hi all. Got my 3rd procedure letter today it’s for 2 weeks time.
but yesterday I saw a different ep about a possible PFA procedure but could be 12 to 18 month wait
Don’t know what to do ??
Any advise
The ep yesterday suggested trying soltolol instead of flec & bisoprolol??
As far as I understand, whilst PFA is faster and less "invasive" meaning quicker recovery, overall results are little better than "normal" ablations. On balance. knowing how AF begets AF I would rather have mine now than wait 18 months but that is just me.
Cheers Bob. What’s your knowledge of sotolol?
He suggests I try that instead of bisoprol and flec?
Dual action drug. Never used it as it was very much out of favour at the time I had problems. Was always reffered to as a dirty drug whatever that means.
I have Sotalol with no problems. My EP who is a Professor favours it and says it's a very good drug
You take it every day. My ep. Said rather than pill in pocket flec plus bisoprolol. Take the sotalol
Yes I take 40mg morning and night. Prior to ablation I was taking 40mg x 3 daily. I understand that this is considered a low dose
Agree 💯 My EP who is a leader in the research into AF told me only a couple of months ago that the PFA is a quicker process allowing them to do more ablations but the results so far show little difference in comparison to RF
I had a PFA 10 months ago and so far so good, but the same was true for many months after my first ablation ( cryo) & 2nd (RF)! My only thought is to not be in persistent AF because that makes me really miserable. Before the PFA I was out of whack for 18 months even with 3 cardioversions & a couple of different meds.
I would take the one soonest if it were me.
I didn't have much luck with Sotalol, it did it's job but I felt weary a lot of the time, However I know several people for whom it has worked really well, so horses for courses I guess. The best med for me was Amiodarone. I'm one of the lucky ones and had absolutely no side effects but Dox don't want to use it long term so I was switched to Bisopalol which has worked for me just like Atenalol did for 15 years prior to a minor stroke back at the begining of my AF adventure.
If I were you I'd try the Sotalol because there's a good chance it will do the job for you, and if not there's still a bunch of meds that are subtly different.
Best of luck with whatever you decide.....
Thanks. I’ve decided to go for the one 20th Jan.
It’s the same ep who did the 2nd he said he’s gonna look at areas outside the 4 PV
I may be wrong but I think a PF ablation is similar to. Cryo in that it only treats the PV areas. When I had my RF ablation the EP did a ‘box’ isolation as well as PV because testing showed errant signals coming from other areas. So I think you are doing the right thing.
Snap! I had RF 4 pv and box isolation with my first ablation. My EP prefers to try and zap as much as possible with the first ablation to try to avoid patients coming back for another if only the PV are treated.
Good to know about the amiodarone . I have been given it as a pip but haven’t used it yet
I got put on a loading dose before the PFA. It takes a while to build up & consequently a long time to get out of your system. I then took 200mg a day. I did blood tests for liver & thyroid function every 3 months and at 9 months a chest x-ray and a thyroid ultrasound. Mine were all good but still doc wanted me off....it's a terrific med but can have some side effects just like everything else so I understand the retisence for them to keep me on long term..
Best of luck
I've been on both Flecainide and Bisoprolol in the past. Now on Sotolol 320mg daily since October which seems to be keeping the lid on it. No apparent side effects apart from a slower HR down to 50 and max 64 when out walking which suits me just fine... for now. As for the 3rd ablation (personally I'm done with them), I'd go for it sooner rather than later.
Good luck with it.
Cheers appreciate it. What size tablets do the sotalol come in. My ep said 1 pill a day ?
According to the patient leaflet, they come in 40mg, 80mg and 160mg tablets. I started off with 160mg daily (two 80mg taken 12 hours apart) then doubled to 320mg (two 160mg 12 hours apart) which put me back in NSR after 27 hours and has kept me pretty good since, although not totally free of irregularities but a 99 percent improvement. All taken under the advice of a cardiologist that specialises in EP.
I take Sotalol (prior to ablation and post ablation). Sotalol didn't really help my AF that's why I went for the ablation, I still had breakthrough episodes. Seems to be keeping the beast away at the moment though 10 months post ablation
Think you've done the right thing Len. Wishing you the best. Is it Prof Osman? Xx
I agree. Makes you feel at ease and comfortable. He’s a highly regarded ep as well I think ? One of best ?
Very nice chap. He's not my EP but I've met him a couple of times when I've been hospitalised.
Who’s your ep at Coventry?
Shamil Yusuf. Lovely guy. Happy for me to email him directly with any issues/problems. It used to be Sajad Hayat but he headed off to Qatar about 6 years ago.
I have taken Sotalol for many years. I only had problems, when I tried to stop it a while ago, as my BP soared to over 190/95 and I had to go to A&E. I had what is called a hypertensive crisis. I had managed to reduce it from 80mg twice a day to 20 mg, before I had problems. I’ve been put back on 40 mg now. I read it’s a safe drug to take long term. I have read up about the new ablation technique and it sounds a much better and with better results.
Ablation in 2 weeks or 12-18 month wait. 2 weeks so free of AF is my choice.
Can you not go private, get it done quicker?
I don't think PFA is more successful just slightly quicker recovery (but more bruising...).
Cheers. Yeah the ep said for PFA it’s a general anaesthetic??not sedation
Yes, I had GA for PFA but also for both RF ablations. Only the first, PVI, was sedated. Omg, looks like I'm talking in secret code with all those abbreviations 🤣🤣🤣🤣
PFA seems to be a safer option since no heat can transfer to the pulmonary veins, pericardium, oesophagus or phrenic nerve (which controls the diaphragm and breathing) - the main risk factors for a standard ablation, rare as they are in terms of their being serious. However, studies have shown that oesophageal changes were evident in nearly half of patients who had undergone a standard ablation, with nearly a fifth showing some degree of ulceration. A PPI drug is often given after a normal ablation, I understand, to help any injuries heal by preventing acid in the stomach from causing oesophageal erosion.
I'm on the waiting list for a PFA at Leicester.
Steve
Interesting Steve. Thank you. I had an ep appointment at Leicester last week. Does the damage to osophegus heal or is it permanent ?
I’m sure so - but it does make me pleased I am down for PAF. I’m guessing the longer waiting time is perhaps because, as with me, the specialist wants you to have a general anaesthetic?
I don’t know what I’d do in your shoes. I’m not 100% convinced by ablations anyway but the thought of a PFA type calms my nerves enough! I wasn’t sure that the evidence for early ablation was fully accepted so the wait might be of little consequence? Symptoms are everything in these decisions, of course.
Steve
2nd Ablation 
3rd Ablation Friday
Cryo ablation
Ablation done
3rd Ablation
