Arrgh! It's back!

It's 14 months since my Bordeaux Ablation. I felt after the year mark passed with my heart calm with hardly even a Pac that I could look forward at least years without any problems.

Then last night at 2.00 a.m. I woke in Afib. I tried the twisting stretch but no good. At 2.15 I took 400 mg of magnesium and potassium powders. with 50 mg theanine.

At 2.45 I took 150 mg flecainide. The plan was to take another 150 mg at 3.45 if the first dose didn't work but by that time the heart was beating fast with just a few Pac's.

I'm pretty helpless during an episode but my wife was doing everything for me. I asked her to check up on A Flutter but first my PC froze and then I couldn't get a signal on my iPad. By 5.00 the rhythm was closer to normal Afib again so I took another 150 mg Flec.

Converted to NSR 8.00a.m. As usual after an episode I'm weak as a kitten; completely washed out out.

Could someone remind me what's recommended regarding taking an anticoagulant. I've taken 110 mg Pradaxa this morning.

Thank you

Sam

Sorry to hear of this Sam. My personal experience is that anticoagulants are necessary after being out of rhythm for over 24 hrs. However, I would recommend calling your EP or their answering service to get direct instructions.

The dosage should be printed right on the prescription label. The normal dosage for afib in someone with normal kidney function is 150 mg twice daily. Not sure why you have the 110 mg pills.

If you're going to use flecainide as a PIP, the usual procedure is to take 300 mg all at once along with a beta blocker. You want to hit it with a single, hefty dose, not two smaller doses.

Sorry to hear this Sam. Particularly disappointing as you say as getting to the year mark AF-free usually indicates a successful first ablation procedure.

That said, a couple of points. If I recall correctly your initial ablation was long (4 hrs) and difficult. Shannon told me before I had mine to expect to need two procedures and be grateful if I only needed one! Combining both of the aforementioned suggests that there’s still a bit more work to do on your heart and a second procedure is required - as it often is with even the best operators including Jais and Natale.

As Carey said hit an AF episode hard with 300mg Flecainide at the outset. For what it’s worth I always took 20mg Propanalol immediately and then the 300mg Flecainide 10 minutes later (chewed with warm water).

All the above said, this could have been a one-off and you won’t get another for a year, two or three. We’re you dehydrated? Alcohol? Large late meal? High stress?

Thanks for the replies, folks.

rocketrich - there's only one EP in this country and I know from past experience that he's not very good. I arranged the ablation myself.

Carey and mcwf - thanks for the flecainide dose details and no I wasn't dehydrated, unusually stressed, I don't drink and never eat after finishing tea at 7.00 p m.

I wasn't clear enough about the anti-coagulant. I wanted to know how many days to take it after an episode.

PS last night was fine and indeed I am hoping it was a one-off as I dread having to go back to Bordeaux - not because of the operation itself but because of the complications of organising an appointment date, with flights (only one a day from here), accommodation, a TOE and blood tests to be done during the week before the op. Getting these all together was really difficult. Not forgetting the dreaded flights when suffering from aerophobia!

Quote
Sam
I wasn't clear enough about the anti-coagulant. I wanted to know how many days to take it after an episode.

I'm unaware of any accepted guidelines on this. What I did in the past when I was taking Eliquis as a PIP was to simply stop the next day. My reasoning was that risk of clot formation is during afib when blood pools in the left atrial appendage. Once the afib ends your atria begin pumping normally again and any clots that happened to form will be pumped out then, so that's when strokes are going to happen if there's a clot lurking in there. But once you're past that period, the danger of pooling and new clots forming is gone. My EP at the time was actually okay with this practice, but then again I was a CHADS 0 and arguably didn't need the Eliquis at all. Not sure what your CHADS score is, but if it's >1 I wouldn't do what I did. I'd stick with taking the Pradaxa daily.

Thanks, Carey, just what I wanted.

Sam