Dramatic increase in Afib in weeks following Colonoscopy

So I was a 5 episode/yr afibber for the past 6 years until a routine colonoscopy (my first) a month ago. Had a few episodes in the 2 weeks following, then a dramatic uptick in the last 2 weeks with over 6 more short (2-3 hrs average) episodes since. All connected to gastric pressure/burping until last night when I had numerous ectopics/short Afibs related to breathing rate. I was able to control them to an extent with rhythmic breathing and short breath holds. All of this seems very vagal in nature.

Anyone else experienced this? Did it settle down?

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JoeM
So I was a 5 episode/yr afibber for the past 6 years until a routine colonoscopy (my first) a month ago. Had a few episodes in the 2 weeks following, then a dramatic uptick in the last 2 weeks with over 6 more short (2-3 hrs average) episodes since. All connected to gastric pressure/burping until last night when I had numerous ectopics/short Afibs related to breathing rate. I was able to control them to an extent with rhythmic breathing and short breath holds. All of this seems very vagal in nature.

Anyone else experienced this? Did it settle down?

I had a lot of PACs during the prep--related to electrolyte balance and fluid loss I think. As soon as they hooked me up to a saline IV it settled down. I wonder if you electrolytes might still be out of balance?

I think that it was Jackie who long ago suggested drinking EmergenC (sp?) during the day before having a Conoscopy. It is a good liquid form of electrolytes and is available in drug stores.

It worked for me.

Although colonoscopy preps are notorious for throwing your electrolytes off and causing afib episodes, it's virtually impossible that the effects would still be present a month later. Your body is actually pretty good at regulating electrolyte levels unless you're doing something that works against it. Do you take a diuretic by any chance? Diuretics are a common cause of chronic electrolyte disturbances.

Failing an explanation along those lines, I think the colonoscopy is likely just a coincidence and your 5/year trend has now changed. Mine did that. I had 1-2 episodes per year for 6 years, and then in one year it suddenly went to monthly and by the next year it was more than weekly. That's when I pursued ablation because I didn't want to let it become persistent.

Yes, I think you are right and my next move is to talk to an EP. If I do decide to pursue an ablation I would look for someone with plenty of experience. Who did yours?

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Carey
Although colonoscopy preps are notorious for throwing your electrolytes off and causing afib episodes, it's virtually impossible that the effects would still be present a month later. Your body is actually pretty good at regulating electrolyte levels unless you're doing something that works against it. Do you take a diuretic by any chance? Diuretics are a common cause of chronic electrolyte disturbances.

Failing an explanation along those lines, I think the colonoscopy is likely just a coincidence and your 5/year trend has now changed. Mine did that. I had 1-2 episodes per year for 6 years, and then in one year it suddenly went to monthly and by the next year it was more than weekly. That's when I pursued ablation because I didn't want to let it become persistent.

Mine followed the exact same progression pattern. Would agree it's coincidence.

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JoeM
If I do decide to pursue an ablation I would look for someone with plenty of experience. Who did yours?

You're exactly right to look for someone with plenty of experience. And "plenty" should mean a thousand, preferably a lot more.

I made the mistake of allowing a highly regarded EP with excellent credentials to do my first three. Two other more highly regarded EPs tried to fix his work and failed. Dr. Natale finally fixed the whole mess for me.

Carey is absolutely right, look for the most experienced and well-vetted ablation doc you can find that has a decent backlog of cases and at least a regional, if not national, reputation for excellence in AFIB ablation. Meaning, you won't be able to get the procedure done quickly in the next couple of weeks (outside of exceptions where one might get lucky by getting a slot vacated suddenly due to a cancellation).

Unless you live near a large metropolitan area that has a renowned AFIB center of excellence with at least one very highly regarded ablation EP running the show ... then be willing to travel for up to 5 days to get your index ablation done by an elite ablation expert who meets at least my admittedly strict criteria of having a minimum of 2,500 to 3,000 AFIB ablations under their belt. And that means an EP who regularly ablates a fair percentage of persistent and long-standing persistent AFIB (LSPAF) in addition to the more typical PAF cases. You definitely want an operator who can comfortably address any degree of difficulty your case might present to them, once you are out cold and in the midst of your ablation.

It is not unusual for an established medium to longer term PAF case to manifest more advanced structural changes in one or both atria. These are the kind of changes more typically found in persistent or LSPAF cases that need to be address successfully to achieve durable long term freedom from all AT. Meaning, the type of ablation protocol needed for durable success may well require more advanced procedural steps beyond the typical primarily clinical EPs PVI/LAPW-iso solely anatomical ablation that is the limit of skill and/or training that a significant majority of EPs who offer AFIB ablations are only comfortable performing. Such 'jack of all trades' primarily clinical EPs, typically don't attract enough ablation patients to create a significant backlog of cases such that they become known region-wide as a full-time ablation expert.

You definitely want an EP who does almost nothing else beyond AFIB ABL, plus those ancillary procedures common as part of the ABL process.

Finally, I want to underscore that, in my view, there are reasonable exceptions to my roughly 2,500 to 3,000 strict range of minimum numbers for making your best choice. Those exceptional EPs who have been carefully selected for mentorship in the relative few large, high volume AFIB ablation research centers in which they learn how to successfully ablate the more challenging persistent and even LSPAF cases, can certainly be a reasonable choice, even if the number of AFIB ABL 'skins on the wall' is still in the roughly 1,000 to 1,500 total procedures.

Another reason why such carefully chosen EPs could be a good choice is due to their concentrated training and because these EPs have shown an extraordinary talent with a catheter by then as well.

We all have just one heart, so make a very discriminating choice, accordingly.

Shannon



Edited 1 time(s). Last edit at 01/04/2020 12:56AM by Shannon.

Shannon - thank you so much for your sage advice. Luckily I am well insured and live in a major metro area (SF Bay Area) so hopefully I will have access to an EP of the caliber you recommend. Does Natale still rotate through SF? I am willing and able to travel though. Before I decide to pursue an ablation I would like to eliminate the possibility this is all driven by an autonomic nervous system imbalance. Even in sinus rhythm I have been suffering from digestive issues/ bloating that preceded the uptick in AFIB. The other new symptom has been a storm of ectopics with even the slightest pressure in stomach. I also have an unusually low HR, in the mid to low 40s. Used to be very fit, but gave up trail running and other endurance sports 2.5 years ago when I figured this might have been the original cause of my issues. I still wonder if my already excessive vagal tone was further amplified by the colonoscopy, but who knows...

Again, thanks for your advice and everything you do for this community!

Can you head down to Thousand Oaks California ? It’s north of Los Angeles. Natale is there one week a month-Wednesday through Friday. The hospital is great. Private rooms, it’s not that far. If you don’t want to fly back afterwards you can take the train. I’ve taken the train from LA to SF and Thousand Oaks is closer to you. I find the train relaxing.

Carola - The recommendation for the colonoscopy prep that I found useful is Go-Lytely... it contains electrolytes and definitely helped prevent afib in my case.

Jackie