Eliminating meds following ablation.

I recently had a my 6th month follow up for my ablation. Everything is going well. Following the ablation my cardiologist removed cardizem 225 mg 3xs per day and 150 mg propafenone from my med menu immediately. They did their job keeping me afib and aflutter free from the end of February, post cardioversion, until my ablation at the end of June. Eliminating those meds was as welcomed as the ablation. Even though they kept me in NSR, I did not feel real. They kept me on Xarelto and 25mg of Metoprolol post ablation but now as a result of my appointment they said I could stop taking those also, “If I wanted to.” In other words, no recommendation, just whatever I wanted to do. I’ve never been put in the situation of decision making regarding taking meds before and I’m not sure of all the considerations I need to evaluate. Any advice would be appreciated. Thanks

I am puzzled by the '...if you want to,' part as well. Every physician in my AF train so far has said, 'Do this...or stop that.'

Perhaps it was left for you to make up your own mind that you felt sufficiently secure to stop as an experiment if nothing else. IOW, make you the agent in your own cessation of the medications which had kept you comfortable...sort of like asking you if you'd like to give up your bankie.

I'm pretty sure almost everyone who responds will say they were told they could stop metoprolol partway along the blanking period, or at its end, and that they should wean themselves off any anti-arrhythmic drug well before the Holter monitor at about the 10 week mark. Also, I was advised to cut back on metoprolol over a couple of weeks, 3/4 dose for five or six days, then half for four days, then quarter, and by Day 14 I was off it completely.

My advice about Xarelto would be to continue to take it until your electrophysiologist gives you the all clear, probably a few weeks after the Holter.

Absent any other reason (hypertension?) I don't see the point of 25mg of Metoprolol if you are in NSR. I believe you may want to look into weaning off it if you do stop as I recall that is the advice for those who have been on beta blockers for a while.

As to the Eliquis, may depend on your age and also your CHA₂DS₂-VASc score. Some here, after successful ablations have decided to stay on a half dose (2.5 mg/2x day), others quit completely.

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gloaming
I'm pretty sure almost everyone who responds will say they were told they could stop metoprolol partway along the blanking period, or at its end, and that they should wean themselves off any anti-arrhythmic drug well before the Holter monitor at about the 10 week mark. Also, I was advised to cut back on metoprolol over a couple of weeks, 3/4 dose for five or six days, then half for four days, then quarter, and by Day 14 I was off it completely..

They also never mentioned weening off of it. i've been on it for over a year.

I was told to cease taking metoprolol when I was at an ER in severe AF with RVR (rapid ventricular response). But that was not it. I was two switch to amiodarone.....instead....and right that very minute. I swallowed two 200 mg tablets within 20 minutes, and had another two 12 hours later. This was to be a week-long 'loading dose', after which I took a single tablet twice a day for three weeks. Then, two weeks of taking only one tablet daily, and then to cease, so a total of six weeks on amiodarone.

I believe it is best to cut dosages several times over at least two weeks.

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gloaming
I believe it is best to cut dosages several times over at least two weeks.

That makes sense. Ironically iwas told to stop Propafanone and Cardizem immediately post ablation. I didn't give it much thought, but in hind sight maybe I just got lucky because I had no problems after stopping.

UPDATE : I have successfully weaned myself off of Metoprolol and for the first time in six and a half years I am not taking a rhythm or rate med. Following my ablation last June, my cardiologist took me off of Diltiazem and Propafenone but kept me on Metoprolol. Being off of those two meds felt great so I didn’t think I would notice eliminating 25 mg of metoprolol. Even by cutting it in half for the first week I could feel the difference.
The benefits of the ablation were obvious but I wasn’t expecting how much better I would feel by eliminating all the drugs. They did their job and I grew accustomed to how I felt while taking them for that long but now the fog has lifted too. I was not expecting the double benefit of ablation plus no meds. Had I realized that aspect of a drastic change in how I felt, I may have been less anxious about the ablation process.



Edited 1 time(s). Last edit at 02/12/2025 09:21PM by JDfiB.

Great news, and I am happy it worked for you. You are feeling better, and that is what self-management is all about. Good for you!