Need advice for husband in persistent AF in UK

Many of you here will know my story - long term persistent AF, ablation in Bordeaux in January 2003, sinus rhythm since then. A year ago my husband age 79 was diagnosed with persistent AF - asymptomatic so we don’t know how long he has had it. He is on rate control medication and Apixaban anticoagulant and he feels fine.

After several tests he had a phone consultation today with a consultant EP from King's College hospital here in London, UK. Their suggested plan of action is to do a cardioversion, with amiodorone on board, to get husband into normal rhythm to see if he feels better than in persistent AF. If yes then they would go for ablation, if no then he would stay on rate control and anticoagulation. They said there is no point in doing an ablation, with its attendant risks, if it doesn’t make him feel any better.

We told him that we were not happy about amiodorone because of the side effects but he said that it would only be for a short time, ie a year, and side effects would be minimal short term. If the side effects were bad they would stop the amiodorone.

We mentioned going to Bordeaux but he said that he had worked in Bordeaux himself, had consulted them (I don’t believe this) and they agreed it would be their preferred course of action as well. Husband said he needed to think about it all and the consultation ended.

So we have three possible courses of action:

1. Stay on rate control + anticoagulation since he feels fine and is asymptomatic.

2. Contact Bordeaux directly, get on their waiting list if they will accept him without cardioversion/amiodorone trial and travel to France as soon as they could offer him a slot.

3. Accept their plan ie cardioversion with amiodorone.

Would be very grateful for opinions on what would be the best course of action for him. Carey? Shannon?

Gill

Hi Gill,

Without committing to an ablation, is it possible to schedule & pay for a consult with Bordeaux for their opinion?

Best,

George

Quote
Gill
They said there is no point in doing an ablation, with its attendant risks, if it doesn’t make him feel any better.

There are few medical statements I would agree with more than this one.

Months of amiodarone just to find out if he would feel better after an ablation? Sorry, but that's wrong on several levels. I would not do it if I were him.



Edited 1 time(s). Last edit at 04/21/2021 01:13AM by Carey.

I agree somewhat with the concept of getting into NSR, to see if he feels better. I also was in constant AFIB for a long period of time. I am relatively asymptomatic, but I do feel better in NSR. After you have been in AFIB for awhile, particularly if you don't know how long, you might not realize that you don't feel as well as you did in NSR.

Perhaps substitute another Anti-Arrythmic in place of the Amio? If he just maintains NSR for a week, that would be long enough to tell the difference, so the AAM is not absolutely necessary to find out if he feels better in NSR.

If it were me, I would be more inclined to do an Ablation, if I thought it might get me off of Anti-Coagulants. I would ask this question.



Edited 1 time(s). Last edit at 04/21/2021 06:54AM by The Anti-Fib.

Thanks George, Carey and Anti-fib. He's still thinking about his choices but I think he definitely won’t be going down the amiodorone route!

Gill

Hi Gill, yes I am very aware of your story and I unknowingly followed your path to Bordeaux from 2007 to 2010 - 3 times- if my memory is correct.
I would certainly consider a try at cardioversion however no chance 1 year on amiodarone, 2 weeks on that stuff was enough for me when I started out on this adventure in 2006. If your husband is physically in reasonable shape perhaps he could take the path to Bordeaux as although he is asymptomatic surely he would feel much better in NSR if an ablation was to be successful - people just learn to put up with things and consider them to be a part of aging. Not sure about the current success rates of cardioversion on AF but I am coming up to a 2 year anniversary of a cardioversion of Atrial Flutter (possible left side Flutter, most difficult kind to ablate) and keeping well within my exercise tolerance levels to keep me from triggering into AF or AFL again.
P.S. Just remembered the time I was back in AF a month or so after my 2nd or 3rd ablation and I needed to get 3 consecutive weekly warfarin readings within the required parameter's before the hospital would carry out the cardioversion of the AF. It took nearly 3 months to get successful readings in 3 consecutive weeks. I was functioning more or less normally but certainly internally miserable knowing I had to take care going up steps and anything other than sitting down. I got use to it and was just waiting for the conversion that I hoped would free me from this affliction. I finally turned up at the hospital for the procedure in my fatalistic state and one cardioversion hour later I was walking on air, AF free, absolutely fantastic feeling with zero negative effects after 3 months in pretty pour shape. I know you may be aware of my story but hopefully something to help up-lift any 'newbies' reading this. NOTE: I believe Warfarin is now superseded by drugs that eliminate any problem getting 3 consecutive weeks within the parameters.

Cheers,
Barry G.