My aim is to reduce my AFib frequency which is currently about 3 episodes per month.
In August I had episodes on the 3rd, the 14th and the 26th.
The duration was respectively 18, 16 and 18 hours.
The intensity of the palpitations was mild for the first few hours and for the last few hours I was unaware of any symptons but my Kardia mobile was still registering Afib and my heartrate was about 70bpm as opposed to my usual waking rate of 50bpm.
This is much the same as previous months this year.
My cardiologist is happy that Edoxaban is mitigating the stroke risk and Bisprolol is complementing this by reducing the heart rate peak during episodes. Hence I am a low risk. He even said that the risks of ablation at this stage outweighed the benefits.
Should I just accept that I will continue experiencing mild and regular Afib episodes 3 times a month?
Written by
Crimson2020
To view profiles and participate in discussions please or .
Electrophysiologist this is a cardiologist who specialises in arrythmias. It is an EP who will carry out an ablation. You should get referred to an EP or seek out a private consultation with one.
risks of ablation at this stage outweighed the benefits.
In addition, per your bio age 68 is not considered a negative for an ablation providing you have no other heart or health issues. May want to consult with your cardiologist and ask for a referral to see an EP (if a referral is needed).
Thank you for your reply. The full quote from the cardiologist's letter to my GP was as follows:
"He is aware of the option of an ablation procedure. I think at this stage the risks outweigh the benefits"
I think the first sentence removes any suggestion of there being any medical objections, and appears to be quite balanced.
I will consider asking for a referral but not necessarily to pursue the ablation option but to obtain a more accurate assessment from a more appropriate specialist.
The one thing that frustrates me is what is triggering my Afib with such a regular frequency. It still appears to be linked with my RHR dropping.
obtain a more accurate assessment from a more appropriate specialist
Would be a good idea in helping you make the decision. Suggest you further discuss with your cardiologist. Afib tends to progress so early intervention is best.
Interesting you mention the link between AF episodes and low RHR. My situation certainly improved once I was permitted to reduce by dose of bisoprolol to manage my RHR to low mid 50s.
Only just, Pete, and you had a pretty torrid time along the way. And considering that an ablation takes a big chunk out of your life one way and another some people might wonder if it was worth it?
Cardiologists (plumbers) often hate Electrophysiologists (Electricians) because they are "more clever" but as we say to people, "would you get a plumber to re-wire your house? "
Since AF is an electrical disturbance not a plumbing issue you need to speak to the correct specialist.
That said you must understand that there is no such thing as a best treatment for AF. So long as you are anticoagulated for stroke prevention where appropriate and your heart rate is well controlled within normal limits (60 to 100) it really becomes a matter of quality of life. After all many people have asymptomatic permanent AF and live happily for many years
First there’s the anticipation and the prep, arrangements re time off work, transport, possibly overnight stay etc which may all be cancelled on the day, then after the procedure there can be complications, recovery can take six months or more for some people, quite often a ‘touch up is needed, sometimes new arrhythmias emerge afterwards, the procedure’s effects don’t last forever or even for more than a couple of years (less than two in my case) - this is all worst case scenario but a gamble if your QOL isn’t being much affected. The younger and healthier you are with no comorbities it seems the greater the chance of success.
Cardiologists don’t rate EPs for all sorts of reasons but I think one of them is that ablation is a treatment, not a ‘fix’. When ablation was first mentioned to me as an option the cardiologist said to me with a grin, ‘Wait as long as you can so they’ll get better at it!’ Cardiologists like ‘one and done’ operations. Also they don’t see ablations as a necessity if rate can be successfully controlled and an ablation doesn’t remove the stroke risk. I’m not saying I agree, just putting the case for the cardiologist’s attitude.
Truth is I am really an exception with so many ablations, but try to help on this forum with the benefit of my experience.
The fact of the matter is the ablation is a well used procedure to improve quality of life and the vast majority of patients with a successful outcome don't hang out in Forums for those complaining about AF. That is because they are now getting on with their lives.
I'd be surprised if your cardiologist doesn't have good reason for his view. Presumably he knows more about your circumstances - noting you have also tagged Cardio Vascular Disease in your profile and you are also not on any form of rhythm control. I therefore suspect there are other factors affecting his/her thinking, which you should really discuss with them.
FYI - I also have PAF, which I consider to be low burden. My frequency is less than yours (<6 times/year) and episodes, although noticeable, aren't a problem for getting on with whatever I was doing. So, unless my quality of life deteriorates significantly then I won't seriously consider an ablation. I know plenty of people think otherwise and they've had several ablations without issue, there are others who seemingly have had a torrid time. The fact that they've had several is itself a concern for me. Anyway, we're all different and ultimately, it's up to you - just ensure you make an informed decision i.e. always discuss pros and cons, risks and benefits of options (ablation, rhythm and/or rate control medication and AC etc) with your cardiologist/EP/GP
Sorry, must have been someone else I was looking at. Anyway, has rhythm control medication e.g. Flecainide (in conjunction with beta blocker) been discussed? It appears to be an essential element of my medication (Metoprolol and Flecainide) in keeping my AF largely controlled.
Had scan & echo stress test before starting flecainide. Started on 50mg twice daily, then 100mg and finally 150mg. I've tried dropping back to 100mg but reverted to 150mg after having PAF episode. Thinking about trying again in near future.
Sorry to be dense here, but I'm confused by the tests you describe.
Are you mentioning three tests, as in (1) scan, (2) echo, and (3) stress test?
Are you mentioning two tests, as in (1) scan and (2) echo stress test?
I had an echocardiogram myself. The cardio's office called me and said something like "not remarkable" or "for the most part, normal." Then, "See me in three months."
But my episodes since have been more frequent and longer than he wrote in his notes for my experience. Alas, he got it wrong at that time. I had episodes lasting 10 to 12 hours every 10 days -- not 2 to 3 hours every month. Despite this "clerical error," he seemed like a good doc.
I had been to GP and ED on several occasions suffering from chest discomfort/pains in the year or 2 prior to AF diagnosis. AF was not detected during any of those visits but I suspect it was the cause of most/all of the visits but AF episode(s) finished before I was put on ECG.
I am on Flecainide for AF but it is contraindicated for anyone who has had heart attack and/or certain heart structural issues.
I had several tests prior to starting Flecainide, which along with checking for any problems that would rule out taking it, also provided a pre-medication heart status.
Tests included
1. CT Coronary Angiogram (checks for narrowing of coronary arteries)
2. echocardiogram (provides moving picture of heart - check to see how well it is functioning, any defects etc);
3. echo stress test (echocardiogram while undertaking vigorous exercise to see how heart performs under pressure)
Earlier this year my cardiologist sent me to repeat tests 2 & 3 from above. I presume this was to see whether anything had changed as a consequence of having AF in that time or from medications I've been using.
So you should have tests prior to starting Flecainide and periodic checks on your heart's condition/function.
PS I've also had coronary calcium scan and a cardiac MRI. The latter was after having Covid and suffering from increased frequency of episodes which subsequently settled down. I believe calcium scan was done after starting Flecainide but not sure
I scanned over the responses, so may repeat advice given by others.
DEFINITELY see an EP or make sure your cardiologist is an EP - its like the difference between calling in a plumber when you should be calling in an electrician (this is an analogy a cardiologist gave me).
Second - in terms of goals as per the title of this post - i think the focus should be on weight loss, lifestyle goals, good nutrition, time spent exercising (e.g. time spent walking rather than distance walked) etc. which you can control, rather than on the number of afib episodes.
Have he done all the test for a structurally normal heart? With Ct Scan or ECHO. Also ECG and 24hr Heart Monitor. Otherwise too risky to have an ablation.
At the very least the catheter ablation gives a view of your heart and its working.
Scarring the heart can never be reversed. Lots end up with too low H/Rate and a Heart Pacemaker which takes over is required.
Do make sure that he is happy that your heart is working well. I can't have a cardioversion. ablation or Flec or any other arrhymn med.
I am maintained on control of rapid heart rate 60s Day now and my natural low 47bpm at night. Diltiazem 120mg AM is my god send.
Yes, I have had the echo 8 years ago and also last year. Both were fine. I had a 24 hr monitor a couple of years ago with no afib. Then earlier this year I had a 7 day monitor with one episode so a 15% burden was noted. Based on my records of 10 to 12 day cycles I would suggest a more accurate figure of 8 to 10%.
I have a severe dilation of my Left Atrium, regurgitation in the Right. Ventricle and slight leakage of tricuspid valve. Systolic normal function and pressure.
Make your decision re ablation focusing on its risk, harm on your heart and success rate. I've been on my 3 meds for 2.1/2 years now and I'm stable.
Low Heart Rate is bad too and worrying. You can control high rate with meds.
Take care. The next reply is a true and honest opinion, I feel.
if you’re asymptomatic most of the time and if your resting heart rate stays within comfortable limits, your cardiologist was quite right to discard ablation as a safe and worthwhile option.
It is an invasive, irreversible procedure that has a rather low succes rate (re. all the people who had to have more than one to get some result) and a considerable risk of unwanted damage to your heart, oesophagus, lungs, arteries etc…
My best friend is a retired cardiologist who has PAF himself. He would never consider an ablation. He keeps his AF under control with an anti-arrhythmic.
As for myself: I just take Bisoprolol and an anti-coagulant and I’m fine. If anything, the frequency of my PAF episodes has diminished rather than increased, so in my case it is certainly not progressive , rather the contrary.
Even if, in a rare case, your AF should become permanent, with the right rate control and anti-coagulation you can live to be 100 with that condition. My late mother made 94 with it.
My friend cardiologist calls ablation ‘the moneymaker of the cathlab’. 😉
Can quote the numbers for "low success rate"? Last papers I read report very good success rate.
I also had a retired cardiologist friend shouting on the phone I would have a stroke when I was asking for suggestions. As it turns out, the risk of bleeding outweighs the stroke risk until 65 years old, and cardiology is a very big field and AF was clearly not his speciality but he liked to push his opinion anyway, discarding the consequences. Maybe your friend is not updated with recent research. Regarding the progression, it's totally subjective and a bet, some people deteriorate in few years, others stay with the same symptoms for decades, the problem is you don't know in which category you are falling in, until the time passed and if you are unlucky and have symptoms the AF is not treatable anymore...
AF is manageable most of the time and certainly not always progressive. And I do not think a ‘first try succes rate of about 50%’ is acceptable, at least not for my standards. Just try to find patients who got rid of AF and all their AF-related meds after one ablation…. Good luck with that!
But if you feel comfortable with those averages… good for you! Everyone is different.
Success rate is 75% for persistent (over 2 procedures) and much higher for paroxysmal with one procedure. I had one successful ablation, I'm not taking any meds and I don't have any symptoms. And I met many more like me. Your standards are fine by you but not scientific, if you read the last research on afib, it makes really clear that the first line of action should be rhythm control to produce the best long term outcome for the patient. We are all different, some people are very scared of medical procedures, others go for a number of beauty surgery without thinking twice. Each patient should make their own decisions, but it's important they have the correct information, otherwise they won't be able to decide for themself.
Here’s the opinion of a well known EP, who has performed thousands of ablations himself, dr. John Mandrola. I tend to agree with him.
“AF ablation is a big deal. Â It is not for the faint of heart.
• It requires 3-4 hours of procedure time with either general anesthesia or significant sedation and an considerable dose of harmful radiation.
• A harpoon-like needle has to be poked across the beating heart in a patient on blood thinners.
• Over a hundred burns are made in the most sensitive of the heart’s four chambers.
• In low-risk young patients–a minority of AF patients–the procedure successfully eliminates the AF in only a modest two-thirds of cases.
• Almost half of these successes need to have a second procedure to touch up areas that “grow-back.”
• Complications are real. There is a risk of stroke, heart attack, perforation of a perfectly good heart, pulmonary vein stenosis, air embolism, esophageal damage, and of course death. The overall complication rate is low, but since AF is not immediately life-threatening, any major complication becomes even more magnified.”
I had troublesome episodes of PAF which as most do was increasing in frequency and intensity. I had pulmonary vein cryoablation 10 years ago and am off all drugs except anticoagulant and have only had two very slight episodes in 10 years. The success rate is, I understand, around 80% for PAF and less for persistent which is why it is better earlier rather than later.
By the way, you could try the cocktail D-Ribose (15 gr/day), Ubiquinol and L-Carnitine. It helps keeping my AF at bay for extended periods. Up to 12 weeks, sometimes.
My daughter has nagged me forever to drink more I finally got the message after a few admissions and magnesium drips. . Thirst is not an indication of hydration, you need to drink little and often . You can most definitely be dehydrated and not thirsty. Your heart is an electrical muscle and relies on electrolytes amongst other things to function. I use an electrolyte powder in water from time to time to hydrate if I am dry. It is a mix of potassium, magnesium, salt and others. I take 200 mg magnesium glycinate . every night - helps me sleep. I think many others on the forum mention the importance of hydration. It really helps to keep my rhythm steady. If I don't drink enough I will get tachycardia.
An electrolyte is described as replacing vital elements you may be lacking. Diuretics are bad, as is sweating - salt, magnesium, potassium, glucose.
You can make up your own concoction. like fresh unchlorinated, unflorinated water, squeeze lemon, orange, lime, pinch salt, tspn glucose.
But researchers stumble on milk as a revitalized drink for athletes now. Up and Go is a god bost 2 weetbix and elements. Look at the list on the back. I always get banana flavour.
hi, I have PAF too. I think it’s only natural to want to lessen paf episodes, - changes in diet, exercising more, supplements, avoiding stress, etc. May I ask, do you have high cholesterol? Good luck with it.
Yes high cholesterol and been on statins for at least 25 years. About 6.00 mmol/mol unmanaged. PAF is more recent at about 5 years since diagnosed although possibly 5 more undiagnosed.
Depends how it's affecting your life. If you can ignore it (i've got regular bouts of arrhythmia but don't even monitor them anymore) then i should carry on as new normal. If you you can't do things you need to (like exercising for instance) I would think about another intervention.
It seems that the main risk of AF is stroke and anticoagulation protects us to some extent from that; another problem, if the rate during episodes is over 100, can be damage to the heart leading to heart failure; also consider how much the condition affects your quality of life.
If you barely notice the episodes and the rate isn't over 100 then the risk of ablation may not be worth it. II would talk it through with your cardiologist and ask him to explain the reason for his decision to you. He may be right.
But then I'm very cautious about any kind of invasive treatment. Have you tried deep slow yogic breathing and other natural techniques during the PAF episodes, I find this sometimes can return me to NSR (not always). Lifestyle changes, hydration, and reducing stress as much as possible etc. can make a big difference ..
Flecainide might well reduce or end your episodes as it has for me. I have not had an episode for over a year and a half and now take 50 mg am and 100mg pm. No anticoagulants any more as no risk of stroke when no episodes. You could try it first as a PIP and then regularly as I did but we know we are all different.
'anticoagulants any more as no risk of stroke'... I understood that a chads risk score of 2, ( 1 for bringing female/ 1 for age) means anticoagulants are prescribed or has this changed lately?
Well, I’m still here at 80 and haven’t taken them for well over a year now. They caused terrible digestive problems - the CHAD score stuff is just tick boxing and seems to be designed for the drug companies ( and their profits)!
Anti-co.agulants some are trknown for the outer capsule being difficult to break down. I have never had a problem but I had the bits of left gall bladder removed in 2000. It had disintegrated.
So if I don't have a gall bladder bile drips into the stomach continuously.
The gall bladder analyses how much fat, acid and sends it into the stomach. Any fault in the gall bladder's analysing what's in the stomach makes it a problem.
I suggest you take it with fruit or fruit drink. Then water.
I take 110mg x twice day PRADAXA. I am 75. I chose PRADAXA because it is 1/2 dosages, has an antidote and comes in a safe foil safe way of distribution. I'm not sure how the other meds are packaged.
Leading up to my gall bladder operation - removed through the tummy button, I had heaps of feeling unwell and reflux and pain episodes. Do have the tests - ultra sound, colonoscopy, and mouth to stomach test. The fact that my grandfather had his out gave me a gold star review.
The Rivaroxyban came with diarrhoea and the Apixaban came with constipation or something as when I had the endoscopy when my hiatus hernia was discovered (along with the damage to my oesophagus) I could see that over 5 hours since I had last eaten my stomach still hadn’t emptied!
I was on rivaroxaban had a mini stroke so was switched to apixaban then I had a blood clot in my brachial artery so was put on warfarin. It's a pain going for inr checks but the other new blood thinners didn't work for me. I've had two ablations now and although I still have the af episodes my heart rate rarely goes over 135 . I can live with that I take flecanide and verapamil. Both twice a day
Poor you! Flecainide works fine for me. No episodes for over a year and a half and have even reduced the Flecainide dose with no ill effects. Didn’t like the idea of an ablation, especially reading about so many here that aren’t successful. How different we all are!
I was told that all over 65 year olds should have a low anti co-agulant!
I would think that you are right into an AF episode before you know it. Would you know if you had thyroid Cancer. No, I didn't so the thyroid caused the AF which caused the stroke. 1 rogue clot.
I was not on any meds except a Solgar supplement sublingual 1000ug nugget x 3 x times week. I keep my level 800-1000. I'm deficient in B12. Only way to take it is under tongue to blood supply NOT through the stmach.
I could always feel as soon as my heart went into AF and could check with my Kardia and take Flecainide PiP. Episodes never lasted more than a few hours so according to the EP I saw, I was not at risk of stroke and I’m still here at 80 (and over a half!)
It may be your confidence that will see you through.
But I would say that you need it in your blood stream earlier than 'after seeing it on your Kardia".
Still its your decision so fingers crossed for you.
A stroke is debilitating to give you the truth, unable to speak coherently, dropped mouth and bad swallowing. Ring screwed painfully off as swollen, and dropsy! Right hand. I couldn't put light rings up and over the stick.
Well, as we know, we are all different. I certainly could feel when my heart went into AF but as I have noted here before, I have reached over 80 and a half and, as I haven’t had a lengthy episode of AF with a high heart rate since being prescribed Flecainide, as the EP told me, I am not at risk of stroke, and I certainly don’t want the side effects of a drug I don’t need!
My AF burden was roughly double yours but I could function normally during episodes (albeit at 20% lower cardiovascular output when cycling). I didn’t like the ~1% chance of very bad outcomes from an ablation and opted for flecanide 16 months ago. The minimum dose has reduced the frequency of attack by a factor of 10 and the duration by a factor of 5. No side effects.
Not a doc, but perhaps get a second opinion on an ablation…? I had one late last year. Took a while, but I’m off meds and inching towards a normal lifestyle
This is an excellent query. In my case, before diagnosis, I was having episodes 2-3 times a week, on occasion lasting up to 24+ hours, with elevated HR (130+). Following diagnosis (Kardia), I was placed on Eliquis along with rate control (metoprolol) AND an antiarythmic (propafenone). After some adjusting of dosages, AF frequency is now about one episode/2-3 months, usually lasting 15-20 minutes. I and my cardiologist are pleased. If I were in your shoes, I would “suggest” addition of propafenone or flecainide to your regimen and see what happens, certainly before even considering the ablation route
Metoprolol is not a good rate control. 186 Day with pauses at night and I couldn't exert myself. Fatigued through breathlessness. Never wanted Metoprolol. Changed to Bisoprolol (better for Afers and Asthmatics) again high 156! But no breathless or pauses. This was proven through 2 x24hr heart monitors.
A private h/specialist consultation introduced 180mg CCB Diltiazem within 2 hours went from 156 to 51!
Adjusted dose nw:
AM Diltiazem 120mg for rate control
PM Bisoprolol 2.5mg for BP control.
Always separate these the NZ Heart Foundation Nurse told me.
I am roughly the same as you. Stress, heat or eating the wrong food will bring it on and it lasts for about 18 hours. I’m in France at the moment- very hot - and it came on the other day. My son had an electrolyte drink and I took it. Within 15 mins I watched as my heart rate went back to normal. I’ve never taken electrolytes before - just a banana every day, but I will be very happy if this helps me in the future. I’m going to get some coconut water to have handy as well. I wish you all the best.
For peace of mind you might be better seeing an EP, but your burden of AF is very low with your heart rate only increasing to 70 bpm during episodes, which is within the accepted normal range of the heart. I suspect the avoidance of large meals, especially in the evening and a reduction of alcohol would improve your situation. After 20 odd years of Paroxysmal AF, largely controlled by drugs, Flecainide in particular, I was found to be in permanent though asymptomatic AF.It causes no problems
I take only an anticoagulant because I have AF, Warfarin being my choice. I don't have a Kardia, apple watch, Wellue or Fitbit. I eat a largely plant-based diet, and drink little alcohol. I enjoy red wine, but only sip it for the taste, not have glasses of it for the warm glow it gives. The last bottle of wine I drank lasted 6 weeks. I have had no alcohol for about a month.
I should exercise more, just a 30 minute walk a day would be beneficial. I am 79.
Just to clarify about the 70bpm when in Afib. This is my Fitbit measurement which I believe is an average because it cannot cope with the spikes and troughs.
My last Afib Kardia shows a 30 second ecg with 3 peaks at about 100 and 3 troughs at about 42. The other 24 are in the 70s
I used to have boats of PAF fairly frequently once every three or four months that then became more frequent a few times a month and I’m now in permanent AF I find the permanent AF much easier to deal with than the boats of PAF which were debilitating the AF I know live with so the choice is yours about the ablation. I don’t know whether I’d want one at the moment for myself because I can live with the symptoms.
Too many different opinions contradicting each other here. Firstly cardiac ablation is a reasonably safe way to deal with your AF or other life threatning rhythms and while it does have some slight risks is considered minor surgery and very low risk. On the other hand most of the antiarrythmics meds have some horriffic side effects both short term and permanently. My brother was on a commonly prescribed antiarrythmic tablet for his afib and developed lung fibrosis which has severly reduced his quality of life while others develop heart failure and CAD from taking some of these meds. He has had an ablation that kept him AF free for over 7 years since and had to have a top up ablation a year ago which is still keeping him in Sinus Rhythm. I have just had my first and hopefully only ablation 4 days ago and feeling very good although its early days. The fact that the NHS frequently carry these out should endorse their role in treating afib and they really have come on in leaps and bounds both in safety and success rates. It is not really acceptable for people with low frequency Afib to comment negatively on people who had to have several ablations and the courage to do so because their afib was very symptomatic and its ironic because these people are now afib and drug free!! apart from anticoagulants I would imagine depending on your circumstances. Almost all Afib cases progress to a worse state given a bit of time so it really is an individual choice.
They say it is not although it increases your chances of stroke by up to 5 times the average so really who knows. What I do know is that AF effects your quality of life and for me thats worth going for the ablation. If I was assymptomatic then I probably would not. I would prefer the ablation than long term toxic meds to be honest but thats my stand on it. Because its very expensive to have done and time consuming they will offer you the meds everytime.
Some of your assertions are a bit dodgy to say the least. I presume your brother had the ‘last resort’ med, Amiodarone? Obviously wasn’t properly monitored. And which drugs cause CAD and heart failure? I don’t think anyone is commenting negatively on others having an ablation if their AF was severely affecting their QOL, just questioning whether it’s the best treatment if it isn’t.
There are no assertions in my post never mind dodgy ones as I researched all these medications fully before deciding on the ablation in the first place. Amioderone is not a last resort medication for afib but one of the main antiarrythmics used to revert people back into rhythm, and also frequently used as a maintenance agent ofeten for long periods of time. There are also some very commonly used meds like sodium channel blockers which carry a black box warning with some very unsavoury side effects so all these were what swayed me towards the ablation. Cardiologist do not hate electrophysiologists ( thats ridiculous) or dislike them as they both work hand in hand so I fail to see your point with this as you say they use ablation as a treatment and not a fix??. Well I would argue that medication is a treatment and not a fix for almost all ills. Also new research shows clearly that a reduced burden of afib such as you can get with an ablation has a significant reduction in stroke overall although the fact you have afib pushes you towards a higher risk of stroke just by its nature. My point was not meant to upset or unsettle people regarding their treatment options but merely to put forward my view point regarding afib treatment types and to be fair you have listed an awful lot of reasons why somebody should not have one albeit only your viewpoint mind, and I see ablation did not go to plan for you so I thought it only fair to remind people that cardiac ablation has leaped ahead in recent years and is highly regarded as a safe and efficient procedure to allieve people of the horrible side effects of afib.
I wouldn’t, at very least I would seek 2nd opinion and discuss with your GP to ensure all possible contributory factors are covered, Lifestyle, BP, thyroid, diabetes etc.
I too have PAF weekly with HR 128bpm, and lasting anywhere from 10- 17 hours. Usually in bed a day and exhausted next day. So I understand and commiserate how you feel. I'm currently taking Sotolol, Bisoprolol and warfarin. I had an ablation 2 years ago which didn't work. I was put on dronedarone which caused rashes and extremely sore fingers. (It didn't work), So much so I could hardly pick anything up. I'm now back on Sotolol as mentioned. It's helping but not stopping PAF. I'm waiting for another op for doc to see what's going on. Was told I have to wait a year. My life is restricted to not knowing when PAF will happen so QOL is awful. Often need to cancel outings etc.
So yes like you would like an answer and this dreaded PAF to be happening less.
I had so much support from the group a few months ago and appreciated the advice given.
FYI…I have PAF and started on flecainide and metropolol November 2022. After 3 months my afib episodes essentially stopped, had one episode this past spring when I had a serious upper respiratory infection for a few hours . I’m 72, no other issues ( no hypertension , diabetes , obesity, rarely drink, no smoking etc, and heart is healthy). On the other hand, my brother aged 63, had an ablation about a year after his diagnosis of afib, though I’m not sure if it was PAF or continuous. He had a good experience, no adverse effects and the afib has been gone for about 2 years. Both options can work well for people and it depends on your situation as well as personal preference. I met with an EP who encouraged an ablation but suggested the meds were also a fine option for me.
Unless your symptoms impinge on your life I would probably accept your cardiologist’s recommendation.
Similar to you I have 2 episodes per month.
My episodes are symptomatic (HR avg 140)and very uncomfortable, lasting between 11 to 18 hours. In August, I started taking 50mg flecainide as a PIP. After two episodes the drug has reduced the severity and duration of the episodes, but not the frequency.
This morning I had a follow up consultation with my arrhythmia nurse who, suggested I start taking 50mg x2 of flecainide daily.
Apparently, if you experience frequent symptomatic episodes- i.e., a couple or more a month, this is the recommended approach.
The expectation is to reduce the frequency of episodes.
She said if I was asymptomatic, then flecainide would not be considered.
She seems more concerned with elevated HR than abnormal rhythm.
Why doesn't she try you on CCB Diltiazem unless you have Ventricles not funtioning normally.
BBs did not control my H/Rate. CCB did within 2 hours. 1/2 dose too much.
To prove 24hr heart monitor showed on Metoprolol which made me breathless and gave pauses at night 186bpm couldn't exert. (1 year 5 months). Bisoprolol 156bpm could exert no breathlessness (better for AFers) no pauses.
I even have a low 47avge bpm at night.
AM Diltiazem 120 mg for 2.1/2 years. Day 86-96bpm has reduced to 60s.
PM Bisoprolol 2.5mg " " which controls my BP.
I have to stop whilst walking. For blood to catch up the Dr says.
No pain, no palpatations, no flutters.
Diagnosed with Stroke, rapid and persistent AF and Day 4 Papillary Thyroid Cancer.
A heart specialist and not a Dr should try you on CCB. Please separate CCB and BB though.
180mg was too high in Diltiazem and my h/rate reduced from the 156 to 51! Within 2 hours.
My Arrhythmia nurse did say it was my decision to take Flecainide.
My PAF is very symptomatic and tends to be nocturnal, my HR peaks around 140 and can last anywhere between 4 to 11 hours. At the moment, my episodes occur every fortnight. During an episode I have to rest as any exertion makes my symptoms worse.
My BP is a funny one. My home monitor registers my average BP at 126/80. However, whenever I enter a medical building my BP registers 210/110 (hypertension) and doesn’t reduce much throughout the appointment.
My consultant wants me to take my home BP monitor along to a pharmacy/GP and ask them to perform a comparison on both machines. If they register similar readings: then it proves my elevated BP is caused by ‘white coat syndrome’.
If not, then I need to purchase a new machine and revise medication.
A few months ago, I reduced my diltiazem to 60mg per day, I felt the 120mg made my HR drop too low, and was making me feel lethargic.
As of Tuesday, at consultants advise I reverted back to taking 120mg per day.
The plan is to see how long I can continue before PAF kicks in. If the episodes occur 2 to 3 times a month then I will probably start taking Flecainide on a regular basis.
The jury is out on diltiazem as an effective anti-arrhythmic drug. Some medics say it is not, although some literature suggests otherwise. Either way, for some people it does not provide the benefits of Flecainide.
I think Diltiazem works in that my rapid is controlled down. So not rapid, arrythym slows down the rate and symptoms. No flutters, no flutters and no pain.
Diltiazem CD 120mg works differently to the 60mg which is not a 24hr/7 med.
But because I am rapid taking it early morning Dr says my med runs out towards end of day so that it does not interfere with the low overnight rate - remains at 47bpm. Probably the 60mg Diltiazem taken at night would interfere with 47bpm.
I started with 180mg Diltiazem CD when introduced this was too much. From 156 as still on bisoprolol, to 51 made me 'light headed' and I could see definitely no driving.
Changing down to 120mg was best although at the time of reporting on first visit to private, read "Joy could take up to 360mg!"
If your AF with high rate is at night to prevent it taking Diltiazem CD 120mg or more at night would be worth a try.
In 2020-21 NZ dropped the 60 & 30mg Diltiazem. Can't get it here.
With me perhaps Diltiazem "senses" the natural reduction of my heart rate towards night and at night.
Spooky to say the least but I have always had cold shoulders at night. Need to wear a sleeve.
Heart rate and white coat BP are different but high BP won't help your rapid heart rate.
I recently had a pulse field ablation which has stopped my af episodes completely so far. I think the risks of pulse field ablation are much less than radio frequency ablation and apparently it's better to stop Af episodes completely to stop the heart remodeling that will make AF even more frequent.
Content on HealthUnlocked does not replace the relationship between you and doctors or other healthcare professionals nor the advice you receive from them.
Never delay seeking advice or dialling emergency services because of something that you have read on HealthUnlocked.
Mild PAF symptoms, should I bother?!
AFib/Atrial Flutter Burden
set pattern to PAF
Outlook after cryo ablation 
