Ablation continued …

[aFibber55]

Well I was doing so well after my ablation on Wednesday, but I am currently waiting to be seen in A&E.

Started fast AF, way worse than usual,last night and after extra Bisoprolol and Flecainide finally converted to normal sinus rhythm about 9 am.

Phoned the cardiac department in Hammersmith where the ablation was done as instructed if unsure about anything and was told to go and have an ECG in A&E anyway.

Oh how I wish I hadn’t. 6 hours sitting around with collective misery, while yet another nurse lost his vampire credentials, rummaging for a vein amongst my ever growing bruise collection, not once but twice. I swear I saw him pale when he saw me limping towards him.

Anyway back home now after 6 hrs in a packed Same Day Emergency Care Department. That’s if you go through 111, if you just walk in, it’s the Accident and Emergency for you and that my friends makes the SDEC look like a paradise.

Apparently some abnormal blood test results indicating damage to the heart, but then again the poor thing has been prodded and battered and 6 hrs of fast AF doesn’t help either.

They spent a bit of time trying to located the only cardiologist in the hospital before remembering it was half term and she was home with the kids, so phone calls were made to another hospital (the only emergency cardiology unit for miles) which happens to be the unit I am under, but of course my only access to them is by 18 monthly appointment or through A&E which is located somewhere else.

I really feel for the staff and patients alike. All the staff I have come across have been wonderful, but working with one hand tied behinds their backs and a foot in a bedpan, is not ideal.

So I have instructed Himself not to take me to hospital under any circumstances for a long while yet.

I would like to say huge thanks to you lovely people replying to my earlier post. Total legends the lot of you.

I know I shouldn’t be disappointed with the return of beast, but …..

All your advice gratefully received and duly noted.

[agnostic1]

Ughh what a trying journey! I can empathize with the hunt for veins- mine sometimes collapse like damsels in distress and then the needle heads for my hands. Wanted to send you good thoughts and hope some ablation veterans here have great advice for you. Hang in there.

[JoDogBlue]

I went into fast highly symptomatic permanent AF three days after my ablation in April. I hadn't been in it for months before the ablation, it's so disappointing, I know how you feel. I really regretted having the ablation. I didn't even consider 111 or A&E; I contacted the arrhythmia nurses (who took over a week to reply). They were reassuring however and I had a cardioversion after a few weeks- I've been in NSR since then. Your heart has taken a battering and needs time and rest to get back to normal so be kind to yourself. Wishing you good luck on your post-ablation journey.

[50568789]

I've had 3 lengthy, miserable waits in A&E in the last couple of years. They had to be done, but not one of life's better experiences. I've told my wife I will refuse to go there ever again, but what can you do? The fear of a complication from AF is no doubt stronger than the dread of a night in A&E.

[aFibber55 in reply to 50568789]

Yes very familiar dilemma. I think what makes decisions to go to A&E so hard is that you get very different advice from different health professionals. Some tell you to sit it out and some to go straight to A&E. I think 111 also increases your chances for a visit as they have to be very careful not to overlook something serious and anything with heart probably raises a red flag. Specialist cardio nurses are you best bet, but not easy to get hold on in a hurry.

[Ppiman]

Can I ask how much of a "beast" is your AF? I mean, how does it impact you in your daily life? My AF has become much more frequent this past year, maybe 7-14 days intervals, with daily regular palpitations that feel, often, worse than the AF. All that said, I can get on with most of the things I do. Exercise, even a stiff walk or anything uphill, when the AF starts, is not easy, though, as the rate soon goes to 180+bpm. if it starts during a walk, then I tend to rest much more often - and worry much more!

Steve

[aFibber55 in reply to Ppiman]

Yes that sounds very familiar. I was very symptomatic 2020 just before I was diagnosed and the first year was hard going adjusting to all the meds and to the fact I had inherited my grandmother and mother’s condition which didn’t end well for either. I have since come to realise that medicine has moved forward hugely in the last 25 years and life style changes can be very helpful.

From 2021 onwards I only had a few episodes a year and always managed to ride them out at home. Being a bit of a control freak, my main problem with the beast is the unpredictability which together with occasional migraines makes me hesitant to throw myself into adventures. I find myself constantly looking for flashes of migraine auras or second guessing if the eptopics will release the beast. Mostly I use deep calm breathing to control both as much as I can.

About a year ago I had my first encounter with Covid which increased the episodes and after my second and quite severe encounter I started having episodes even more frequently.

I wasn’t looking for ablation as I thought I was coping quite well, but my cardio nurse suggested I should at least go on the waiting list and 18 months later when the date came through, I was if not ready, at least a little more open to this option.

Apparently most European countries are now suggesting that ablation should be the first line of defence rather than the last after all medication has failed. She said that they are considering changes to NICE guidelines to support this.

It sort of makes sense as we all heard that AF begets AF. There’s also a better chance of success the younger and fitter you are.

My decision to go ahead was more based on giving ablation the best possible chance for good outcome than finding my episodes unbearable. More about looking after my poor heart than hoping to totally change my life. I know many on this forum have had multiple and eventually ablations later in life or after going into permanent AF and in a way they gave me the courage to try it now and stop being a wimp.

Of course I still worry about the permanent damage ablation courses to your heart, but there comes a time in your life when you realise that you have to weigh pros and cons not on the basis of black and white, but in shades of gray. Whatever gives you best possible outcome with least damage. Not easy as it seems that my decision making ability has joined all the other bits of my body slowly falling off.

[Ppiman in reply to aFibber55]

I doubt it's possible to weigh the pros and cons effectively since the data is unavailable, partly because each case is different enough for what data there is not necessarily to apply. I just get the feeling that the whole picture regarding AF and its prognosis is unknown and is as much an art as a science.

I have never been advised what to do with any of my AF episodes, and have never been advised to phone 111 or whatever. Only once was I frightened by the tachycardia and light-headedness to the point of phoning the arrhythmia clinic. This was soon after my ablation for persistent fast atrial flutter and was my first AF episode. The doctor was at his usual clinic and spoke to me and told me to come in, where they gave me an ECG, and put me down for an emergency CV but, in the end, a 5mg dose of bisoprolol settled the heart rate within an hour and all was well and I went home.

Since then, the episodes have slowly become more frequent but, fingers crossed, I have never felt the need to go in again, just either sitting it out or taking an extra dose of bisoprolol, as needed. I have been given flecainide following a recent clear MRI scan but have not wanted to start it for fear of side effects.

In truth, and luckily since that time, I am not quite sure what "might happen" if an episode felt awful but I still sat it out. I suspect my heart would eventually and naturally convert to NSR, or, I suppose, the AF could become persistent. How that would feel, and how I would cope with it, I don't know. An elderly friend has had persistent continuous "slow" AF for very many years and has been well throughout without any treatment except warfarin. I have read that a very few people suffer with a catastrophic drop in BP and have a risk of organ failure from circulatory collapse, but I feel this to be a very few cases indeed, and that those patients at risk would likely know of the risks. Others that phone 111 or 999 presumably feel that if they didn't, the end would be nigh? It is an awful predicament wondering wether to phone.

I am on a waiting list for an ablation and will likely have it, but I do want to ask first what the prognosis would likely be if I didn't. It has been suggested that alternatives are to live with it, or to be fitted with a pacemaker.

Steve

[Auriculaire]

I know how you feel re veins. During one hospital stay one nurse was nearly in tears as he could see how much he was torturing me trying to find another vein for a canula after two had packed up for the iv drugs I was on. Eventually my gastroenterologist relented and said I could go over to oral antibiotics. It is good that you reverted to NSR and hopefully the episode will just be a blip in your post ablation recovery.

[Cliff_G in reply to Auriculaire]

My one and only electrical cardioversion (prep) was while I was on a trial for Dofetilide, 2001. It didn't convert me so down to the hospital bowels for a quick "paddle". The young doc putting in a cannula hurt me so muxh that I converted. 🤣🤣 They couldn't believe it, but after a little while they indeed called off the cardioversion.