Ectopics immediately after ablation,

Q to those here who’ve had ablations recently - did you get a LOT of ectopics/atrial irritability in the hours and first few days after your ablation and, if so, how long did things take to settle down??

Mike F

I started noticing some PAC's and PVC's about 10 days following my procedure. They became more frequent as the days progressed and I'm pretty sure that's what threw me into flutter the third week in.

I was cardioverted three weeks to the day of my ablation and my heart has been quiet ever since. It's been over a week since the cardioversion.

I've been supplementing with potassium and magnesium ever since the ablation. It's completely normal to have PAC's and PVC's so early on
I wouldn't worry about it.



Edited 1 time(s). Last edit at 08/20/2018 01:23PM by rocketritch.

The issue seems common after an ablation procedure.
Before my PVI (2016), I never had any ectopic.
After that, I had lots of PACs and PVCs during some weeks, flecainide+bisprolol helped relieving this.
I still had afib. I had a second procedure in 2017 (which failed) and a third nearly five months ago. I've still a few ectopics and runs of unsustained afib and atypical flutter.

My guess is that once the highway (PV) has been closed, the invaders try other roads...

Hi Mike - It's normal to feel some PAC-type activity in the first few days or even a week or so after ablation. Your heart is in a state of irritability.

I've commented previously that after my first ablation (years ago), I was amazed that my heart was so calm after I came home the following day. I was sent home with an event monitor and that did show minor fluctuations but nothing much that I could feel or worry about. After ablation #2, the same thing... heart very stable for the week afterward when I stayed in Texas ...but on the way home, connecting in the Nashville, TN airport, my heart went into a-flutter. The very thing I had just had ablated. So, when I arrived home, I called my local contact and made a date for ECV. a day later. After that, heart was calm... until 7 months later when flutter started appearing again... so flew back again for #3. And for the last 3 years, my heart has remained calm and free from noticeable PACs. I choose not to check or monitor routinely.

For all three, I've had very little, if any, noticeable other activity and I'm quite sure that calmness was facilitated by my continuing with the heart support electrolytes and nutrients including natural anti-inflammatories that helped me for so many years.

One thing I always did and which may help you relax is to have a plan worked out ahead of time... as to who you would call if you did need ECV and how you'd go about getting prompt attention if needed ..... rather than scramble around when your heart is acting up and you're in nervous anticipation.

Hopefully, your situation will resolve soon, Mike. Sending you good positive thoughts.
Best to you,
Jackie

None the first week or two. No more than 2/3 a day after that.

I've been on this afib journey with you for a long time, Mike.

When do you head to Bordeaux?

You are in excellent hands.

Wishing you a spectacular outcome!

Cheers,

George

Yes, there will likely be a lot of ectopic activity immediately following an ablation. Think about it. They basically shoved a soldering iron up into your heart and branded it from the inside. It’s going to be swollen and irritated for some time. The good news is it heals and everything gets better. Hence the 3-month blanking period. In reality, I wouldn’t get excited about ectopics even 6 months to a year post ablation. As long as nothing sustains, it’s probably OK.

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wolfpack
Think about it. They basically shoved a soldering iron up into your heart and branded it from the inside. It’s going to be swollen and irritated for some time..

That's the fear, anyway. As explained to me, it's nothing like cauterizing...far more gentle with pressure sensors and water spray to make sure the catheter isn't too hot.

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jpeters
That's the fear, anyway. As explained to me, it's nothing like cauterizing...far more gentle with pressure sensors and water spray to make sure the catheter isn't too hot.

Well, that's what EPs like to tell people. ;-) It's not like cauterizing only in the sense that the burning is done more slowly and collateral damage to surrounding tissue is minimized. But they're still third-degree burns that kill tissue. When done properly, the atrial tissue at the burn site will be rendered permanently dead just as surely as if a soldering iron had been used. The burns must penetrate nearly the full thickness of the atrial wall to be durable, so they can't somehow be less damaging to the tissue. They're just better controlled and don't cause collateral damage. I can't seem to find them now, but I've seen autopsy photos of ablation lesions and I couldn't tell whether a soldering iron or top-of-the-line irrigated catheter made them.

I'm a "victim" of an EP who didn't know how to make durable lesions. He was too timid and used insufficient time and/or insufficient temperatures, so this is a subject near and dear to my heart (pun intended). The result was my heart healed over the burns he made instead of forming permanent scar tissue. Fact is they have to permanently destroy tissue for ablations to work, but it's hard to explain that to the average patient without freaking them out.

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jpeters

Think about it. They basically shoved a soldering iron up into your heart and branded it from the inside. It’s going to be swollen and irritated for some time..

That's the fear, anyway. As explained to me, it's nothing like cauterizing...far more gentle with pressure sensors and water spray to make sure the catheter isn't too hot.

It’s 40W of RF power. That equates to a handheld soldering iron or wood burning tool. Certainly with a far greater degree of finesse, of course!

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Carey
Fact is they have to permanently destroy tissue for ablations to work, but it's hard to explain that to the average patient without freaking them out.

Yes. They have to walk the fine line between not doing enough and burning a hole through the thin atrial tissue. This is why...

EXPERIENCE MATTERS!

Geez you guys are scaring me!!!!!

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bolimasa
Geez you guys are scaring me!!!!!

Sorry, we don't mean to scare anyone, but ablations are what they are. They are burns applied to the inner walls of your atria that create permanent scar tissue that blocks afib signals. There are tons of other surgical procedures that give people back their health and their life that are a lot scarier than that. I've undergone six ablations, but I'm sitting here in perfect NSR after having ridden my bike 30 miles today up and down big hills. I haven't experienced a moment of afib for over a year and that's the first time I've been able to say that for 16 years.

Ablations are nothing to fear as long as your EP is highly trained and experienced at doing them. Being a nice guy and a smart guy doesn't count. What counts is having done thousands of ablations.

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Carey

Geez you guys are scaring me!!!!!

Sorry, we don't mean to scare anyone, but ablations are what they are. They are burns applied to the inner walls of your atria that create permanent scar tissue that blocks afib signals. There are tons of other surgical procedures that give people back their health and their life that are a lot scarier than that. I've undergone six ablations, but I'm sitting here in perfect NSR after having ridden my bike 30 miles today up and down big hills. I haven't experienced a moment of afib for over a year and that's the first time I've been able to say that for 16 years.

Ablations are nothing to fear as long as your EP is highly trained and experienced at doing them. Being a nice guy and a smart guy doesn't count. What counts is having done thousands of ablations.

I know you guys don't mean to scare me... Lol
The emotional side of this I so hard.... I'm pissed, bitter and depressed about suddenly having this problem. I'm trying pretty hard to make informed decisions, and my research seems to say ablation is the thing to do, I've set the date, yet it seems like such a crapshoot.... I wish I truly felt confident I'm doing the right thing...

Part of me wonders if I should just wait and see what happens with my afib, see how tolerable it is... But on the other hand I see no indications that this ever gets better or resolves on it's own, and I really want a shot at getting off blood thinners... But sheesh.... Who wants heart 'surgery'.

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bolimasa
The emotional side of this I so hard.... I'm pissed, bitter and depressed about suddenly having this problem. I'm trying pretty hard to make informed decisions, and my research seems to say ablation is the thing to do, I've set the date, yet it seems like such a crapshoot.... I wish I truly felt confident I'm doing the right thing...

Well, having said all of that, you leave me with no choice but to diagnose you as normal!

I went through the same crap. 40 years old. Two young kids. Maybe it’s the Y chromosome talking, but lead with the head, not the heart. After all it’s the latter that needs care.

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bolimasa
Part of me wonders if I should just wait and see what happens with my afib, see how tolerable it is... But on the other hand I see no indications that this ever gets better or resolves on it's own

Go with your instincts because they're exactly right. Afib does not get better on its own. It does the exact opposite. And the longer it lasts, the more entrenched it becomes and the more difficult any type of treatment becomes. Drugs eventually quit working. Ablations become more difficult and beyond the abilities of all but the top EPs. Some people have limited success with alternative treatments (I'm one), but it usually involves a lot of trial and effort, money, research, and years of continuing to put up with afib and the limitations it imposes on your life.

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Carey

That's the fear, anyway. As explained to me, it's nothing like cauterizing...far more gentle with pressure sensors and water spray to make sure the catheter isn't too hot.

Well, that's what EPs like to tell people.

hmm..that's what Hongo told me, and it worked. I took the next available slot. I guess that's why hybrid techniques are being used...to burn from both sides for success with difficult cases. Makes sense.

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jpeters
I guess that's why hybrid techniques are being used...to burn from both sides for success with difficult cases. Makes sense.

Only time will tell which works best but if I had to bet I would bet on catheters. The downside of hybrid procedures is those holes they have to make in your chest. They may not be big but they add significant risk, pain, and weeks of recovery. (Not sure about cost but I'm sure it has to be higher.)

I would have to agree. The human body rarely does well with extra holes! I'm always taking the minimum invasion route unless there's no other choice.

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jpeters
guess that's why hybrid techniques are being used...to burn from both sides for success with difficult cases. Makes sense.

Here is Shannon's comment on the hybrid technique <[www.afibbers.org]

Jackie - Which natural anti-inflammatories would you suggest?

Thanks,
Leah

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wolfpack
I would have to agree. The human body rarely does well with extra holes! I'm always taking the minimum invasion route unless there's no other choice.

[stanfordhealthcare.org]

"A failed endocardial ablation procedure can suggest that the critical area might not be reachable from the endocardium. In these patients, preprocedural imaging is particularly helpful, especially if an intramural or epicardial substrate can be demonstrated."

" In some patients there may be ECG clues that the focus is more likely to be epicardial in location."

I had ectopics for weeks afterwards, also a minor episode of afib a week later. My heart was extremely sensitive to many things for a good 6-9 months afterwards but this gradually settled down. I took advice from the great people who run and now this website and introduced a number of supplements which, touch wood, seem to have helped a great deal too.