Afib 30 hrs post-ablation

I've sent the following to Shannon via PM, but since time is of the essence and he might not pick up soon enough, I'm posting here too.

I had an ablation on Thursday, August 15 - Dr Verma at Southlake Regional in Newmarket, Ontario. I live in Ottawa, Ontario. The procedure went well. Dr Verma ablated the pulmonary veins plus the posterior wall. I came home yesterday (Friday) and started getting ectopics around 7pm. At 11 pm I went into Afib and am still in Afib, almost 11 hours now. In the last hour or so, I've been experiencing intense waves of wooziness, seven so far.

Instructions from Southlake say if I go back into AFib within 24 hours, I should be electrically cardioverted. Another instruction says if I go into Afib and it lasts more than 24 hours I should be electrically cardioverted. I'm not sure which action I should take and I can't reach the Heart Rhythm Program Nurse at Southlake because they are only available weekdays.

Though I went into Afib at 30 hours, it's pretty close to the 24 hours so I don't know if I should go to emergency now or wait and see if a self convert before 11 pm tonight. I'm concerned about these intense waves of wooziness. While I've experienced them many times pre-ablation, never to this degree. I'm also experiencing some chest pain, more like a pressure, which I understand is normal.

I'm looking for some direction.

Many thanks.

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afapr14
Though I went into Afib at 30 hours, it's pretty close to the 24 hours so I don't know if I should go to emergency now or wait and see if a self convert before 11 pm tonight. I'm concerned about these intense waves of wooziness. While I've experienced them many times pre-ablation, never to this degree. I'm also experiencing some chest pain, more like a pressure, which I understand is normal.

Chest pain, pressure, and extreme wooziness are not normal. I recommend that you head to emergency now. It's probably nothing serious, but they don't want you in sustained afib immediately after your ablation. 30 hours is close enough.

Thanks Carey. Appreciate the fast response. I will take your advice and head to emergency right now.

Lorraine

Yes ER ASAP or as Carey mentioned now.

It's normal to experience Afib within the first 3 months so I would not fret about that until after you speak with your EP.

Hi AFAPR14,

Sorry for my delay in getting back to you I have been traveling recently plus juggling my usual ten balls lately, but our trusty teamwork with Carey joined by rockekritch addressed your concern quickly and right on the money, as usual.

Normally, an EP will try a diltiazem IV drip for any recurrence during the first 24hrs post ABL while trying to slow down the rate (if it was well over 100bpm), in anticipation of a likely self-conversion so soon after the ABL. If that doesn’t work over the first half day or so with diltiazem drip they will then typically do an ECV.

I assume the correct interpretation of the mildly conflicting instructions you got would be from door #2 ... that you should get thee to an ER for an ECV for any recurrence lasting 24hours.

It’s clear from from your report, though, that your episode in question started later than the initial 24 hours post ABL, and in any event this is very likely to be common variety blanking period stuff.

The one issue that I agree would earn you a quick trip to the ER ASAP was the report of ‘extreme wooziness’. My only caveat is to just suggest that you also inform the ER docs that you have had such periods of ‘wooziness’ many times before this ablation. It may well be the case that this episode of wooziness was indeed more intense than prior episodes, but it’s also human nature for all of us to ‘feel’ a actually occurs physical reaction for more strongly in real-time, in the moment, than what we tend to recall in terms of intensity or seriousness from a, perhaps, long past series of such similar symptoms. We all are prone to that phenomenon and most seasoned ER docs will take that into account, especially when you inform them that you have had similar symptoms previously and totally unrelated to an ablation.

Nevertheless, because this is so soon after discharge from a cardiac procedure I’m very glad you took the absolutely right advice from Carey and Rocket to get yourself to the ER ASAP just to be on the safe side. They should be able to contact Dr Verma directly too ... or his on-call EP ... to clarify to the ER how they would prefer the ER docs to handle the situation.

I assume you have had your ER experience by now so please let us know how it all went when you return. I’m sure it all will go just fine!

Best wishes,
Shannon