the help I have received & appreciate the pressure NHS staff are under.
Yes, I try to challenge the "the NHS doesn't care," "the NHS let me/my grandmother get into this state" narrative wherever I see it. I have met nothing but dedicated people doing their very best in almost impossible circumstances.
I too had mostly asymptomatic, persistent AF. Had one cardioversion that was successful for a week then one more after a trip to A ad E after a really unpleasant reaction to eating chocolate, that also lasted about a week.
I really didn’t like the idea of a long term restricted lifestyle propped up by medication so I pushed for an ablation as early as possible.
7.5 years AF and drug free so far. Definitely the right choice for me.
Ablation, Amiodarone not a med I wanted, refused it, out in Dronedarone not a lot better, nasty drugs, had ablation 2 wks ago, early days yet as weaning off Dronedarone.
Better to have ablation sooner than later, better chance of long term success
I don't have any insight to offer but appreciate your question because I'm in the same situation -- paroxysmal AF has become persistent AF since having Covid 10 months ago, and after a six-month wait for it, my cardioversion failed after three days. That was two weeks ago and I'm waiting for a follow-up. Amiodarone was mentioned when I phoned in to report that I was back in AF. For myself, I am not keen on fiercer drugs. I am really struggling with what I'm already taking and I think it's time to get on the list for ablation. Good luck!
Thanks for responding. It’s particularly interesting to hear from someone in a similar situation.
I waited around 6 months for a cardioversion. Where I live there is a nurse led heart function team. They take information and involve a cardiology consultant as necessary. This means you don’t get to have even a phone discussion direct with the consultant. It may work, who knows…
I was a tad put out when they told me it would have been better if I’d had the CV within a couple of months of AF diagnosis!
My latest query was in relation to an angiogram which the consultant listed me for in November 23. A further 8 months to wait it would seem.
The immediate dilemma is what happens next. I think if I gave them the nod they would go down the amiodarone route with a further cardioversion in a few months. The consultant may straight to ablation. When I say “straight to” probably another 6 to 12 month wait.
Hm. The cardioversion two weeks ago was my first, and I was diagnosed with AF in 2012 -- but it was very infrequent paroxysmal fib. My cardiologist at the time gave me the hard sell for ablation. He framed it as "you are the perfect candidate for this procedure" (I was not yet 50 with no co-morbidities), but another cardiologist pointed out that "just because you're their perfect candidate doesn't mean it's the right thing for you to do right now." It seemed to me that ablation would be total overkill while my episodes were still so infrequent that I didn't even need daily medication (every cardiologist I saw agreed about my not needing daily medication at that point). Once that tissue is cauterised, it's dead meat. That put me off.
I was hoping that if I waited 10 years the technique and outcomes for ablation would improve. I don't think they have significantly.
In terms of symptoms, having started on daily meds in November while waiting for cardioversion, I feel worse on the drugs (flecainide + metoprolol + rivaroxaban) than I did without them. Previously, even a low daily dose of bisoprolol turned me into a zombie (1.25mg versus the 25mg metoprolol I'm now taking) and my current cardiologist agreed with me that they were more trouble than they were worth. Now, all I can say for the drugs is that they have kept me out of hospital and prevented clots, so I keep taking them even though I hate the side effects. Amiodarone sounds worse, and gets worse with time.
I used to have cardio check-ups every six months but that stopped with the pandemic. Last June, after having Covid and noticing more breathlessness, I asked to see my usual cardiologist again. I finally saw him in November by going private; otherwise I would have had to wait until mid-January, and would have had to wait even longer for cardioversion. He didn't mention amiodarone in November. We agreed that I'd get straight on to the other meds to stabilise me until I could be cardioverted, and if it didn't work, the next step would be ablation.
It was a specialist cardiac nurse practitioner who performed my cardioversion, and another nurse on the cardio team who mentioned amiodarone (though obviously the nurse can't prescribe it if I did want to try it). I'm fine with this because it shortens the queue, although we don't want to replace experienced specialist nurses with inexperienced generalist physician assistants.
I don't know how long I'll have to wait for my follow-up. In the meantime I'm doing research. Among other things, I've read a book by two US cardiologists who insist that AF can be cured with lifestyle changes, although I'm not sure if this applies equally to people with no co-morbidities, or only to people who have health issues (very overweight, diabetic, smoking, etc.). Cardiologist, at a previous check-up some years ago: "There is no cure for AF; you can't get rid of it by losing weight or exercising more or quitting smoking." But the specialist nurse who did my DC disagrees; she said there is now lots of evidence of people putting AF into remission by losing 10% of their body weight.
I'm looking into intermittent fasting (yes, I have gained weight since I started on all the drugs, alas...), but read somewhere (can't find the citation!) that fasting is incompatible with taking blood thinners/anticoagulants. My GP agrees; he said it would cause these drugs to build up too much in the bloodstream. However, there's been a lot of research into this due to the huge number of not-young people around the world who fast for religious reasons despite having cardiac problems and taking blood thinners/anticoags. The consensus is that intermittent fasting IS safe and DOES help. It seems to make a difference whether the anticoag is fast-acting (low dose, twice a day) or slow-acting (high dose, once a day, which is what I'm on) -- the slow-acting dose seems to be preferred. Another nurse in my cardio team said that she is doing intermittent fasting herself, and she pointed out that staying hydrated will prevent build-up in the bloodstream; food isn't necessary for that. Hence the encouraging results from the religious fasters.
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