In February this year I underwent an abalation and for the last 2 months I was medication free with no signs of AFib. After 3 months following the abalation I was slowly taken off the meds.
The last couple of days I have noticed Ectopic beats which I never had before. Today I went back into an AF episode. It is so disappointing and now extremely down. Currently still in AFib
I had been on Flecainide and Diltiazem.
Has anyone had this situation?
Prior to having the abalation I would get episodes of AF that sometimes would last for 6 -8 hours.
I am wondering what I should do. Any advice would be appreciated.
Written by
Murphy10
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I would try to get out of a fib as soon as possible either with medication's or electrical cardioversion. You mentioned flecainide. Have you ever used it PIP to convert? That's what I would do, but if you haven't been authorized, I'd call your doctor right now..
But do not be down. I had exactly the same thing happen to me. I continued with the meds incld flecainide for three months after the ablation. Three months later (month #6) , I had an a fib episode which I terminated within three hours using PIP Flecainide. It's now a year later (18 months since ablation) and that was my only episode.
A successful ablation doesn't mean you necessarily get rid of atrial fib entirely. It can just be a significant reduction in a burden, like in my case and many others. Plus at six months post ablation you conceivably still in the healing period.
Again, If it were me, I would try to get out of afib ASAP and then maybe stay on daily flecainide for a week or two until things calm down.
Thanks Jim, yes I took Flec. About 40mins ago. 50mg. My cardiologist when I went into Fib prior to the abalation recommended that I increase the dosage of Flex. Was on 50mg. Daily and he suggested perhaps 100mg with an episode.
He also did not like me taking Flex. Without slow release Diltiazem. I don’t have any of this available. So I have taken the Flex.
It is just on 2am in Australia and hospital system is not great so if I have not come out of Afib by later this morning will make my way to the hospital.
So basically he was saying take 150 mg to convert (50 on board plus 100 PIP).
This is similar to what my protocol was. However, when I was not on daily flecainide, this protocol translated into taking 100 mg pip at the start of the episode and then another 50 if I did not convert in an hour. And then another 50 if I did not convert in another hour, but it never came to that.
I can't advise you without the Diltiazem but maybe he can give you a one time permission or you can go grab some at the drugstore. Beta blockers are also used in as similar manner with. Fkecainide.
Also some members have been authorized to take flecainide without diltiazem or beta blocker but it's always best to listen to your doctor because he knows your individual case
It was a total of 100mg when I was taking Flex regularly. He never advised me what to take once I went off the meds and had a Afib episode. I only saw him last month and the discussion was ceasing all meds.
100mg converted me most of the time. But 150 always did the trick. Some here have used up to 300 mg which is the 24 hour maximum. Hopefully you'll convert soon.
Even though I haven't had an episode in a year, I still carry flecainide and diltiazem in a small container attaches to my keychain.
I did convert back into sinus rhythm a couple of hours after taking the 100mg of Flec.
I will make an appointment with my cardiologist to what they recommend.
I don’t really want to go back taking regular meds and hopefully he recommends what you do. Probably will depend on how often I get an episode. I have only been off the meds for 2 months.
Glad you converted. I don't see why they would want you on a daily anti-arrhythmic based on a single or even occasional episode (1-2 month) especially so relatively early in the healing process.
Flecainide seems to convert you well and to be more safe, just stock up on diltiazem, preferably the fast acting tabs if they sell them in your country. Alternatively, you can use beta blockers for the same purpose.
Also, and I have only done this a couple of times in the last year and a half. If things start to feel very jumpy with a lot of PACs, I'll take my old maintenance dose of flecainide for a day or two until things calm down.
I was on the 180mg Diltiazem slow release. I then went onto the 60mg which is not slow release when coming off the meds. Not too sure whether they are fast acting but doctor indicated they don’t stay in your system too long , 3-4 hours.
As mentioned I recently noticed ectopic episodes which I didn’t have previously which is making a bit anxious. I notice these mainly at night when trying to sleep.
after my last cardioversion 8 months ago i thought i'd try, with agreement from my cardiologist, low dose Flecanide 20mg morning and night and low dose Metoprolol 10mg morning and night. My son laughed he said it sounds a bit more than homeopathic dose! (He's a Doc in emergency). Any much higher than that my HR goes into the 40's. So far so good, prior i went into AF in September last year and again end January this year when not on any drugs.
Trying to live a healthy life, good diet, only zero alcohol drinks and only decaf and exercise daily. On supplements after blood tests for my deficiencies which are magnesium, vitd3 and coq10. Not sure if its the lifestyle changes or the meds or even a combo of all of the above!
Glad that you converted back to SR with the flecainide. My situation is alot like yours after my first ablation about 4 years ago. Was few months out from procedure and was taken off flecainide and heart doing ok for a bit then over next few months the ectopics (PACs) increased substantially and eventually started triggering tachycardia and AFib episodes. Pip Flecainide helped convert me back to sinus after each episode but eventually AFib episodes started to become too regular so was put back on flecainide 75mg 2x a day and that did settle my heart for many months with reduced PACs and no AFib episodes. Even though I could not come off the medication the ablation did seem to change my AFib presentation and make it more responsive to regular flec.
All this to say that hopefully you can stay off the regular mediation and your heart stabilizes, if not though you may still see many positives post ablation if you have to go back on regular flec.
Regarding the ectopics there are many many great contributions from people on this topic so do a site search and have a read of some topic specific threads as many people have found some relief from ectopics with different supplements, breathing exercises etc...
I also get ectopics alot at night when trying to sleep which is an absolute bugger. Best thing for me is to sleep sitting up - does not necessarily make PACs go away but seems to reduce their intensity vs laying on your side or back. Luckily ectopics have a tendency to wax and wane. Keep safe
Thanks for the reassurance and hopefully this is just a one off
I was wondering whether you considered having a second abalation?
My electrophysiologist mentioned approximately a 70% success rate with the first abalation and a second abalation would provide a 90% success rate of having no Afib medication free for a patient that had no other medical issues.
Hello Murphy10 - have actually had 3 ablations in past 4 years. 2 for AFib and 3rd for AFib and ectopics. Since the 3rd ablation I have had longer periods of no Afib but each time I try to wean off the flecainide my ectopics increase and start to trigger tachycardia runs and eventually AFib runs so I have had to go back on flecainide and bisoprolol. Going back on the meds improves my situation greatly and mostly keeps the AFib at bay though my ectopics have a mind of their own sometimes with some day none some days a few and other days thousands. At this time though relatively stable - have discussed with ep and am in line for 4th ablation at some point (am age 50 with no other major health concerns) but ep and I are holding off as long as possible so that pulsed field ablation has time to become more fully adopted. At this time my ectopics are far more problematic for me mentally and physically than the AFib...
I would definitely talk to your health team about pro and cons of 2nd ablation and the potential to be AFib free and med free for a long period.
Thanks. When considering an abalation I asked my Electrophysiologist about pulse field. He advised it is still rather new technology and he seemed to think it is early days and would rather wait until it is proven to be as affective as RF abalation.
He did say it may become the standard in the future.
I have never had to have a cardioversion. I generally went back into sinus rhythm however my AF became mor regular (an episode monthly) hence the decision to have an abalation.
I also exercise daily and may have a couple of low alcohol beers on the weekend. My cardiologist said having 1 or 2 coffees a day has no relationship to AF.
At resting my heart rate is low 50s. I do a bit of bike riding and I generally get my heart rate up to mid 130s. I have never had an AF episode exercising they have always been at night when resting or waking me up when sleeping.
The disappointing aspect is going through the process of having an abalation then having my AF return 7 months later.
I am going through similar in that I had an ablation 11 months ago. Since then I had a 3 hour AFib in June and a 6 hour AFib this month. So I am very disappointed as well!
I am not on meds and my Dr advised me not to take flec, even as a PIP. Not sure why…I plan to ask him!
I was so hoping the ablation had worked, but it seems that I am just back to that feeling of never knowing when AFib will next strike. It is affecting my sleep with the anxiety (as AFib happens to me only when lying in bed asleep). My brain tells me to stay awake to avoid the chance of it…the way to madness I am sure.
I definitely need advice, but not sure what they can do…
I definitely feel for you as have been in your situation post ablation numerous times. Have you had discussions with your ep or AFib team about your episodes and possible followup ablation as statistically the success rate increases for 2nd ablation (though not sure of your overall health, age etc... and if you would be a candidate for this)In the meantime though, perhaps a discussion with your health team re: possible antiarrhythmic meds to keep your heart more stable? Again not sure if you are able to take meds and possible interactions with other conditions... For me though prior to first ablation my meds were not working well but post ablation the medications have provided much greater benefit (not the absolute cure I was looking for but a better situation nonetheless). Cheers
Thanks so much for taking the time to reply to me. It helps knowing I am not alone! I will speak to the cardio guy and try and work on my anxiety in the mean time. Otherwise I am very healthy (I think!) and aged 63. Perhaps a further ablation could help me?
I would think that an additional ablation could be of benefit, but again best to discuss in depth with your health team all of your options (inclusive of medications in the short term and ablation in the longer term). Have a look at the research that definitely shows that successful outcomes higher for 2nd ablation than 1st (though successful does not mean cured ). Wishing you greater heart stability
Sorry to hear that you are going through a rough period. I am also feeling the same but look on the bright side. There are people dealing with a lot bigger health issues than Afib.
If you have any structural heart issues then Flec. Is not recommended. It is however regarded one of the best ‘Pill in the Pocket’ if you have an Afib episode.
Thanks for your positive thoughts, it really helps.
That is interesting about the heart structure v flec. My heart has an enlarged atria and 2 mildly leaky valves…is that enough for flec to be a problem, do you think?
I will ask the cardiologist about flec as a PIP, as that may be ok perhaps…
I also have a slightly enlarged atria and may be due to Afib. Best to speak to your cardiologist or your electrophysiologist. Flec. however is no wonder drug but it has been around for a long time and seems to be the drug of choice for PIP
Thanks for sharing. It’s good to know I am not the only one! You have given me impetus to at least ask my heart man about the flec. Indeed, during my ablation, apparently I went into AFib and the surgeon administered flec at the time to stop it. Then suggested I use flec in future as a PIP. But my cardiologist disagrees.
One thing to keep in mind with flecainide is that you may also need to take a beta blocker as flec can cause other arrthymias. Again sure you will discuss this with your health team. Keep safe
This is just an fyi about flecainide that many people don't like to hear. As flecainide may be beneficial for some, there are risks for others. One being a new or worse arrhythmia. You can find more info on flecainide at Cleveland Clinic.org. I hope you get all this worked out. It is quite possible you will not have another episode.
Oh and as far as etopic beats, I have periods of time where I am having them. They will come and go. I had my ablation over a year ago. I don't worry about them much.. I just try to get good sleep, eat right, exercise and stay stress free as I can.
I am not sure I can help you but my EP wouldn't take me off the medication as he said he likes 'belt and braces' not sure if he ever will. I am still taking apixaban which he tells me will be for life and Sotalol x 3 per day. My ablation was in March this year and so far no episodes 🤞 but maybe the meds are keeping it under control. I did have a 24 hour holter monitor after 4 months which showed occasional ectopic beats and 3 runs of atrial tachycardia lasting less than 3 seconds. I will be guided by my EP although I am disappointed I am not off the antiarrhythmics. Perhaps you could resume your flecainide? My episodes used to last 36 hours!!
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