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1 Week Post Ablation Question

Posted by mainegal3 
1 Week Post Ablation Question
September 17, 2017 05:23PM
Good Afternoon to All,

My husband had his ablation with Dr. Natale last week and we have had a great first week with him being out of afib. I know in the 3 month period after the ablation we should not be surprised if he goes back in afib, but is it normal to experience long periods of it? Last night he noticed he was in it again and it has remained persistent for 17 hours so far with him still in it at this moment. Is this still within the normal of what can be expected? Is it normal if he stays in it for several days or more? Thanks.

Jennifer
Re: 1 Week Post Ablation Question
September 18, 2017 02:58PM
Hi Jennifer,

Yes sometimes blanking period activity can be persistent and not infrequently requires a cardioversion (and sometimes two) to quiet blanking period activity down again. Because the right and left atrial tissue walls of the atria are variable in thickness along the trajectory of a given lesion created by the ablation to form a durable scar, there is also a variable healing rate for these lesions with thinner walled areas typically forming durable scars sooner than the thicker areas where ablation burns have been made and, understandably, those still somewhat raw thicker burn areas take longer generally to form a mature scar and this can form
temporary new flutter/AFIB.

The ablation can only do its full job of quelling any activity once all intended lesions have become fully mature scars. In the meantime, during the blanking period your husband is in the early stages of, it common to have a variety of 'reminders' with runs of atrial flutter and/or AFIB. It's not possible to predict ahead of time who might have such blanking period activtiy and who will not, but most do experience some degree of activity, and not infrequently it will manifest as a persistent flutter and sometimes a longer duration run of AFIB than he might ha e been used too, based on a usually temporary new flutter or AFIB circuit formed by the variable healing rate making new connection circuits that most often will self-terminate and disappear during the remaining blanking period.

You should definitely let your Nurse Practioner at St Davids or CPMC (wherever your husband got his Natale ablation) know about this and be sure to send them an ECG recording from the monitoring device they gave you. Then they will guide you as to what steps they wish your husband to take, if any at this time.

In most cases, once an atrial flutter has been persistent for a few days to a week they will typically have him go in to a local ER for an ECV (electrocardioversion) so that he is not in arrhythmia for too long. Also, it tells them more as well seeing if this is just a single temporary circuit when the ECV holds up well and no more mischief occurs, or if the ECV doesn't hold for long too then that is instructive as well.

You do want to see a big drop off in any blanking period activity generally by end of the 8th week post ablation. Any increase in actual arrhythmia (not including just ectopy like PVCs or PACs) past the 8th week or so (give it 10 weeks for good measure and to cover a few outliers) but with an increase in activity past this period will indicate a need for a touch up sooner than later and you should then contact your NP about setting up that touch up with Dr Natale as soon as they can fit you into the schedule which will be as soon as they can work him in once he is past the full three month healing period.

If you or your husband would like to discuss this in more depth send me a PM with his cell phone and time zone at the 'PM' link above by my name and will try to call. I'm currently in Honolulu seeing a couple of my old time docs and running some errands in what was my home for 38 years of my adult life since college. But will try to connect this week while still in Hawaii if your husband has more questions or would like to discuss this further while he is still in this blanking period flutter or AFIB run.

No worries at all, this is all part of a perfectly normal blanking period range of activity.

Aloha,
Shannon
Re: 1 Week Post Ablation Question
September 20, 2017 01:37PM
Hi Jennifer,

I had a cryoablation for paroxysmal afib just more than 8 weeks ago. The first week post procedure was pretty quiet, but the second week I had one day of being in and out of afib for 24 hours. All was quiet again for about a week, then at the end of the third week, I had an hour and a half episode that self corrected. I have now gone more than 5 weeks with no new episodes, and feel great.

I had a follow up yesterday, and doctor is beginning to wean me from Metoprolol, and will also wean me from Xarelto within the next few weeks, assuming no new episodes, and will keep me on baby aspirin.

I'm pretty happy with where things are now, but was a bit disappointed in the moment when I was in it a few weeks ago, despite knowing that I should expect it to happen during the blanking period. Patience is key right now.

Good luck!
Kevin
Re: 1 Week Post Ablation Question
September 20, 2017 09:31PM
Yes, patience.

I actually caused AF 8 days post ablation by getting on a treadmill and running for 30 minutes. Bad idea. yawning smiley

Take everything one day at a time.
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