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Medication or ablation?

Posted by clhotka @clhotka, Jul 20 1:10pm

I am an active 84 year old female in good health. Have been on blood pressure meds for hypertension since 2007. Currently living in Panama City, FL and seen regularly by a cardiology group. I have a cardiologist and electrophysiologist as I have been experiencing irregular heart rhythm for several years, increasing in frequency. After being on several heart monitors--24 hour, 30 day, Medtronic Linq, the electrophysiologist determined that I am a candidate for an ablation. (Apparently the Linq wasn't picking up the irregularity coming from my right atrium so my irregularity was less than what is required for an ablation. The 24 hour monitor I wore recently did pick it up). Electrophysiologist recommended medication as the first line of treatment. I was taking Metoprolol, Losartan and Amlodipine as needed. First the cardiologist put me on Eliquis for stroke prevention and electrophysiologist switched me from metoprolol to 6.25 mg carvedilol twice per day with losartan only at night, amlodipine as needed and added flecainide. This did not work as I felt like I had the flu almost all of the time. Stopped flecainide. Have been taking Carvedilol 6.25 mg twice daily and losartan at night. Dr. increased to 9.37 twice daily two weeks ago and now I have periods of feeling "okay" and periods of feeling awful. My blood pressure flares in the afternoon and my heart rate drops into the 40's and I feel like I have the flu most of the time. Also experiencing sleep disruptions, change in bowel habits and frequency of urination. Additional meds are losartan at night only, amlodipine as needed for blood pressure flares and Pepcid for nausea. Would appreciate receiving the benefit of any of your experience/wisdom... Thank you....

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Profile picture for gloaming
gloaming | @gloaming | Jul 20 4:31pm

Hi. Depending on the EP, what they know and think about your circumstances and health, their experience ablating elderly patients, especially with your particular health concerns, it may not be a great idea to ablate you. Next door, another EP, maybe more experienced, different 'upbringing', might think you're the perfect candidate for an ablation.

You are still in the paroxysmal stage; it limits the time in AF by reverting to NSR and stays in NSR for hours or days. THIS IS LIKELY TO BE THE BEST YOUR HEART HEALTH WILL EVER BE. As a progressive disorder, your heart will continue to decline until you are in persistent AF, then long-standing persistent AF, and finally permanent. This is not absolute....cases vary widely between individuals. Some progress rapidly, some take decades. But, almost every one progresses. So, today, actually yesterday, was the best time to have an ablation to help to stop any morphological 'remodeling' that the heart undergoes the longer it is in arrhythmia, especially in AF.

This is just my philosophy, and it is probably not going to be affirmed by every responder. I do know that ablation is 'the gold standard of care' for AF patients. Drugs can work, even very well, and even for a very long time. However, they tend to get used to by the heart, especially since it's always progressing in its AF journey, and you'll need more of the same drug or have to resort to another, and then another, and finally amiodarone or get a pacemaker if your ventricles try to keep up all the time with beats running in the 140-200 range, which so many AF patients experience.

It's a complicated subject and well worth your time with self-education. But as you age, as your heart's condition deteriorates, ablation will slowly be drawn out of reach for you. Either get it done now, even if you have to seek another EP's services, or expect to have a difficult time with drugs and perhaps morphological changes such as valve problems, vessel enlargement, more complicated and additional arrhythmias, and finally heart failure ( a horrible term that doesn't mean what it says, but that's what the medical community uses...).

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sjm46 | @sjm46 | Jul 20 7:46pm

Your heart rate dipping into the 40's is bradycardia and the culprit is probably Metoprolol. My husband's (since fired) cardiologist put him on this med recently to keep his heart from working too hard since he had had a heart attack in the past (38 years ago!) and as we take our B/P and pulse every morning and record it on our calendar, I noticed his pulse was in the 40s! This just isn't right so when he went in for a follow up, he asked the doctor about this and he said, "well, if it gets too low, we can consider a pacemaker." What? A pacemaker after all these years of being perfectly fine? So I looked up metoprolol and sure enough, that was the problem. I told the doctor that his theory didn't make sense and so he stopped that med and he's been fine without it, especially since he lost some weight. Your other med Losartan also has some nasty side effects including dehydration and low pulse rate. You can look these up yourself online or on YouTube. I am just a humble retired psychiatric nurse (80 years old) but in my opinion you are getting a medical combination that is making you feel worse rather than better. Flecainide is also pretty powerful stuff, but it does control rhythm very well and I took that briefly before I had an ablation for A-fib. You can use that as a "pill in a pocket" for an A-fib attack to stop the arrhythmia on a episodic basis unless you are in a constant state of disrhythmia. I took flecainide briefly before I could get an ablation, but it has some serious side effects, at least for me. I declined to take a regular dose. Too many meds interact, especially with us older folks so dosages and combinations need to be carefully monitored. If you continue to feel lousy, you need a "come to Jesus" meeting with these doctors to sort out what is needed, what works and what is going on with your situation. They need to listen to all your issues and find a plan that works for you. You aren't too old for an ablation if you are in good shape; I was worried about that when I had mine, but I did fine and have been good for months. You deserve to feel better! Do some research on YouTube about A-fib and then get yourself list of questions for that cardiologist's appointment asap!

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1 reply
Profile picture for snop
snop | @snop | Jul 21 1:46am
In reply to @sjm46 "Your heart rate dipping into the 40's is bradycardia and the culprit is probably Metoprolol. My..." + (show)
Profile picture for sjm46 @sjm46

Your heart rate dipping into the 40's is bradycardia and the culprit is probably Metoprolol. My husband's (since fired) cardiologist put him on this med recently to keep his heart from working too hard since he had had a heart attack in the past (38 years ago!) and as we take our B/P and pulse every morning and record it on our calendar, I noticed his pulse was in the 40s! This just isn't right so when he went in for a follow up, he asked the doctor about this and he said, "well, if it gets too low, we can consider a pacemaker." What? A pacemaker after all these years of being perfectly fine? So I looked up metoprolol and sure enough, that was the problem. I told the doctor that his theory didn't make sense and so he stopped that med and he's been fine without it, especially since he lost some weight. Your other med Losartan also has some nasty side effects including dehydration and low pulse rate. You can look these up yourself online or on YouTube. I am just a humble retired psychiatric nurse (80 years old) but in my opinion you are getting a medical combination that is making you feel worse rather than better. Flecainide is also pretty powerful stuff, but it does control rhythm very well and I took that briefly before I had an ablation for A-fib. You can use that as a "pill in a pocket" for an A-fib attack to stop the arrhythmia on a episodic basis unless you are in a constant state of disrhythmia. I took flecainide briefly before I could get an ablation, but it has some serious side effects, at least for me. I declined to take a regular dose. Too many meds interact, especially with us older folks so dosages and combinations need to be carefully monitored. If you continue to feel lousy, you need a "come to Jesus" meeting with these doctors to sort out what is needed, what works and what is going on with your situation. They need to listen to all your issues and find a plan that works for you. You aren't too old for an ablation if you are in good shape; I was worried about that when I had mine, but I did fine and have been good for months. You deserve to feel better! Do some research on YouTube about A-fib and then get yourself list of questions for that cardiologist's appointment asap!

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@sjm46 thank you so much. I found comfort in this. I have been Cravediolol and I’m having insane side effects. I cut it back to the lowest dose. I tried to stop it twice and after 40 hours, I had a slight episode and took the pill right away because I became frightened and I tried it again. A few days later I got to 36 hours without the pill and had an episode and I’m only taking the one pill and the lowest dose I’m going to make an attempt at it one more time they want to do the ablation, but I don’t have enough information. The doctor. I’m with the EP just met me and decided that day because the heart monitor I told him showed 23 episodes in 27 days but I wasn’t even aware that they were up that many episodes. I was only aware of two. Life is hectic and stressful right now caring for my father and there is no one else here to do that. And three other major life, events and stressors to consider so doing the ablation is making me nervous, especially when I am an uncontrolled diabetic in the mid 200 range no meds I have tried five different ones since September 2025 with no luck always severe side effects any input any direction would be greatly appreciated. I live in South Carolina near Clemson, University. It is a medical desert here. I finally after 27 years found a general practitioner that I can stay with. I wish I could get an appointment with the Mayo Clinic in Jacksonville. I’m not sure how to go about it. I would like to have all my care transferred there. I have stomach problems as well and this medication is irritating. It’s severely my elbows feel like someone took a hammer to them. This tiny pill is evil and it’s the smallest pill I’ve ever seen. Thank you in advance. Any feedback is appreciated.

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Profile picture for wcuro
wcuro | @wcuro | Jul 21 11:32am
In reply to @snop "@sjm46 thank you so much. I found comfort in this. I have been Cravediolol and I’m..." + (show)
Profile picture for snop @snop

@sjm46 thank you so much. I found comfort in this. I have been Cravediolol and I’m having insane side effects. I cut it back to the lowest dose. I tried to stop it twice and after 40 hours, I had a slight episode and took the pill right away because I became frightened and I tried it again. A few days later I got to 36 hours without the pill and had an episode and I’m only taking the one pill and the lowest dose I’m going to make an attempt at it one more time they want to do the ablation, but I don’t have enough information. The doctor. I’m with the EP just met me and decided that day because the heart monitor I told him showed 23 episodes in 27 days but I wasn’t even aware that they were up that many episodes. I was only aware of two. Life is hectic and stressful right now caring for my father and there is no one else here to do that. And three other major life, events and stressors to consider so doing the ablation is making me nervous, especially when I am an uncontrolled diabetic in the mid 200 range no meds I have tried five different ones since September 2025 with no luck always severe side effects any input any direction would be greatly appreciated. I live in South Carolina near Clemson, University. It is a medical desert here. I finally after 27 years found a general practitioner that I can stay with. I wish I could get an appointment with the Mayo Clinic in Jacksonville. I’m not sure how to go about it. I would like to have all my care transferred there. I have stomach problems as well and this medication is irritating. It’s severely my elbows feel like someone took a hammer to them. This tiny pill is evil and it’s the smallest pill I’ve ever seen. Thank you in advance. Any feedback is appreciated.

Jump to this post

@snop To start the process of getting a second opinion at Mayo/Jacksonville:
Call 904-953-0853
This is the Central Appointment Office.
Hours: M-F 8am- 5pm.
Clearly state that you are seeking a second opinion regarding heart arrhythmia.
Best if your current doctor makes a request for you - the process goes faster that way.
Just Google or use Chat GPT for many details and suggestions, including hotel info.
Query for Google:
How to best schedule a second opinion at Mayo Clinic, Jacksonville, FL?
Good luck to you. You’re on the right track seeking a second opinion from a premier institution.

REPLY
Profile picture for clhotka
clhotka | @clhotka | Jul 21 12:46pm
In reply to @gloaming "Hi. Depending on the EP, what they know and think about your circumstances and health, their..." + (show)
Profile picture for gloaming @gloaming

Hi. Depending on the EP, what they know and think about your circumstances and health, their experience ablating elderly patients, especially with your particular health concerns, it may not be a great idea to ablate you. Next door, another EP, maybe more experienced, different 'upbringing', might think you're the perfect candidate for an ablation.

You are still in the paroxysmal stage; it limits the time in AF by reverting to NSR and stays in NSR for hours or days. THIS IS LIKELY TO BE THE BEST YOUR HEART HEALTH WILL EVER BE. As a progressive disorder, your heart will continue to decline until you are in persistent AF, then long-standing persistent AF, and finally permanent. This is not absolute....cases vary widely between individuals. Some progress rapidly, some take decades. But, almost every one progresses. So, today, actually yesterday, was the best time to have an ablation to help to stop any morphological 'remodeling' that the heart undergoes the longer it is in arrhythmia, especially in AF.

This is just my philosophy, and it is probably not going to be affirmed by every responder. I do know that ablation is 'the gold standard of care' for AF patients. Drugs can work, even very well, and even for a very long time. However, they tend to get used to by the heart, especially since it's always progressing in its AF journey, and you'll need more of the same drug or have to resort to another, and then another, and finally amiodarone or get a pacemaker if your ventricles try to keep up all the time with beats running in the 140-200 range, which so many AF patients experience.

It's a complicated subject and well worth your time with self-education. But as you age, as your heart's condition deteriorates, ablation will slowly be drawn out of reach for you. Either get it done now, even if you have to seek another EP's services, or expect to have a difficult time with drugs and perhaps morphological changes such as valve problems, vessel enlargement, more complicated and additional arrhythmias, and finally heart failure ( a horrible term that doesn't mean what it says, but that's what the medical community uses...).

Jump to this post

@gloaming A sincere thank you for your thoughtful, informative philosophy. There is a lot to consider and discuss with my doctors. I have had concerns that the process of evaluating different medications is affecting my heart health. So far, my echocardiogram and PET Stress results are good.

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bradsnanny | @bradsnanny | Jul 25 10:28am

I was on medications for some time. They didn’t fix the A-fib.. I then had ablation that was good for nine months. I then had another ablation that didn’t work at all. Then got a pacemaker that was great for 5 years, but then the A-fib got to 50% of the time. I am now on Amiodarone for 2 years. I am checked every 6 months and the A-fib is below 1%.

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