I was diagnosed with PAF about 23 years ago, and have managed it with medication, at present on 300mg of Flecainide daily, along with Bisoprolol 2.5mg and Apixaban 10mg, For the last 6 months I've been in AF for weeks and then a couple of day I'm in rhythm. I don't want an ablation. Would I receive different medication when my heart is in Persistent AF. I take Losartan for blood pressure which I have had for 40 years now. Family history of heart problems.
Waiting to hear from Cardiologist, advice from this group would be appreciated. Thank You.
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Bee-Honest
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If you are ageed to be in permanent AF then flecainide would not be used as this is an anti-arrhythmic drug and there would be no point. Obviously the anticoagulant would remain but the main treatment would be rate control, eithyer more bisoprolol or maybe a calcium chanel blocker instead.
Curious to understand why you reject the idea of an ablation if it were offered?
Thank you for replying so promptly. You've confirmed my thoughts. I was told about 15 years ago by a specialist that the risks during ablation were fairly high and he would not recommend it for me. I'm now in my 70s and read that the older you are the less successful it will be. All this info and a bit of fear has made me reject the offer.
Cardiologist or electrophysiologist? Cardiolgists are often anti ablation as it is not their field of operation. There is no age bar on ablation. I had my first at 60 and my last at 74.
That said, unless DCCV (cardioversion) can return NSR ablation is unlikely to work. Do remember though that permanent AF is just an agreement between patient and doctor to accept AF and not try to return NSR .
It was a Cardiologist and very well thought of in his field. Recently my 'younger' Cardiologist thought he was giving me confidence by saying ablations are very accurate now as they use 'Robots'! Still not for me, at the moment. Thanks again
How are you checking your afib status, Kardia, Apple Watch, other ? And what is your average heart rate and blood pressure ? In other words, is your afib being controlled.
If you have not done recently, suggest asking your cardiologist for an Echocardiogram to determine the effect of afib on your heart. And ask him to refer to an EP just for a consult. Would be worth your time.
BP 134/103 pulse 80 ~90, waiting to hear from Cardiologist. My BP monitor shows if I am in AF. I also have a Kardio which confirms AF. Thanks for replying
I felt like you about ablation but then the thought of the AF episodes made me think again. I had my ablation in March with no regrets. My EP says just forget about it now as I am a worried 😊
I'm coming up to 80 and had my 5th ablation 4 weeks ago.....with the same EP who performed my first procedure in London in 2009.He hasn't quite given up on me.
I recall a conversation with a cardiac registrar in 2008 who advised me against having an ablation at that time as they still needed to be perfected( or words to that effect). I note that he is now a top EP (Professor)
My cardiologist however strongly advised me to accept referral to a London EP as my episodes usually required dccv to terminate and were becoming frequent, with the last one resulting in pulmonary oedema. I have no regrets on having the procedures as there was no alternative. The drugs don't work for me
PS my husband is in permanent AF...completely unaware and takes Rivaroxaban. He used to have a resting heart rate in 50/60 s and now, whenever I check on him it's 80/90s. I discovered his AF when I randomly put my Kardia mobile into action and sent reading to his GP!
I can't understand your reluctance to go for ablation, given that you are on the maximum dosage of flecanide and a hefty betablocker too.What are your concerns?
I'd rather listen to the advice of an Electrophysiologist than a cardiologist regarding AF,Cardiologists being the 'plumbers' as opposed to the 'electricians'
My AF was paroxysmal for 20odd years. I was on 300mg of Flecainide, no beta blockers as I am asthmatic, and various bp medication. Ablation was nearly offered, but I'm single with 2 loving cats but no close friends. About seven years ago I was found to be in persistent, though asymptomatic, AF. My heart rate is in the 80-90 range. The only medication I take for AF now is an anticoagulant, Warfarin being my choice, after my body rejected Rivaroxaban. I've agreed my AF is permanent.I have annual blood tests, BP using a sphygmomometer ( not sure of spelling), a month ago was 117/73. My blood is within normal parameters except for red blood count, quoted on the report as 'ab normal but not unexpected'. I am borderline anaemic. Treatment for it has never worked, so I live with it.
In another area of health I've had one sigmoidoscopy, followed over the next six years by three colonoscopies. I've never had sedation as it requires being with another person for 24 hours after the procedure, not possible in my case. I suspect needing another adult around for 24 hours would preclude me from having an ablation, before it became persistent. And then there's the take it easy stage for the first month after ablation which for me would also be difficult.
I do wonder if my life would have been better with an ablation or two, rather than Flecainide. Flecainide stopped 99+% of AF episodes. I had one it two ten minute episodes a year.
My permanent though asymptomatic AF causes no problems.
My asthma is well controlled by inhalers. Losing weight helped by general health. I'm still a little overweight, but have the disadvantage of having foot drop of my right foot, which means I can't walk fast, or for long, so I can't lose weight through a daily walk. I'm just over 6'6" tall, aged 79.
I understand your reluctance to have an ablation. I don’t want one either. Hopefully they will help you with other medications. I just take bisoprolol and anti coagulant. The AF comes and goes, sometimes more persistent than others. Good luck.
I was in PAF and very symptomatic, and Cardioversion followed by Ablation was the best thing I ever did. I got my life back. I'm drug-free and my heart is at peace with itself.
In my position, unless there's good medical reason, I find it difficult to understand the negativity towards ablation I see from time to time on this forum.
Hi Bee, i have refused ablation also, i follow this forum closely and note some people still have af after ablation and not so long ago someone mentioned that they thought ablation has ruined their live, so i dont want to risk that , however small of a chance that may be, maybe in the future i may reconsider but for now , no, i am currently getting bouts approx once per week for between 24 and 36 hrs, on bisop and multaq, they subdue it somewhat, suffer from fatigue most of the time, but i can cope, if i can continue this way then i would rather this than risk potential negative effects from ablation.
That sounds like an awful lot to put up with, losing what is virtually a day each week to this condition. However the decision is yours.
Note that there are very many people who have had successful ablations but no longer stay on the forum, simply getting on with their lives. Others stay on here to hopefully help those who ask for advice.
All I can say is that I was reluctant following my own research, thought I could manage AF and Flutter with lifestyle, medication etc.Then I went into highly symptomatic AF and Flutter for 2 separate 5 weeks and 6 weeks 24/7 episodes. 12 weeks apart
After which I decided to trust my Electrophysiologists years of training in basic cardiology and then extra training as an EP.
Double ablation done,no problem.
I had concerns about it but weighing it all up,if meds fail....your options are limited anyway, what's to lose?!!
Hi Wilsond, yes it is risking it you are right, and i know that only too well as i watched my mother who had afib and a sister and a niece and likely another sister and maybe even another niece, who havent been diagnosed yet, hope they dont , i have been symtomatic for 30 odd years but coping with meds so far ,so if any thing changes and progresses to the point where i feel im not coping i would certainly then give ablation very serious consideration, meanwhile hoping that further advances in treatment occur, such as pulsed field ablation, and the technique further enhanced, i might add that my niece had failed ablations , and someone on here said that they didnt think ablations was the be all and end all, its like russian roulette works for some but not others, and i am happy for those that it has worked for.
My bpm is regulated now with CCB Diltiazem 120mg AM 180mg too high. Now controlled in 60s Day
As my Night rate (24hr Heart Monitor proved) is only 47avg bpm I found thsat the Diltiazem wears off nearer to bedtime which suits me.
2.5mg Bisoprolol PM for control of BP.
PRADAXA 110 mg x twice
125mg Synthroid early morning 1 hr prior to breakfast as I had a Stroke 2019 with AF rapid and persistent and found to have papillart thyroid cancer. Removed Feb 2020 with 12 lymphs 2 affected.
It is important to control your H/Rate and BP.
No cardioversion, Ablation or Flec .. as ECHO shows abnormal heart structure.
I have been in persistent AF for 4 years now, with medication, my heart is controlled to stay with in 60 to 100 beats per minute. I take 70 mg of metoprolol and 10 eliquis per day. i did have a cardiovascular, but it worked only for a very short time. I get palpations and get tired more than I used to. I blame it partially on my age as I am 90. I cannot do as much as I used to, but am happy and my condition is livable. I hope this helps!
I woukd take ablation over meds every time, especially if you are or progressing toward full-time fibrillation. It will just get worse. My first ablation was great, and that was before the latest improvements. I have needed three, over about 12 years, the third for a whole different area, and wouldn't change a thing. So much better and more effective than the meds and their side effects!
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