Different issues post ablation

Hi everybody, i had a PFA back in november 2024 following a year of intermittent Afib episodes primarily triggered by intense exercise i would say. I am in very good shape athletically and generally heart in good shape 46 vo2 max, usual resting heart rate of 53. I am 57 years old.
I would feel it "click in" and then have a day of chaotic afib symptoms with high heart rate in the 140s. I was placed on 25mg metoporolol daily to keep things under control.
Since the PFA i have had episodes approx once per month but they are now different, still lasting a day until conversion back. Now when i feel it "click in" i get a high heart rate 140 in rhythm but it just stays there, so more like a tachycardia.when it is converting it does so via afib. The latest addition is i am getting short intermittent bursts of high heart rate lasting a few seconds to a minute before settling down with me having a feeling like its going to click into a full blown episode. I get a feeling in the base of my throat.
My EP has offered a touch up ablation and says i have nothing to worry about, however, i feel like i want to see how it goes for a while.
Anybody have anything similar or have any suggestions.

I take 25mg metoporolol each morning and have extra fast acting 25mg doses that i have taken when one of the new episodes or mini episodes flare up.

Thanks

Many procedures any specialist is willing to undertake hinges on the patient's tolerance of the symptoms associated with the condition. This is no less true in AF and flutter, and for the other more common arrhythmias. It's not to say there's little risk in letting AF run its natural course, including progression to mitral valve prolapse, if that's in the cards for the individual, or heart failure (I wish they'd change that lamentable label to 'cardiac insufficiency' or something less foreboding than 'failure'). And, of course, there's the hypertrophy that seems inevitable. However, I have a history of being very unpleasantly symptomatic, and I pestered my cardiologist for help beyond just metoprolol and Eliquis. He finally referred me to the person who performed two ablations inside of 7 months. The first was an immediate failure; I was in the ER inside of a week and had to be placed on amiodarone to get me stable. The second ablation has me in NSR, symptom-free, for about 27 months now. I can't tell you how relieved I am, but I hope you can take it at face value.

The disorder is progressive. It does advance, and even after a successful ablation (one full year with no arrhythmia), the very next day can be a different story. The idea is to keep it suppressed, or to minimize its potential to make lasting changes in the substrate and in the mitral valve. You want to minimize the deposition of collagen, and the ensuing fibrosis. So, if drugs do that for you, you don't really need another ablation. If you feel you're beginning to revert to more steady and persistent AF or flutter or SVT, or.....AND you're not feeling especially well or secure, then start the process all over again and get 'er done. That's my advice.

There's nothing to be gained by waiting to see how it goes. I would do the touch-up ablation.

thank you for your advise..as a very active person and soccer player, this condition takes me from somebody that can do all of the physical demands of a soccer player to flick of a switch lying in bed with a 140bpm heart rate, peeing like a horse and getting anxiety...post ablation the normal days are better than before but the clicked in days seem a bit more violent even though it seems to be in rhythm.
i guess as you say, ultimately if this develops further, lasting damage may be done, so having an additional procedure may be the way to go.

You might check out this thread. In my case I learned to limit my exertion for longer duration activities to only what I could do nasal breathing. Turns out, when you over breathe, you deplete CO2. Because of the Bohr Effect (which loosens the bond between hemoglobin and oxygen), you can actually create hypoxia at a cellular level. This can be a much longer discussion, but I'll limit it to this, unless there is greater interest.



Edited 1 time(s). Last edit at 04/10/2025 12:28AM by GeorgeN.

IDK, but extensive exercise frequently seems to do this to you. You may have to choose from something that gives you pleasure to physically protect your heart so you don’t end up getting many ablations, flutter or last resort an AV node ablation and a pacemaker when other choices could fail. Please don’t have >3 ablations and still get tachycardia after a workout. It’s not worth it.

thanks for the helpful comments..
i guess one of the difficulties we all face is trying to weigh up all of the things that affect our immediate future versus doing things that our 10 year futures selves will thank us for.

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mbrinksoccer
i guess one of the difficulties we all face is trying to weigh up all of the things that affect our immediate future versus doing things that our 10 year futures selves will thank us for.

I can relate. I'd figured out within a month of my first episode (by finding published studies) that chronic endurance exercise was my path to afib (training for and competing in a race that gained 7,800' and topped out over 14,000' in a bit over 13 miles). Yet I competed in that race 6 or 7 weeks after my first episode and the next two years as well. I finally had a talk with myself and decided that this participation was counterproductive for me. Nearly 21 years later, I remain very fit and active, however, there are activities I don't do. For example, I alpine ski. I have friends that will skin up and ski down. The skinning up doesn't fit my situation and would almost certainly precipitate an episode, so I don't do it. I've also done mountaineering, climbing up a very steep couloir with ice axes, crampons and a heavy pack at around 13,000'. I knew I was playing with fire and overdosed heavily my normally large magnesium intake. I managed to avoid an episode, but decided that doing this was also counterproductive to my health and afib. Hence haven't repeated.

On the other hand, there are many things that I enjoy that I can do. At 69, I alpine ski, kayak, canoe, rock climb, hike, jump rope, slackline, do HIIT on a fan bike while training with low and high O2 (7.5% and 80%) through a mask, & strength train with calisthenics and also short and long duration (90 second) isometrics (and much more). All of this with nasal breathing. I just don't do long duration activity using my anaerobic metabolism (skinning up on skis is a perfect example).

Wow George! I’m impressed!! Don’t forget you shoveling snow barefoot and wearing shorts without a jacket.

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GeorgeN

i guess one of the difficulties we all face is trying to weigh up all of the things that affect our immediate future versus doing things that our 10 year futures selves will thank us for.

I can relate. I'd figured out within a month of my first episode (by finding published studies) that chronic endurance exercise was my path to afib (training for and competing in a race that gained 7,800' and topped out over 14,000' in a bit over 13 miles). Yet I competed in that race 6 or 7 weeks after my first episode and the next two years as well. I finally had a talk with myself and decided that this participation was counterproductive for me. Nearly 21 years later, I remain very fit and active, however, there are activities I don't do. For example, I alpine ski. I have friends that will skin up and ski down. The skinning up doesn't fit my situation and would almost certainly precipitate an episode, so I don't do it. I've also done mountaineering, climbing up a very steep couloir with ice axes, crampons and a heavy pack at around 13,000'. I knew I was playing with fire and overdosed heavily my normally large magnesium intake. I managed to avoid an episode, but decided that doing this was also counterproductive to my health and afib. Hence haven't repeated.

On the other hand, there are many things that I enjoy that I can do. At 69, I alpine ski, kayak, canoe, rock climb, hike, jump rope, slackline, do HIIT on a fan bike while training with low and high O2 (7.5% and 80%) through a mask, & strength train with calisthenics and also short and long duration (90 second) isometrics (and much more). All of this with nasal breathing. I just don't do long duration activity using my anaerobic metabolism (skinning up on skis is a perfect example).

Sorry to hear this. Sounds like you are 5-month post ablation, and your symptom did not improve as expected. I'd probably get in line for a touch up. Did your EP say what method will he use, Radiofrequency?

it was a pulsed field ablation and as mentioned the main issue i have is that although i have been having these new episodes approximately a month apart, they have been completely different to before..now in rhythm but very fast and staying there for almost a day, then doing a bit of chaotic afib on the way out as it is reconverting to sinus..he did say that he would have a new look in the lab and that he had some new tools that have just become available but the decision was mine...
i'm not sure i will be backpacking at 13,000 ft but i would like to be at the point where i have the confidence to give it a go if the opportunity arose. I would ultimatley be happy to continue to lead an active livestyle, perhaps with a few tweaks here and there.

i had another episode today that clicked in halfway through my hill walk..cruising along then click..i was able to get home and there it started to organise and my pulse was stuck in a loop at around 140bpm..i was fortunately able to see my EP today during the episode..he seems to think it may now be an AVNRT..It reconverted by itself this afternoon but after a day of 140+...as it converts, it goes through boughts of Afib at lower rates 70-80 and fortunately is now back to NSR at 52...
Anybody have any experience of these episodes or have any tips as to how to avoid/reconvert.

Thanks to you all

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mbrinksoccer
Anybody have any experience of these episodes or have any tips as to how to avoid/reconvert.
l

Maybe ask your EP if flecainide on-demand would be appropriate for you to try for conversion. Here is the original paper on the use as needed for afib: [pubmed.ncbi.nlm.nih.gov]