Bisoprolol before Abaltion

I stop Flec Wednesday before Bordeaux Ablation next Monday. I got Bisoprolol today for rate control when heart goes into Afib. but she was wary of prescribing it thinking it should not be used before an ablation. She checked with a cardiologist who felt the same. I'm certain it's OK but I promised to contact an expert to confirm hence my query.

Hi Sam,

I likely hardly need to tell you that the only people you should be directing this query to are the team (as in Meleze Hocini and Pierre Jais) at Bordeaux. I'm figuring/guessing that they'll be OK with you taking something to control your ventricular rate should you get AF between this Wednesday and next Monday.

Wishing you all the very best of luck. IMO you are definitely going to the right folks for your ablation!

Also very much looking forward to hearing all about it once it's all done and dusted. Not least as I myself will almost certainly be heading over there in two or three months time.

Best regards,

Mike

I second Mike's comments. Contacting an expert means your contact person at Bordeaux. I can almost guarantee they don't want you on rate control medications prior to your ablation but the final word on that has to come from them.

Thanks for the replies but I don't think I can get a response from Bordeaux in time.

Quote
Sam
Thanks for the replies but I don't think I can get a response from Bordeaux in time.

Then I strongly recommend not taking it. EPs virtually always require their ablation patients to be completely free of rate and rhythm control drugs in the days preceding the procedure.

My Bordeaux information sheet states inter alia:

"Anti-arrhythmic drugs will be stopped 5 days before."

No mention is made of stopping rate control drugs. No disrespect Carey (you are a top top poster by the way!), but I'd be surprised if one was expected to to take the risk of travelling abroad in high ventricular rate AF.... that would not be at all pleasant! But the final call is obviously down to the folks at Bordeaux. Maybe stopping AADs is enough: as we've discussed before Flecainide has a half life of around 5 days - hence why it needs to be stopped 5 days before the procedure to enable the team to be able to find and ablate any non-PV triggers. Maybe travelling a day or two before the procedure and stopping any rate control 24 hrs before would do? Isn't a BB out of one's system within 24 hrs??

Coming back to Flecainide, in a previous post of 22nd May 2018 you state: "I'm currently on 25 mg Flecainide twice a day." 25mg BID to my eyes at least is pretty much sub-theraputic (I take 100mg BID) and, as such, I'm guessing you won't have too many problems stopping your 25mg BID for those 5 days anyway.



Edited 1 time(s). Last edit at 06/05/2018 04:56AM by mwcf.

Quote
mwcf
I'd be surprised if one was expected to to take the risk of travelling abroad in high ventricular rate AF.... that would not be at all pleasant! .

I travelled to Austin via 2 flights including an OJ Simpson type sprint across DFW in afib/flutter. You are absolutely correct - it was not pleasant. But I presented in the lab the same way, and I was "clean" and not masking anything for Dr. Natale. I guess I don't understand why Bordeaux folks can't respond to your inquiry in a day or so?

Just received a reply from Professor Jais in Bordeaux regarding the use of a rate control Beta-blocker.

It was "Sure, no problem!"

Great, then that settles that!

As for traveling with a high ventricular rate, I got on my flight to Austin with a heart rate of about 240. A fast rate is no fun, but as long as it doesn't cause dizziness or fainting then that's all it is -- uncomfortable.

My doctor told me about it too.