Annoying ectopics six months post ablation

Six month post afib ablation. I'm having more ectopics lately. One a minute at times, or runs of five or more separated by 3-5 normal beats. Nothing in my life has changed so it's a pretty random thing. I get them for a window of a few hours, typically early afternoon from 1:00 - 5:00 pm, but they can start around 10:00 am as well. It has nothing to do with working out (which I do the early morning (light not crazy) and which doesn't bring on any ectopics). I have no trouble sleeping really as they don't crop up at full rest very much, and I don't get them in the middle of the night best I can tell. Just sort of mid day wierdness when sitting still mostly and no tied to exercise or deep rest apparently.

I'm taking the 50 mg Felcainide morning and night. I've taken 12.5 mg of Metropolol on and off, but am trying to ween myself off that per my last visit with my EP. I've asked him if I should up my Metropolol to 25 mg morning and night to see what that does. Just looking for something that can settle down these ectopics down. I really feel them.

Remind me please. Anyone end up getting a bunch of ectopics after six or more months? I've heard of them starting immediately after ablation and I did have some of that but they calmed down a little. Now they are back in force. Ugh.

Thanks.
Keith

I got PVCs starting a month after my ablation. They started randomly when I drank and escalated to full time 7 months post ablation. My heart was a race horse. They then stopped completely when my EP started me on 37.5mg (1.5 pills split in half twice a day) Tenormin and after that almost immediately AF and atrial flutter took its place.

Do you have PVCs? Or PAC?

Atrial I believe. That’s what they were on Kardia after the ablation. These feel the same but I guess I don’t know for sure. They’ve never completely gone away since the procedure. Just been worse lately. I’m hoping it’s all still part of the healing process being only at seven months.

Kardia cannot detect PVCs according to my EP. You should post a Kardia strip. Carey is an expert IMHO and can either rule out PVCs or not. If you want answers, a 12 lead ekg would be the the correct route to go.

Ya I posted them before (months ago). They were PACs. These are the same just given the timing and how they feel. I'm just trying to figure out why they surfaced with such a vengeance out of nowhere and due to no triggers i can think of.

Just a thought...Are you drinking enough water? Jeff

The hallmark of PVC's on an ECG is a malformed or oddly shaped QRS waveform. In this article, there are examples.

Here is one:

Quote
Jeff W
Just a thought...Are you drinking enough water? Jeff

It's a fair question. I really try to but I bet not enough still. Especially as hot as it's been in St. Louis. I keep water nearby all the time, but actually drinking it is another matter. Lol.

I don’t mind PAC. They are harmless to me at least and I started getting them in 2004 when starting flecainide. I stopped flecainide in August 2019. Now I only get them after a ECV and they resolve on their own until my next ECV.

You need to hydrated yourself. If you don’t like the taste of H2O, then spike it with a few slices of lemon, orange, cucumber, or fresh mint. That’s what I do except for orange which interacts with my meds.

Good advice all on the hydration. I’ll make a concerted effort to drink more water and see how it goes. I knew it was important but probably haven’t been doing enough. Thanks

I'm about 3 years out from my successful Natale ablation and past week started throwing tons of PAC's. For reference I wore a 7 day monitor in Feburary which only picked up 110 for 7 days. Have not done a monitor yet but extrapolating from random Kardia's I have been running, could be 1000's now.

Haven't really changed anything and have begun religously drinking water and potassium last couple days which seems to be helping but to short of a time to draw conclusions and it's not like I changed my hydration habits anyways. There does seem to be a postural and eating component indicating vagal which is consisten with my afib before successful ablation as well. Like many it was random before it became basically permanent but always had a vagal connection for me.

Who knows, Natale's crew will have me wear another 7 day in 3 months and go from there, time will tell.

To the original poster, I had a lot of them the 1st year after my ablation, even 2nd year but getting less. It also took over 2 years for my resting HR to approach normal. I had a lot of work done including isolating my coronary sinus due to a PLSVC.

Thanks Fibrillator. Good info and hope yours get straightened out again. So random.

I have read (on this forum actually) that a successful vagal procedure is often indicated by a heightened heart rate post ablation. I can’t recall the physiology of it but something about getting enough penetration to where the vagal nerve is impacted as weird as that sounds. My heart rate never increased. Was around 65 before ablation and was around 70 the first day in recovery. Never went up. That always made me worried my vagal issue hadn’t been addressed. Like you, I have vagal triggers due to posture or eating cold things or bending over on a full stomach. I guess given I’m only seven months out I still have some recovery ahead. And interestingly hardly one ectopic all day today after several days of many. Who knows. I drank a little more water today but not a ton

Keefer,

A little more on water. For me it is the first thing I do when I go into afib, as dehydration is my most universal trigger - very predictable, but kinda sneaks up on me over time... (I have had LAF for 15 years, episode a month or so, 68 y.o.).

When I go into fib, I really soak my whole system with about 6 quarts of water throughout the next 12 hours. I always convert at between 12-20 hours. When I initially go into afib I am always very hypotensive: dizzy and orthostatic (almost pass out when standing). After I get the water on board I am much less weak and hypotensive - feel much better and can tolerate the afib much better.

I don't know if this hydration example will be meaningful or helpful to you or if it is appropriate for your specific health profile. But it is just what I have found that rebalances me - water is truly foundational to all complex cellular metabolism...

I hope you feel better soon.

Jeff

I'm going to be diligent in keeping my water intake up. Not just for a day but for a solid week for starters to see how it makes me feel. I mean other than being 50 and having to pee more than I use to anyway, what can it hurt. Thanks for the advice and well wishes.