Post Ablation- advice? Pregnancy- advice?

Hello

I'm Rebecca, an English girl living in Paris (girl, I mean I'm 43 but still feel young!)

I've just had an ablation last week.

My Afib story:
Felt arrythmia several times over a few years after alcohol consumption- usually next day
Did nothing about it and used to just lie down and wait for it to go
Then in 2014 it was more frequent and scary
Went to see a cardiologist- we decided to eliminate alcohol and nothing else, and it worked- 2 years- no incidents (including marathons etc and loads of sport)
End 2016, woke up twice at 3am with really strong Afib- decided to go on medication
1 year on Flecaine 200mg and Bisoprolol 1,25mg- no incidents
2018- 8 incidents lasting 10 minutes to 4 hours...popped an extra flec and it went back- obviously the meds no longer working very well to avoid the attacks
Triggers= nothing- usually sitting down, or chilling...no link to any food etc

2019- decided to go for ablation because want to have a baby this year (already done the IVF and have little embryons waiting for me!) and you can't take the meds pregnant and also havng afib atacks with a baby is dangerous (I'm on my own)
Another question- I can find nothing on pregnancy and afib...only onset Afib through pregnancy but not an Afibber who wants to get or is pregnant and the care and what to do if Afib comes on during pregnancy...I can't find anything here either...

Just had ablation last week (25th March)
Stayed in 1 night in hospital, was released the next day
Just blood pressure and ECG observation for 24 hours
No heart scan etc
Meds reduced to 100mg Flec and same 1.25mg Bisoprolol

So now I'm at home carrying on, with a big bruise on my leg and I don't really know the post-op guidelines...they kind of just sent me away and told me to see my normal cardiologist in a month

When can I do sport again? Lift stuff etc?
How do I know I haven't got post-op inflammation of the heart etc?
What signs should I look for if somehting is wrong?
I feel more or less normal for the moment...is this normal? Because everyone keeps talking about post-op trauma etc...and apart from the bruise and feeling tired, I feel ok

Seing cardio in 3 weeks for check up

Thanks for your help and advice

Rebecca
Female,43, Paris , France

After an ablation there is a 3-month "blanking period" during which you will continue anticoagulation. You didn't mention Eliquis or an equivalent DOAC (direct oral anticoagulant) medication. Are you taking one? This is an important preventive measure as the heart tissue is quite swollen after being burned by the RF catheter or frozen by the cryo-balloon. Do you know which type of ablation you had? It doesn't matter as far as the blanking period or anticoagulation protocols go - they remain the same. In short, your atria are swollen and don't beat as effectively as they normally would so there is an elevated risk of clot formation. Even though you're no longer in AF the heart is still irritated (much as it can be after an extended episode of AF or an ECV - cardioversion) and that is when stroke risk remains high. Thus the Eliquis. Please do follow up on that immediately if you're not taking anything.

You should avoid any heavy lifting or strenuous exercise for two weeks at least. Some folks have waited less, but I'd err on the side of caution if it were me. (I've posted a few time in the past about how I screwed this up myself and was rewarded with more AF).

I'm curious as to why they are continuing the AAR (anti-arrhythmic) and beta blocker after the procedure. I'd ask if the plan is to discontinue that at the end of the 3-month blanking period. The pregnancy certainly argues for that course of action.

The "new" normal following a successful ablation should be exactly the same as the "old" normal before AF. You may have an elevated resting HR that slowly returns to what it was before. That's common and can take several months. There shouldn't be any post-op trauma. Catheter ablation is a walk in the park compared to open heart procedures. There isn't really anything you should worry about during the 3-month blanking period. Arrhythmia can happen and it's generally not clinically significant during that time period unless it is very symptomatic and debilitating. As you approach the end of the blanking period you certainly shouldn't be feeling anything like that.

Hello
Thanks for your answer :-)

Yes I forgot to say that yes of course I'm on anti-coags- Xarelto, for 2 months!

I had the radio frequency ablation.

Yes they are going to discontinue the meds after the 2/3 months, I hope so anyway- this was the whole point of doing this!

Maybe that's the protocol in France to continue meds (rediced) and then phase them out all together

I feel normal and hope it continues this way!

Thanks for your advice!

Rebecca

2 months of Xarelto is perfectly reasonable. The protocol here is for 3 months but it may be different in France. The stroke risk decreases with time.

In that case, just ride out the blanking period, listen to your body and get back to whatever levels of physical activity you want. You've timed this well for what should hopefully be a nice, warm and arrhythmia-free summer season. Passez un bon été!

Merci :-)

Great advice from wolfpack above. After my ablation at Bordeaux I was kept on Eliquis for 3 months post-procedure. Where did you have your ablation in France kibe? Did you pay privately?

Hello MWCF

I had it done in the "Institut Mutualiste Montsouris" in the 14th arrondissement in Paris.
No it's all paid for by the state and your health insurance. It's sorted out directly between them.

Ps can anyone help Re pregnancy?

Quote
kibe
Hello MWCF

I had it done in the "Institut Mutualiste Montsouris" in the 14th arrondissement in Paris.
No it's all paid for by the state and your health insurance. It's sorted out directly between them.

Ps can anyone help Re pregnancy?

I looked online to see if I could find any articles on Afib and pregnancy and found this one that seemed somewhat informative: I just noted that it is from 2010, so there have most likely been more updates.

[www.ncbi.nlm.nih.gov]

At your age, you are considered "high risk" with or without the Afib. Is pregnancy via IVF considered high risk also? I delivered my youngest child at age 44. I did not have Afib at the time. The pregnancy and delivery were event free. Actually, much easier than my first!

From the article cited:

**Management of atrial fibrillation should be the same as in non-pregnant women, but requires faster intervention, even in patients with a normal heart function, and cautious use of medication to avoid harm to the fetus. We might remember that synchronized electrical cardioversion has been performed safely during all stages of pregnancy.**

The pregnancy itself will cause additional work for your heart. I would imagine that the main concern would be blood clots and or stroke. I don't know anyone who was pregnant with Afib (either before or during) but I do have a friend who had a stroke in her 20s and had to be on medication from then on. She had 2 pregnancies that were managed as high risk.

Do you already have an obstetrician? I would suggest you consult with him/her.

I'm sorry I can't be more help.



Edited 1 time(s). Last edit at 04/03/2019 09:13AM by katesshadow.

I wonder if Shannon might have a specialist he could refer you to there in Paris?

If not, it may be worth contacting Marla Mendelson's office at Northwestern Memorial Hospital in Chicago. She is a cardiologist & director of the Heart Disease & Pregnancy program there. (My ob/gyn referred me to her at one point.) My understanding is that she has focused over her career on research & management of heart conditions for pregnant women. She is at a point in her career where she may have a good idea of who to refer you to locally for specialized care/case management...

My last post didn't go through..;agghh!!

Thanks so much katesshadow

I suppose I would be considered high-risk at my age but I doubt blood clots would be more likely than in anyone else...I don't take anti-coags normally as am considered risk 0

The article is most helpful, and yes there's a specialist in my local hospital who deals with cardiac patients :-)

Thanks Kbog too but I'm in France, I fear that this lady could not help me

Regards and have a nice weekend!

Rebecca