My heart rate is 100 beats per minute when I get up. Does ablation help? Dr. Martin Score answers

My heartbeat is rapid – rarely less than 100 beats per minute, even after a good night’s sleep. I have atrial fibrillation and I was prescribed bisoprolol, but I haven’t recovered yet. Does ablation help?

Alan Berry, Livingston, Scotland.

A fast heart rate is more likely to be a feature of atrial fibrillation (AF), the most common abnormal heart rhythm disorder affecting 1.4 million people in the UK.

Atrial fibrillation is triggered by defective electrical impulses being fired in the walls of the upper chambers (known as the atria) of the heart.

As a result, these chambers contract randomly, rather than at a steady pace, which means that the heart sometimes beats faster than normal – and I suspect that’s why the heart rate is so high.

You explained in your longer post that your cardiologist decided that cardioversion — a controlled electric shock to the heart to try to restore a normal rhythm — might help. But it didn’t work.

Bisoprolol is a type of beta-blocker medication that helps slow the heart rate.

But your question is whether the ablation procedure might help.

This technique targets heart tissue using heat, usually, to create small scars to prevent abnormal electrical signals.

Ablation isn’t always effective, particularly when your atrial fibrillation is long-term like it is for you, which probably explains why you’re not offered it. (Over time, the muscle tissue of the atria undergoes a process of “remodeling,” which means that ablation does not work.)

But provided you don’t have other symptoms — shortness of breath, extreme fatigue — that might indicate heart disease or failure, your heart rate, while high, is acceptable. However, it is very important that you take an anticoagulant (such as warfarin, apixaban, or rivaroxaban) in addition to the beta-blocker, bisoprolol.

This is because when the heart pumps irregularly, it can slow blood flow, which can encourage the formation of blood clots. This can block the arteries, cutting off the blood supply to the brain or heart, leading to a stroke or heart attack.

The other factor to focus on is your blood pressure and keeping it within the normal range.

I suggest reviews with your GP or cardiologist every three or six months to monitor your dose of bisoprolol: a beta-blocker may lower your blood pressure too much, but an insufficient dose can cause your heart to beat too quickly. The required dose ranges between 1.25 mg and 15 mg per day and regular review allows for adjustment.

I was fitted with a urinary catheter after emergency hernia surgery. But now it’s removed, I’m having embarrassing leaks and have had to wear incontinence pads, as well as take water tablets to try and ease the problem. Is there anything else I can do?

Name and address provided.

I’m sorry to hear this, it must be sad for you – an issue other readers will share. It’s not uncommon for older patients (in your longer post you’re 84) to have trouble passing urine after surgery – this can be a side effect of anesthetics or painkillers after surgery – and need a temporary catheterization.

I suspect there’s an underlying problem, benign prostatic hyperplasia (BPH) — or enlarged prostate — pressing on the urethra, the tube that carries urine out of the body. It is believed that more than 90 percent of men over the age of 80 suffer from this condition.

It is possible that at the time of surgery you already have some symptoms, which may include a weak flow, hesitation (difficulty starting urination) and nocturia (having to empty your bladder more than once a night), and the catheter that you need after the operation worsens the situation.

Treatment for BPH includes medications and surgery. In some cases, the advice may be to have a permanent bladder catheterization, where a catheter is inserted under anesthesia through the abdominal wall.

I think this is a better solution than a permanent catheter in the urethra, which is more prone to recurrent infections.

If you are not under the care of a urologist, I would urge you to discuss the possibility of referral with your GP.

Write to Dr. Score

Write to Dr Score at Good Health, Daily Mail, 9 Derry Street, London W8 5HY or email: drmartin@dailymail.co.uk – include contact details. Dr. Score cannot engage in personal correspondence. Responses should be taken in a general context. Consult your physician regarding any health concerns.

From my point of view…don’t underestimate the dangers of riding a horse

Motorcycles are dangerous and we know that. As a lifelong motorcyclist, I noted with concern that a US study published last month found that areas that hold motorcycle rallies had 21 percent more daily organ donors during the rallies than in the four weeks before and after.

Against this, I set out my experience as a GP of 44 years in the UK, where there are strict legislation regarding training motorcyclists. During all those years, I’ve seen a few accidents that lead to fractures, but not a single fatality on my list.

The paradox is riding: Five of my patients died during that time and one member of my staff.

However, parents often do not allow their children to ride motorcycles, but enthusiastically allow them to attend the local pony club.