I thought I was out of the woods

Atrial Fibrillation, Flecainide (anti arrhythmic) and Dr. Andrea Natale

by Gemita - 2023-11-21 19:14:03

Athena, I am so sorry to hear your news.  AF has a habit of doing this to us.  Dr. Andrea Natale is a well respected and extremely successful EP and one of the best apparently. An ablation is often used as a first line treatment for Atrial Fibrillation (AF) today, rather than going down the medication route because an ablation can be extremely effective and often curative for long periods of time. 

My EP quoted 40-45% success rate with medication as opposed to a 70-75% success rate for a first ablation, rising to 85% success rate for a second one.  He felt I would need two ablations for my various arrhythmias.  An ablation is certainly potentially more effective than medication, although to stop AF is not easy and may take more than one ablation attempt.  You also have to remember that the healing period following an ablation can be up to 6 months or more, when you might still experience episodes of AF.

Since you are young, I would make an appointment with Natale and ask him about his success rates and of your chances of having an effective treatment with just one ablation?

I took Flecainide for approx. 3 years.  It was a good starter med, usually well tolerated.  After 3 years Flecainide stopped working and it apparently triggered Atrial Flutter, so I stopped Flecainide, remaining on a beta blocker instead.  I am now off all anti arrhythmics and only taking a low dose beta blocker but if AF were to become more frequent, I wouldn’t hesitate to have an ablation, rather than go down the anti arrhythmic route.

Athena, it is a big decision, I know.  You could pehaps try the higher dose of Flecainide first or just stay on the current dose and see if you can tolerate the occasional episode of AF?  Are you on a beta blocker too, to protect the Flutter line?  Flecainide without a rate control med could trigger Atrial Flutter.  Remember too, the goal with AF treatment is not to eradicate the arrhythmia, but to control it and any symptoms.  To stop AF completely will be difficult.  Yes sleep apnea is a major trigger for any arrhythmia.  You could ask for a sleep study just to be safe.  Goodnight and good luck

metoprolol

by athena123 - 2023-11-21 21:15:12

Thank you Gemita for your always beneficial advice. I am also taking 25mg of metoprolol with 12.5/morning and night. 

Waking to use the bathroom for five nights?

by Gemita - 2023-11-22 01:13:24

Athena, If you have been waking during the night with urinary urgency and this is unusual for you, I would perhaps ask your doctor whether you might have a urinary tract infection?  AF can be triggered by an infection.  

Urinary urgency can also be a sign (confirmation) of AF occurring during the night, waking you, since it is known to occur with atrial arrhythmias when the heart rate increases. This is due to a hormone called the Atrial Natriuretic Peptide hormone released by the heart to help the body maintain balance of water, sodium, potassium and fat.  It is released in response to high blood volume, especially when you have an erratic heartbeat like AF or another tachy arrhythmia. Clever really, but awful to have to keep running to the bathroom.  It took me ages to correlate this symptom with AF and to understand why it kept happening.  

A beta blocker + Flecainide will cause fatigue.  It may improve as you get used to both meds.  

many nightly bathroom trips

by new to pace.... - 2023-11-22 08:09:24

I know that can  cause sleeping problems.  I found in the past that if I ate foods that have Nitrates in them.  Would cause exececive trips. I started not eating them and those trips stopped.  You might start a food journal of everything you eat to see if you can find the source.  For me once i stopped eating Celery and Celery Seeds, Cabbages.  Those nightly trips stopped.

Also have the same problem when given Saline in the hosiptals.  Up all night long, nurse finally said to me when i get out of the hosiptal should see a bladder doctor.  Chuckled and thought by 5am should  these trips would stop and would finally sleep.  Then the doctor came in said i was good to go home.  But still got a couple of hours sleep before being discharged.

new to pace