Ablate and pace

[Borderterriorist]

I started with left sided atrial flutter which responded well to cardioversion and kept me symptom free for nearly two years. I have stage one heart block so when I started to get occasional further episodes I had a pacemaker fitted so my dose of Bisoprolol could be increased from 1.25mg to 5mg daily. Unfortunately a week after the pacemaker was fitted I had an episode of arrythmia that put me in A and E for a couple of days. Resting HR was 150 initially, came down to 130 but it took 15 hours and several doses of metoprolol followed by digoxin followed by bisoprolol to slow everything down. I was told I had flutter, fib and SVT . I was discharged on 10mg bisoprolol but a check on my pacemaker showed I still had a resting hr of 130, so bisoprolol changed to 7.5mg twice daily. Felt a bit better initially but started to feel unwell again within a couple of weeks. I had a consultant appt and I was in permanent A fib and rate still too fast, so I'm now on digoxin 1.25 + 5mg of bisoprolol bd. Obviously on a blood thinner.

I'm feeling better than I was and I'm on the wait list (8months) for an ablate and pace. Although I'm nearly 76 I was a pretty fit, active woman and I feel the quality of my life is affected by the side effects of the drugs I am on. I don't think I have any underlying cardiac disease apart from having ropey electrics. I'd love to hear from people who have had this procedure and how it has affected their lives. Will I get some of my energy back? Will I be able to stop taking the bisoprolol and digoxin which I know have side effects? Any useful advice for me? TIA

[Paulbounce]

Hi Border.

Bisoprolol (for me) is the one that can knock you for six. 5mg is a fairly high dose but not extreme. Maybe it's worth talking to your medic about reducing this a little? They put me on a 5mg and I couldn't function - they dropped the dose there and then.

Good luck - I'll let others who have been through the same experience as you address your other concerns.

Cheers Paul

PS - HR of 150 at rest is far to high

[mav7]

Borderterriorist Are we talking about a border collie ? 😊

Would encourage you to discuss with your doctor the beta blockers you are taking and your reaction. And please do research on the subject if beta blockers are effective for your condition.

The below link is previous forum threads on the subject of pace and ablate.

Your post was the last one on the first page. Hopefully, this will bring to the top for others to opine.

healthunlocked.com/search/p...

[Borderterriorist in reply to mav7]

Thanks for replying. I've been on beta blockers for four years, doses of 1.25mg to 15mg (7.5mg bd) and everything in between, I tolerate low doses OK but unfortunately even 7.5mg bd wasn't controlling the arrythmia, hence the introduction of digoxin which is definitely helping to keep things more stable. My consultant knows me well, I think, I've seen him privately as well as on the NHS and I trust him. Thanks for the link. Not a collie, he's a delightful border terrier!

[Nannysue1]

Hello. Yes I had the procedure year before last. I'm now 70 and also pretty active. It's been a fame changer for me, feel like it gave me my life back.

I only take apixaban now and feel so much better.

It's a tough decision becausevits also a final one but ,personally I'm so thankful that I did it.

Good luck

[Borderterriorist in reply to Nannysue1]

Thanks for replying. It's good to hear from someone younger than I am. I'm not worried about the actual procedure, I know it's straightforward and I already have a pacemaker although I'm not sure if they would have to change it I just want to be as sure as I can be that it's the best option for me. Did you have some ablations before being offered the AV node ablation?

[Nannysue1 in reply to Borderterriorist]

The odds of an ablation being successful for me were too low .I was on amioderone for 6yrs and then in permanent AF for 2, trying all of the usual medication, digoxin, bisoprolol, etc etc, all had nasty effects on me and like you, drained me of all energy.

[Nannysue1]

I did have a couple of cardioversions which didn't last long

[Koladog]

I had pace & as late only on 1-25 Bisoprolol & Apixiban now. If I have AF don’t feeling after pacemaker fitted I had a stroke rehab amazing life is great travel a lot in France now in motor home for 6 weeks. Have daughter in USA travel there each year. Live in the moment is my mantra

[Borderterriorist in reply to Koladog]

That's really encouraging, Koladog. I've been wondering about foreign travel, especially with regard to travel insurance. Have you found it particularly expensive especially for the US?

[Ppiman]

I had fast (2:1) atrial flutter in 2019 and I was told it was far harder to treat than AF. Like you, my bisoprolol dosage kept going up but never worked and brought side effects. Digoxin finally was tried and it did the trick - but I never felt especially well throughout. Then an ablation stopped the flutter and, at last, life resumed normality. Of course, eventually other atrial conduction issues later came my way - ectopic beats and AF. Pace and ablate has been mentioned.

Pace and ablate will likely help you enormously from what others have written here.

Steve

[Borderterriorist in reply to Ppiman]

I think that's my issue, I seem to have more than just flutter now so although I went in for an ablation back in 2022 they discovered my flutter was left sided and they were not equipped to deal with it so I had the cardioversion instead. My consultant seems keen on going straight to the AV node ablation and with the waiting lists on the NHS I don't want my life taken up with waiting for procedures which don't give me a lasting benefit.

[Ppiman in reply to Borderterriorist]

It sounds as if we are in a broadly similar position except that I also have a thing called LBBB (a bundle branch block). I think your AFl is called "atypical" whereas mine was in the usual right side of the atrium and was much more easy to deal with. The right side requires puncturing the septum between the atrial chambers and I guess your EP wasn't, for some reason, prepared for that when you had your procedure. What a disappointment that must have been! I don't know - the things life throws at us, at times.

Following my successful ablation for AFl, however, within a year, I started to have other left-sided atrial issues starting with ectopic arrhythmia beats and various symptoms from occasional bouts of tachycardia. This wasn't initially AF but that came along soon enough. Apparently ablating for AFl often does "uncover" latent AF and other arrhythmias. This year the whole thing has worsened in terms of frequency although not really severity in that I cope "okay" - partly because I feel reassured by the two MRI scans I have had which gave other aspects of my heart the all clear.

Now my specialist wants first to ablate the left-sided AF around the pulmonary vein as well as try to also ablate whatever is causing my multiple ectopic beats that, in truth, are somewhat harder to cope with than the AF. He has told me that a third ablation might then prove necessary given the difficulties of ablating ectopic areas.

Steve

[Koladog]

we use Nationwide from account. They have been helpful although have new underwriters which we had to negotiate with been with them a while

[Borderterriorist in reply to Koladog]

Thanks.

[Bunkular]

Please tell me your specific symptoms, i.e. what it felt like during your "episode" of arrhythmia that put you in A & E. I had 2 episodes for which I was never told what occurred. The 1st time I was told it was a panic attack (I now Know it wasn't). Then a year later I had another collapse, sweating, almost syncope until I quickly dropped to the floor & was rushed to emergency and later put on Metoprolol, Perindopril & ASA. No doc has yet told me what it was except arrhythmia & the meds have dropped my PVCs down considerably.

[Borderterriorist in reply to Bunkular]

Both times I woke up in the night with a very fast HR (150ish) and I was aware of palpitations. I was very clearly unwell but had no sweating, no feeling faint or sickness. It was the ECG that clearly showed the arrhythmia and the type it was.

[Bunkular]

It's always good to know exactly what other people's symptoms are as we all have learned that ailments affect us in different ways. Thank you.