Discharged after ablation - next steps?

[richardph]

Hi all,

Some brief history: I had a stroke in July 2022, as a result of which I was diagnosed with AF and HF (EF 25-30%).

Following the usual drugs, in March 2023 I had a successful cardioversion, which brought my EF up to a normal 63% (so no more HF). I was put on the waiting list for an ablation, which finally happened in August 2024 (so, just over six months ago).

So far, all seems good, and as far as I know I remained in NSR throughout the wait for the ablation, and have remained in NSR every since. I've had no follow up ECG, but I do have a KardiaMobile, which has never reported anything other than NSR in the past two years,

My only remaining problem is the side effects of the 7.5mg Bisoprolol I have been on ever since after the stroke. I think it's the Bisoprolol that is making me constantly tired and unable to concentrate. I've lived with it up until now, but it's really quite debilitating.

I was really hoping that at the ablation follow up I would be able to discontinue it, or at least significantly reduce the dose.

However, the only follow up post-ablation was a short meeting (not with the EP who I had seen before), at which I was told I could reduce the dose to 5mg, but now further, and then, to me surprise, I was discharged.

So my questions for the knowledgeable folk here are:

1) is it normal to be discharged after an ablation with no follow up tests (not even an ECG)?

2) having been discharged, I presume I'll get nothing further from the hospital, so would it be worth me getting a private appointment with an EP, mainly to discuss if there are any other options for my drugs, other than just living with things as they are?

3) and finally, any tips for choosing a private EP? I live in London, so presumably lots of choice. I guess the EP who actually did the ablation (though that's not the one who listed me for it) who would be a good starting point ...

Thanks.

Richard.

[mjames1]

Maybe fresh eyes might be more helpful, especially since your previous EP did no follow ups.

Professor Richard Schilling OneWelbeck Heart Health1 Welbeck Street London W1G 0AR

Excellent reputation by every account. I didn't end up using him for logistical reasons (I'm in the US) but my interactions with his office staff were very good anr they prioritize private patients. Assuming you really still need it, there are alternatives to bisoprolol, such as Diltiazem.

Also any of the electrophysiologists at Royal Papworth in Cambridge are good.

Just make sure you really emphasize how the bisoprolol is impacting your quality of life because otherwise they tend to keep you on the same drugs forever.

Jim



[Responsable]

Thank you so much for giving us so detailed story. It was very informative! I would like to encourage all the participants here to give as many details as they can remember when writing a post/comment. All of us here are researchers, no matter are we testing one defined hypothesis or just collecting data. This is the best way to fight "beloved" AF. Some day, somewhere, somebody may disclose the way it comes to exist and the way to "kill the beast"...

[50568789]

When you were discharged, were you given the contact number of the Arrythmia Nurses team? Check what the papers say. I have spoken several times to mine in the last year with various queries and concerns, their advice has been invaluable and reassuring and they have guided me down the path to further treatment with the EP.

[richardph in reply to 50568789]

No, there's been no mention of Arrythmia Nurses, either before or after discharge.

[50568789 in reply to richardph]

Here is part of my discharge letter from an NHS cardioversion at Royal Papworth. I would have thought most hospitals would issue something similar.

Black and white copy of letter

[Wilkie1]

I had an ablation at the end of August 2024 which I had paid for privately. I was subsequently reviewed by the EP who performed the ablation at 3 months after the procedure. Whilst this was private I understand that was the routine for follow up. I didn't receive any tests ecgs etc at any time before or resulting from the review rather the EP relied on my self reporting of how things had been. At the review he took me off all my medications which were bisoprolol and apixiban. He then discharged me at that point though with the option to make an appointment in the future should I wish.

[richardph in reply to Wilkie1]

Thanks, that sounds encouraging, though in my case I think that having already had a stroke there's no question of stopping apixiban. But that's OK, I think it's the bisoprolol that's a problem for me.

[Karendeena]

I had my ablation in March 2024 and remain under observation, whether that is because I see him privately or because I am part of a research project I don't know. I am still on the medication albeit a lower dose of Sotalol. He said I will remain on apixaban for life.

[Sixtychick]

I got 2 follow- up appointments, one face to face and the last one a phone call., which was just over a year since I’d had my ablation. I never had any follow-up tests though.

[Jajarunner]

Do you have an arrhythmia nurses? They can speak directly to your EP.

[2learn]

My experience is there was no direct follow up from the hospital, but I get an annual cardiology check up and if I have any issues I raise with GP who if necessary refers me to cardio.

As for Biso, what is your HR and again my experience is that after a successful ablation I have to stop Biso as it brings my HR too low and so after 3 ablations and 3 cardioversions it has always been stopped completely. It can always be reintroduced if your HR goes too high and GP should sort that.

You don't mention anti coagulants, but I assume you are on apixaban or similar after stroke.

First stop I would talk to GP.

[richardph in reply to 2learn]

My resting HR is about 50, with the 5mg of Biso. It didn't seem to have changed at all following the ablation.

And yes, I'm on Apixiban

[2learn in reply to richardph]

Ok, only speaking from personal experience. 50 HR seems low unless you are a trained athlete. I have a pacemaker to stop my HR going below 60. So I would talk to your medics about this.

[MikeThePike]

Hello there, when you say "as a result of which I was diagnosed" what do you mean? Are you saying that the stroke actually caused your AF and HF?

[richardph in reply to MikeThePike]

I was diagnosed with AF and HF when I was admitted to hospital because of the stroke. The stroke and the HF were almost certainly both caused by the AF.

[MikeThePike in reply to richardph]

OK, I thought that's what you meant but wanted to be sure. Thanks for clarifying and best wishes.

[Redactrice]

I had my first ablation six and a half months ago and have not had a follow-up in person, only over the phone, with one trip to A&E because I went into fast AF three weeks after the ablation. I'm in regular contact with the cardiac rhythm management nurses.

Lots of us struggle with bisoprolol. I could barely get out of bed in the brief time I was on it (and I was under 60 and otherwise healthy). The cardiologist agreed that it did not suit me and switched me to metoprolol, which has other side effects, but at least I'm not bedridden. You might ask to try a different BB.