ablation blanking period

Hi, I had a cryo ablation last Monday by an experienced EP (5000+ ablation). Pacemaker installed next day following post ablation EP study.
Was fine for one week then back in afib yesterday. I have appointment with NP next Monday. Any questions I should ask, besides the obvious.
I know blanking period lasts 3-6 months,
I also was wondering how long other people's afib lasted during blanking period.
PS I'm taking Flecainide 150 mg, carvedilol 3.25 mg, and Eliquis 5mg all bid.
Thanks for any suggestions!

People's post-ablation experiences are all over the map, but experiencing afib or flutter during the early stages isn't unusual at all. Have you let the NP know you're in afib? If not, you should. It's quite possible they'll want to cardiovert you. (I would ask for it.)

I don't think you meant to say you underwent an EP study after the ablation. An EP study is done during the ablation before they do any burning or freezing.

Three months is the generally accepted blanking period. I've never heard anyone define it as longer than that, and if they do I think they're kidding themselves.



Edited 1 time(s). Last edit at 03/12/2020 12:23AM by Carey.

As Carey noted above, the generally acknowledged post ablation blacking period after an index ablation (and essentially the same after follow up ablations as well) is a full 3 months.

However, the results of long-term follow up studies by multiple high volume ablation centers have confirmed that the actual average real-world blanking period is over at the end of the eighth week post ablation.

Most experienced centers still use the 12-week blanking period standard simply for convenience and tradition ... and because it encompasses the full range of individual variability normally seen, year in and year out, at high volume centers.

The reason for telling modern ablation patients the end of the 8th week is the actual typical end of the blanking period is because increasing numbers of advanced ablation EPs generally want their patients to report back to their assigned NP(s) after that time, in order to focus the new ablation patients attention on their hearts behavior particularly at the following the 8th week and beyond to see if NSR is truly stable.

After the end of week 8, the patients heart should be as quiet as a church mouse, regardless of how much blanking period activity they did, or didn't have during the first 8 weeks post ablation.

You want to see a great reduction in any degree of any previous atrial activity once you have reached just beyond week eight. Should there be a sudden or gradual increase in actual atrial AT after week 8, that then signals the odds are much greater a touch-up ablation will likely be required to durably put the genie back in the bottle for the long term.

In outlier cases, a patient's heart may not go fully quiet until after week 12, and yet still they may experience a decade or more of unbroken NSR as a truly successful index ablation. But any increase in actual atrial fireworks such as AFIB, Atrial Flutter or Atrial Tachycardia, post ablation that increases in duration and/or frequency past the end of week 8 is a near dead-ringer that a touch-up is in the cards.

Cheers!
Shannon

Thanks !

Quotes from Shannon’s post: “After the end of week 8, the patients heart should be as quiet as a church mouse, regardless of how much blanking period activity they did, or didn't have during the first 8 weeks post ablation.

But any increase in actual atrial fireworks such as AFIB, Atrial Flutter or Atrial Tachycardia, post ablation that increases in duration and/or frequency past the end of week 8 is a near dead-ringer that a touch-up is in the cards.”.

Shannon, I then ask if your above quotes are true, why did the nurse practitioner sign off on my Zio heart test report without Dr. Natale’s signature anywhere on the report and also issue orders that I could stop sotalol? My local cardiologist seems to feel as you do, that since I had two solid weeks of atrial flutter four months after my ablation that perhaps I needed either to remain on an anti-arrhythmic or get a touch up ablation. He also noted concern at not seeing Dr. Natale’s signature on the report & asked me if I knew whether or not Dr. Natale had reviewed the report personally, to which I could give no answer. He has indicated a strong desire to discuss these circumstances with Dr. Natale, but it seems Dr. Natale does not discuss his patients with their local doctors as no one has responded to me when I asked about this in December and since I have been asking about this in March.

On the other hand, I am very happy to be off of sotalol but I also would feel better if the two doctors spoke to one another to clear up any concerns about my late atrial flutter in light of my August 1 ablation. I have been off of the sotalol since right before the Zio heart test in January, and have been doing fine up to this date. I am scheduled to wear the ZO heart patch again in May after which time new determinations will be made. Isn’t it standard medical practice that the doctor should look at the report and sign it even if a nurse practitioner is handling things for him though? I think I am doing well currently heart-wise, but I certainly would appreciate if my doctor could have a quick discussion with Dr. Natale as he keeps asking me for.