Alternative to ablation

Hi all,
I've noticed that my afib episodes begin after a time of hr repetitively speeding up and slowing down before going irregular. Could this point to sick sinus?
Also, as i have no way of getting a top level ablation, after reading Carey's post it sounds as though i would be foolish to go down the local ablation route.
I can't tolerate sotolol or flec, so just use metoprolol if hr is high during an episode, and take elquis.
I read a study showing quinidine had a greater success rate than sotolol in conversion, and a safer profile. Anyone who has used it?
Regards, and thanks in advance for your insights,
John

Sick sinus is unlikely.

It's not used much in the US and I've never encountered anyone who's had it. Reading up on it, it has risk factors similar to flecainide and sotalol. Like flecainide, it's contraindicated in people with structural heart disease (heart attack, heart failure, cardiomyopathy, etc). And like sotalol it can widen the QT, so it's recommend to start it in a hospital where you can be monitored. I gather it's used more as a maintenance drug than a PIP.

Is the impossibility of an ablation because you're not in the US? Are you within easy travel distance of Bordeaux France? If so, there's Michelle Haissaguerre who invented the PVI procedure. He's on Natale's level and a few people here have had ablations with him.

Thanks Carey, i appreciate your response
I don't have private health insurance or funds to cover the costs, also travel would be a problem.
I saw an EP down in Dublin who does the ablations, he trained in MCH and is the head man here, but not easy to get his outcomes. I met a nurse who had worked in the ep lab with him, but she wasn't too keen to recommend.
Guess I'll keep on as i am doing now.
Cheers,
John

Lots of high-volume ep's in the UK with excellent outcomes. Professor Richard Shilling comes to mind as one. You can also try several of the ep's at Royal Papworth. They were the first in the UK to do Pulse Field Ablation.

Jim



Edited 1 time(s). Last edit at 10/24/2023 05:51PM by mjamesone.