Advice on recovery

Looks like I'm headed to Austin (thanks Shannon!) and I wanted to get a little feedback on the first few days after the ablation. We used to live in San Antonio and since St. Davids wants you to stick around for a few days after the procedure we'd like to see some friends in SA if it makes sense. So wanted to ask how people felt 2-3 days after the procedure?

Thanks,

C

I live 8 hours from Austin. I stayed 1 extra night after my procedures then I went home.

You're welcome Clay, and am glad to help out!

Since this is your index AFIB ablation, I'd plan on sticking around Austin the first day out of the hospital .. that is the day you are released from St David's typically mid-morning the day after the ablation.

Day two, you should be fine to go to San Antonio which is roughly about 45 min or so drive from Austin, as you know. If you get tired just rest a bit and ask your wife to drive.

And Smackman, the reason for the two day stay recommendation in Austin after ablation day is for those who have to fly a decent flights distance to come to Austin. While technically, most everyone would be good to go after one day and particularly if they drove there and don't have multiple day long drives to get home. is just to let the two groin puncture sites to be fully sealed before exposing them to the pressure changes from big altitude changes over a longish flight ... plus to help insure the patient isn't slinging any bags of 7 to 10lbs or more up into overhead bins or going through security at the airport so early after the ablation.
Plus, it's just a good idea for anyone to plan to stick around Austin for two, or ideally even three nights, after the ablation day, unless the added cost presents a major hardship, just to give yourself as much easy time those first days to heal up good before the hustle and bustle of a long travel day.

Nevertheless, its true most everyone can handle travel fine on day two post ablation, especially if they have a travel companion to do any bag lifting at all.

Also, another reason for giving at least an extra two days before flying home is the added edema that some folks collect during an ablation with an irrigated ablation catheter, and thus having the extra couple days to bleed off that extra water before the added altitude changes is handy ... though typically only a minor issue.

It's hardly ever a big deal, in any event, if a little blood oozing from either of the groin puncture sites occur on a flight, or on a long drive home, since all you need to do is put the airplane (or car) seat back as far as it goes and then lean back and put strong pressure on the groin site for at least 10 minutes which should do the trick and seal up the bleeding which, by the next day after ablation would rarely become more than a slow ooze on a flight or long drive with body upright and legs sharply bent at the groin during those relatively rare times there is any leaking at all.

In a Natale ablation, there are 3 tiny puncture sites used for sheath/catheter access ... one on the right groin to access the right femoral vein with two sheaths and catheters (the lasso mapping catheter and the ablation catheter). Then the ICE (intracardiac echocardiographic camera) sheath and catheter are place in the left femoral vein via the left groin. The two groin areas are used because both branches of the femoral vein are widest, by far at the groin, and thus most all percutaneous endocardial procedures typically use femoral access when tapping into the venous blood supply anatomy.

The 3rd tiny puncture is in the right lower neck region for access to the jugular vein to install the more global duo-decapolar mapping catheter for mapping both full atria and heart overall, and is parked in the right atria. It is a 'Y' shaped catheter with two long leads with each lead having ten electrodes (poles). One ten pole lead is placed inside the Coronary Sinus along the floor of the right atria, and the second ten pole lead being positioned starting near the tricuspid valve area advancing to the Crista Terminalis which is also in the right atria with this lead terminating roughly located between the interior vena cava (ICV) and superior vena cava (IVC) openings near the posterior portion of the right atria.

The ablation and lasso catheters snaking up into first the right atria from the right femoral vein are then placed inside the left atria after two transeptal punctures (the only endocardial punctures into the left atrial venous blood supply to the rest of the body, that is typically required during an AFIB ablation). The ICE camera from the left femoral vein puncture is parked inside the right atria where, like a submarine periscope, it is rotated side to side and clearly scans the entire left atria close up as well as most all of the right atria, including all of the key parts an EP needs to visualize during an AFIB ablation.

There is almost never any issue two days after ablation with the jugular vein puncture with less gravity up
near the head and a smaller vein involved.

You will do great Clay and you made a very wise choice!

Be well,
Shannon



Edited 1 time(s). Last edit at 02/03/2017 01:02PM by Shannon.

Clay - as Shannon notes...you should be fine. After my first Natale ablation, I couldn't believe how well I felt the very next day at discharge. Just be sensible.

I did travel from Cleveland to Austin for my second ablation which was 11 years later. I stayed in Austin after the procedure for another 4 days visiting with my son who lives there and flew home on day 5. While I felt fine and didn't hoist bags, on the second leg of the trip, I went into Aflutter and that was a bit unnerving. Once home, made arrangements to have an ECV. For ablation #3, same scenario for hanging around Austin and that time, since it was a different airport for the connection, I took advantage of wheelchair transport services to be sure I didn't over-exert. All was fine.

Enjoy your visit with friends in San Antonio.

Best to you,
Jackie

Clay,
Glad you made the right decision and realized FIRM is a pipe dream at the moment.
I got ablated Tuesday March 2 and decided to drive to the Alamo March 4 Thursday morning about 80 miles

McHale

Thanks everyone for the feedback. Looks like we'll plan based on a normal recovery and adjust if needed. Looking forward to some Texas barbecue!!

The (almost) scary thing is how normal you'll feel after the procedure. Once you pee out all the saline, it really is no big deal. That being said, I can give you a list DONT'S. Personal experience. I kinda thick-headed that way.

DON'T go to the gym and run 5 miles on the treadmill one week post ablation. It triggered AF. Oops.
DON'T enjoy a 6-pack of beer watching your favorite sporting event 1 month post-ablation. It was actually a lot of fun at the time, but the next day it triggered a PAC storm of epic proportion. Oops again.
DON'T do any weight training during the blanking period. Having that ill-timed PAC as you're pressing 180lb has the nasty and somewhat scary effect of making the bar go down instead of up. Triple oops.

Just relax, play the long game and rest assured you'll be fine once the body heals. Good luck!

Funny, I've read the same thing several times about people hitting it too hard too soon. And I would definitely forego the six-pack early if it means I can have one or two later on without worrying!

I asked the scheduling person about exercise fully expecting to be told to take it easy until the blanking period is over, but she said you're pretty much cleared to exercise after the wounds heal. I'm taking that with a grain of salt and will get more details as I get further into the process. I love to exercise but if its going to trigger an arrhythmia I can take it easy for a bit. Thanks for the heads-up!

And Clay,

I fully agree with Wolfpacks first few weeks to end of blanking period post ablation avoidance list! With one caveat, in that it's generally okay to resume resistance exercise after roughly a few weeks to a month, but only with the caution to NOT go heavy to failure on any of the resistance exercises so soon.

The best rule of thumb is to keep upper body resistance training at a modest body weight resistance for the first month to six weeks and forgo anything more than this level of muscle tuning exercise the first 4 to 6 weeks and then only gradually increase toward a new normal maintenance level from there.

I also urge folks who have had long term AFIB and/or symptomatic persistent AFIB to avoid permanently doing maximum heavy bench presses, squats and pull ups/overhead presses ever again ... the kind where you have to grunt and bellow like a wounded cow to squeeze out that last rep or two! You can get perfectly well-toned and fit doing those same exercises robustly, but a few ticks shy of failure and heavy grunting, and above all avoid pressing any overhead heavy weight exercise to true failure with the goal of constantly competing with yourself or others to continually reach a higher weight/more reps than your previous record.

The one possible exception to avoiding hitting full blown muscle failure might be when doing high intensity short duration interval training (HIT). I say 'might be' as we don't yet have a good sense of whether or not long term HIT might encourage more negative substrate changes in addition to its early term positive effects (i.e. atrial fibrotic changes) or long term problems with dilated atria and increased incidence of structural cardiac valve dysfuntion as appears to be the case with many hardcore long term heavy iron pumpers after many years of pressing the edge of the envelope.

Just avoid competing with yourself constantly after having had one or more ablations after some years of progressive AFIB. That does NOT mean you have to resort only to yoga or pilates and brisk walking post ablation at all. Its good to challenge your body regularly and engage in a consistently robust exercise program and overcome stagnation in exercise effect more by rotating exercises and periodic short breaks in exercise, rather than always pressing for a new personal best weight lifted or time on the track or bike, especially as we afibbers get older.

Long term intensive AFIB is the canary in the coal mine for many who's AFIB at least has been made worse due to almost obsessive devotion to chronic fitness, warning them that it's best now to listen to your body and take at least a few steps back toward moderation of exercise intensity, especially if the person has been one of those constantly in competition with themselves to do more and more.

And I have consistently noticed in the many folks I have followed closely here over the years that a greater number of them who rush back to a formally intensive exercise program in the first few weeks to two months post ablation, tend to make up a majority of those who anecdotally report more runs of ectopy at least, as well as a tendency toward earlier recurrance of AFIB/Flutter, than do those who ease back into a more robust program over the first month to six weeks after an ablation.

There is no rush, you can get back to a roughly similar level of fitness with a bit less 'pedal to the metal' attitude early on post ablation. The one caveat to this observation with too fast return to a prior intense exercise program being associated more often with generally a jumpier, rougher blanking period for most (but not all) afibbers who ignore this advice and who just dive in head first too soon back to intense exercise, is they tend to be the same group who also tend to be more lax on resuming the nutrient repletion protocols we recommend here too. Perhaps from assuming the ablation should be a permanent 'one and done' cure from the get go?

It's likely a bit of both influences, I suspect, that contribute to this, admittedly, anecdotal-only observation, but I do recommend folks stay engaged in better all-around common sense 'self-health' care not only when trying to manage AFIB prior to needing an expert ablation process, but also as a permanent life-style change embraced after the ablation(s) too.

Shannon

Good advice, Shannon - The last paragraph, especially, can't be emphasized strongly enough.

Ablatees should keep in mind that the ablation does not address underlying discrepancies or insufficiencies that allow AF to manifest in the first place. Many factors influence the path to AF and habits that contribute to deficiencies in key minerals are but one factor; although, certainly, a highly-important one.

As one example, it's known that alcohol depletes magnesium easily and also damages heart cells so resuming a lifestyle that includes a lot of alcohol offers the potential for more trouble. Ablatees still have to manage intake of nutrients that support healthy cell function. Example: If there is a genetic factor that prevents the proper or adequate absorption of magnesium into heart cells, then that person has to be ever-vigilant to optimize magnesium intake and reduce that which depletes it.

We've seen this happen time and time again in posts by by ablatees anxious to get back to their former lifestyle and then, they begin having old, familiar blips and often more Afib.

Jackie

I appreciate the information and discussion. I'm more of a maintenance type in terms of exercise at this point, more aerobic than weights, 20-30 minutes 3-4 times per week, rowing, spinning, running. Although I've been pretty active most of my life I'm not an extreme athlete; no marathons, triathlons or bike races, and I'm also not going to bust a gut doing squats or bench presses. I'd certainly like this ablation to last so I plan on giving it every chance to do so! That includes maintaining my Waller Water and eating regimen, but the reminders are very good to hear - thanks everyone.

Quote
ClayS
I asked the scheduling person about exercise fully expecting to be told to take it easy until the blanking period is over, but she said you're pretty much cleared to exercise after the wounds heal.

My EP told me the same thing. Give 7 days for the groin to heal and then do what you want. I had no idea what to expect, so I charged headlong back into exercise and sure enough got into trouble.

I think it's an area where the EP community should rethink its advice. I don't think you need to sit idle for the whole three month blanking period, but maybe the first month of it you shouldn't do any cardio or weight training.

Clay, I felt fine leaving the hospital after the one overnight. The only discomfort I felt was on my chest for two days, cured by an acetaminofin once/day for two days. That was, I believe, from the two cardioversions The Maestro had to do because of reconnections after isoproterenol infusions when he was working on the LAA. I took a couple of weeks off from the gym and then went back walking and cycling, listening to my body as I added resistance. Good luck!