Stopping Flecainide pre-Bordeaux-ablation and follow-up afterwards

A couple of things concerning me....

1. Bordeaux tell me I need to stop Flecainide 5 day’s pre-ablation. I’ve been on the stuff for 10 years and stopping it for 5 days is especially scary giving I’ll be travelling to Bordeaux on my own from the U.K.! I appreciate that they need to be able to readily trigger AF/AFL or whatever, but 5 days? Is this usual?

2. I recently had a varicose vein (familial issue - large tortuous vein wrapped around left thigh) ablated privately and the surgeon gave me 12 months follow-up included in the price. Is it a similar situation when paying privately for an ablation for AF? I appreciate that I’m in the U.K. and Bordeaux is in France (!), but it would still be good to be able to get advice over the phone - including meds if required - for a reasonable period after the ablation procedure no?

Thanks in advance for any input/responses,

Mike F

Mike

This was many years ago (2003) and things may have changed, but I was referred to Bordeaux, at my request, by my EP at King’s College Hospital. They sent all my records and did all the follow up for several years ie anticoagulation, medication, regular checkups and ECGs.

Re stopping flecainide, if you have chosen one of the best centres in the world, why would you question their instructions? I would do exactly what they told me to - they know what they are doing!

Gill

Mike,

I'm no expert, but, from what I've read here on those going to Natale for ablations, this seems standard.

Perhaps you could travel to arrive early (though would cost more for accomodations & lost work time).

George

Quote
mwcf
A couple of things concerning me....

1. Bordeaux tell me I need to stop Flecainide 5 day’s pre-ablation. I’ve been on the stuff for 10 years and stopping it for 5 days is especially scary giving I’ll be travelling to Bordeaux on my own from the U.K.! I appreciate that they need to be able to readily trigger AF/AFL or whatever, but 5 days? Is this usual?

Yes, that's completely normal. The usual procedure is to stop all antiarrhythmic drugs 5 half-lives before the procedure. The half-life of flecainide is 20 hours, but it's variable and can be as long as 27 hours, so 5 days is about right. Count yourself lucky they didn't make it 6 days.

Yes, you might end up in afib before the procedure. That would actually be helpful to them, so all you can do is put up with it knowing you'll soon be done with this scourge forever.

I can't speak for how the Bordeaux folks handle follow-up, but I would expect they will provide medical direction and drug prescriptions for as long as needed. That's just simple medical ethics, but you'll have to ask them how they handle it specifically.

Gill,

Point taken re the Flecainide! I've always wanted to be off the stuff anyway, but not so abruptly and far from home is all - I hate taking the stuff in principle but that doesn't mean that I haven't come to regard it as something of a comfort blanket! I was referred by my GP rather than cardio consultant. My consultant EP here in the UK will, I think, have his nose put a bit out of joint by me not having him do the ablation. I suppose if I encounter problems I'd simply get referred to another consultant.

George,

Thanks for the advice - I have considered travelling early just so I don't have to actually travel whilst in AF.

Carey,

Thanks for info and opinion.

Cheers,

Mike

Mike

The Bordeaux team sent a report back to the referrer, ie to the EP at King’s, who then did all the follow up. I wonder if your GP will organise follow up for you since he did the referral and will get the report? Worth asking him/her about what happens re follow up perhaps?

Things might have changed, but in 2003 you could have a friend or relative stay in your 2-bedded room with you, accommodation and meals provided for them at a small cost. Might be less worrying for you to travel with a companion if you are nervous about stopping the flecainide. It was also useful to have someone go downstairs to the café to get delicious fresh croissants for breakfast! Hope that hasn’t changed!

If you ever want to chat about Bordeaux then do send me a PM and I’ll send you my phone number.

Gill

Mike, I have been to Bordeaux 3 times (last time 2010), a very difficult case apparently, and after the first ablation on the Tuesday afternoon I was in NSR but with severe PACs if I remember correctly. On the Friday I was about to be released but first they wanted me to do the static bicycle test which I must admit I was a bit worried about as exercise was my only real trigger. To cut a long story short I went into AF on the bike whilst waiting for the GO sign from the nurse. On getting back to my room Prof. Hassiguerre came to see me and I told him NO WAY was I going all the way back to China(Macau) with AFib. He thought for a few seconds and said OK we will ablate again on Monday morning.Severe disappointment made worse by the fact that I had to get an hotel for the weekend as the hospital would be closed. Spent the full weekend in AF and returned Monday morning to be told I was now in Left Atrial Flutter and I was lucky because they could ablate the arrhythmia in live conditions. They stopped the Left Atrial Flutter but I was back in AF by the time I flew home a few days later and straight onto Amiodarone by my own choice. So the answer to one of your questions is that they may do a second without additional charge, though I may have had to pay for one night in a bedroom.

Regarding stopping the Flecanide. It makes absolute sense that you must stop any anti Afib drug before you go, the sooner the better. As they told me "you are lucky as we can ablate in live conditions".

Best of luck with your ablation which will be about 7 years after my last one in Bordeaux and things will be improving there all the time. As Prof Jais said to me "You are possibly in the worst three cases I have ever come across and I have done over 4000 since 1997, if not then definitely in the most difficult 10". Your chances must be far better than mine were at the time, chin up mate.
Barry G.

Thank you Gill - very kind of you and if I definitely decide to go to Bordeaux then I will get in touch via PM.

Thank you too Barry - that sounds like a proper nightmare you've had so really glad you've pulled through! I was wondering how many ablations Prof. Jais has done by now and it must be quite a few if he'd already done 4000 by 2010!! By your own standards I suppose I'm actually reasonably lucky in having had AF for almost 20 years with it still being very much paroxysmal. But now I feel it is very much definitely time to act ablation-wise after having been on the Flecainide for 10 years and whilst I'm still relatively 'young' at 57.

Kind regards to all,

Mike F.



Edited 1 time(s). Last edit at 03/24/2018 08:24AM by mwcf.