PF Ablation

[Mcgandy]

Had a pneumonia in 2017 which triggered persistent AF, then a DCCV in 2017 which lasted 7 years.

March 24 another breathing issue triggered AF again, and a DCCV June 24 didn't last long. Had my first Pf ablation in Bournemouth Hosp 30/12/24. So far, the ablation seems to be working, tho I'm told there is 3 month "blanking period" while everything heals and settles down.

I'm allowed back on my bike now the groin has healed, hoping to resume my regular 20m rides, which I was still able to do whilst in AF.

Just received my post op clinical letter to my GP detailing the procedure , which prompts a couple of questions.

First ; I had assumed the ablation itself normalised the rhythm, but find that as part of the procedure I was given a post ablation DCCV to restore sinus rhythm. I presume this must be SOP, but it was never mentioned in any of my consultations, pre op preparations, or post op advice. Nor have I ever seen it referred to on here. Observations?

Second ; I had assumed, led by my conversations with consultant/AF nurses that once rhythm was restored by ablation, I could cease Bisoprolol. This was one of my motivations for electing the procedure : I had been offered the choice of simply remaining on drugs as a perfectly safe option, or having the PFA.

I was keen to stop any BBs, given that as a lifelong asthmatic I'm suspicious that my breathing is being impacted by them, so chose the PFA.

But my post op letter says "follow up to be patient initiated, all meds to be continued". The cardio who saw me post op also pooh poohed stopping Bisoprolol, ever. I had expected to get a 3 month review, echo, and drug review. I will, of course, be chasing for this in due course, but what is others' experience?

Thanks!

[BobD Volunteer]

Firstly please read our fact sheet on recovery ahealthunlocked.com/redirect... and take things easy with exercise for a while longer.

PFA may be less traumatic on the heart but will still need a lot more recovery than you expect so baby steps please. Many people are able to stop their drugs once recovery is complete. maybe nine months to a year with the probably exception of anticoagulation if your chads score was 2 or higher prior to the ablation. Many of us here are on it for life (even though I haven't knowingly had AF for many years. )

[Mcgandy in reply to BobD]

I do not expect to stop anticoagluiants, ever, tho I did, with cardio approval, in 2017. Few years older and an ablation under my belt, I accept they're with me to stay.

BBs are another thing, tho. I will remount the bike tomorrow and see how I get on, tbh I'm more concerned at taking care not to aggravate the entry wound than any effect on my heart, but we'll see what happens. Quite like;y the full 20m gets cut short!

[CDreamer in reply to Mcgandy]

Good advice from BobD - I would echo the advice of dialling down the exercise for a few more weeks.

Q1 - post procedure DCCV - if you were in NSR when you went into the procedure the team most likely provoked AF to map and see where to ablate and hence you needed DCCV. Only way to know for sure is to ask at your 12 week consult.

It is quite usual to continue meds for the first few months following ablation, however, once past the blanking period and when your HR is stable and back to your normal as you are asthmatic, I would push back on the beta blockers unless there is a further reason for continuing? Not a fan of beta blockers but I can see that some people may benefit to control HR.

I was prescribed Flecainide and Biso following ablation but I didn’t tolerate them at all well and they exacerbated auto immune condition so I stopped them cold turkey after about 8 weeks. I immediately felt much better and stayed in NSR for the next 3 years.

[Mcgandy in reply to CDreamer]

Thanks. I have been in permanent AF since March 24 save a few days post DCCV in June, so that's not it : just interested to know if its SOP as part of ablation to DCCV back to NSR .

[50568789]

It's what I had, never really questioned it but was given the impression it was a standard thing to do if circumstances appropriate.

[Jajarunner]

It's best to stay on the meds during the blanking period so the heart can recover fully. To do the ablation you have to be put into afib so they need a DCCV to put you back in normal rhythm so I think that is standard procedure.Best wishes 🙏

[Mcgandy in reply to Jajarunner]

Thanks, understood, But I was aleady in AF. So it must be that ablation alone does not restore NSR without a DCCV. It's just that I wasn't told b4 that it was part of the procedure.

[Jajarunner in reply to Mcgandy]

Yes, it's interesting. You'd think if they had zapped every thing it would revert to NSR. But obviously it doesn't work that simply. Hence all those years at medical school 🤣🤣🤣🤣

[Model52 in reply to Jajarunner]

The truth is: they have no idea what they’re doing. These are the words of an experienced EP (John Mandrola):

“The main headwind of AF treatment is that we don’t understand the cause(s) of AF.

We don’t know why (ablation with) pulmonary vein isolation works; and we don’t know why it fails. Patients ask how I know where to ablate? This question always makes me smile. Because the true answer is that we do not know. We ablate the same area (PV isolation) in every patient.

I still believe real advances in AF treatment will occur in basic science labs not ablation labs.”

[Wilkie1]

I had a PFA in August. At 3 month review in November EP took me of both my Betablocker and Anticoagulant. I had expected to come of the Betablocker after 3 months but expected that there to be more of a discussion around anticoagulant. In the event EP was clear that the better course for me was not to be on anticoagulant. He agreed that I would stay on it for another 3 months so that I could continue to monitor how my heart is responding to the PFA with no further Afib.

[Fullofheart]

Hi, I've had 3 ablations and DCCV followed each one. It's part of the procedure as I understood it.Usually you'll have a phone review booked in to review recovery of the procedure, and then there might be another review of meds. Usually (in my experience) people are advised to stay on pre procedure meds for at least the blanking period then, dependent on situation, review from there. It may take quite a few months.

I, personally, wouldn't have gotten on a bike for at least a month if not two after each of my procedures. I just managed short walks and I was fit, active, in late 40s at time of all three. I'd advise reading the fact sheet and taking it easy. Otherwise you risk just undoing the work that the EP has done.

[Mcgandy in reply to Fullofheart]

Well, I was tols take it very easy for a week, no cycling for 2. So I pedalled a short way yesterday, day 16, and felt good doing it. I've got a rasre January weather window today so will get out on the bike. It's an almost flat ride, so I won't be busting a gut.

[Mcgandy in reply to Mcgandy]

Well, did my ride yesterday, very gently. 25 miles, went very slowly up the 2 slight gradients involved. Certainly felt good for it.

So far, so good !

[Karendeena]

I had my ablation in March 2024 and I remain on Sotalol. I too wanted to be off the meds but my EP is against it saying he likes 'belt and braces' he has reduced my dose though

[Chilbolton1]

I had my PF Ablation at Bournemouth March 24 and have been doing quite well until recently.

Ecg and echo show I’m back in AF so having another Cardioversion week after next and on waiting list for another Ablation. I only received a telephone consultation after not a face ti face sadly. Bournemouth hospital have been very good for me, but doubt I’ll come off of `bisoprolol either 10mg per day . I hope you hear soon