My heart rate is 100 beats per minute when I wake up. Would an ablation be useful? DR MARTIN SCURR responds

My heart rate is rapid — very rarely below 100 beats per minute, even after a good night’s sleep. I have atrial fibrillation and I’m prescribed bisoprolol, but I’m still not cured. Would an ablation be useful?

Allan Pirrie, Livingston, Scotland.

Your rapid heart beat is most likely a feature of your atrial fibrillation (AF), the most common abnormal heart rhythm disorder which affects 1.4 million people in the UK.

AF is triggered by faulty electrical impulses sent through the walls of the upper chambers (called atria) of the heart.

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

You explain in your longer letter that your cardiologist has decided that cardioversion — a controlled electric shock to the heart to try to restore a normal rhythm — might help. But that did not work.

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

But your question is whether having an ablation might help.

This technique targets heart tissue using heat, typically, to create tiny scars to block abnormal electrical signals.

Ablation isn’t always effective, especially when the atrial fibrillation is old like yours, which is probably why it wasn’t offered to you. (Over time, the muscle tissue in the atria undergoes “remodeling,” which means ablation doesn’t work.)

But provided you have no other symptoms – shortness of breath, severe fatigue – that might suggest heart disease or failure, your heart rate, although elevated, is acceptable. However, it is very important that you take a blood thinner (such as warfarin, apixaban or rivaroxaban) as well as the beta-blocker, bisoprolol.

This is because when the heart pumps erratically, it can lead to slow blood flow, which can promote blood clots. These can potentially block arteries, cutting off blood supply to the brain or heart and leading to stroke or heart attack.

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

I suggest you see your GP or cardiologist every three or six months to monitor your dose of bisoprolol: the beta-blocker may lower your blood pressure too much, but too little can cause the heart to beat too fast. The necessary dose is between 1.25 mg and 15 mg per day and a regular review allows its adjustment.

I was fitted with a urinary catheter after an emergency hernia operation. But now that it’s been removed, I suffer from embarrassing leaks and have to wear incontinence pads, in addition to taking water tablets to try to alleviate the problem. Is there anything else I can do?

Name and address provided.

I’m sorry to hear this, it must be distressing for you – and it’s a problem that other readers will share. It is not uncommon for older patients (in your longer letter you say you are 84) to have difficulty urinating after surgery – this may be a side effect of anesthetic medications or post-operative painkillers – and need a temporary catheter.

I suspect there’s an underlying problem, benign prostatic hyperplasia (BPH) – or an enlarged prostate – pressing on your urethra, the tube that carries urine out of the body. It is believed that more than 90% of men over the age of 80 have it.

You may have already had some symptoms at the time of your surgery, including poor jet, hesitation (difficulty initiating urination) and nocturia (having to empty your bladder more than once at night), and the catheterization you needed after the operation made it worse.

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

I think it’s a better solution than a permanent catheter in your urethra, which is more prone to recurring infections.

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

Write to Dr. Scurr

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

In my opinion… Don’t underestimate the risks of horseback riding

Motorcycles are dangerous, we know that. As a lifelong biker, I noted with concern that a US study released last month found that areas with motorcycle rallies had 21% more organ donors per day during rallies than in the four weeks before and after.

I contrast this with my experience as a general practitioner for 44 years in the United Kingdom, where there is strict legislation concerning the training of motorcyclists. During all these years, I have seen a few accidents resulting in fractures, but not a single death among the patients on my list.

The contrast is with horse riding: five of my patients died during this period and one member of my staff.

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