Another failed ablation?

Hi. I had my second ablation on December 15th. I felt good and stayed in NSR with the exception of the night of the 16th when I had a half hour of mild afib. The 17th was fine being NSR all day. The 18th was pretty good, with a few minutes of mild PACs and then 2 half hour episodes of afib. The 19th started great and I was in NSR until 10PM when I got tachy with my HR over 130. It felt regular, but thready, like flutter.This lasted all night and by morning 10/20 I was in NSR. 10:30 that night I got tachy again. This continued all night so I called the on-call EP fellow per my post op instructions for permission to take a diltiazem (I had some left over from a previous prescription). He called my EP and then called back and said to take it and call back on the 23rd if my HR hadn't come down. The diltiazem seemed to help as my HR went down to about 8 and by evening I was at 87 and in normal rhythm. I woke up on the 22nd to another round of tachy/flutter and it lasted all day, night and into the 23rd. I called my EP and he had me come into the office for an EKG. He confirmed it was flutter and told me that this sometimes happens post-op and that 50% of the time it would resolve itself and if not he could always do another operation. He had me double my diltiazem dose in the morning and also take one in the evening. On the 24th I was up and down as far as heart rate and it finally broke and got down to the 60s-70s in the evening. Christmas day I woke to a HR of 87 and in NSR. Soon I had PACs, afib, flutter, you name it and my HR was anywhere from 75-145. By the 26th I was finally in NSR and my HR stayed 75-85. This lasted for 10 days, no afib, no flutter, just a few random ectopics. This morning however, the flutter is back and I've been in flutter for the last 7 hours. This is what happened after my first ablation. I had a pretty good first week, with random pacs, afib and so forth, then 10 days with only 1-4 random PACs interspersed throughout the day, then a few days of tachycardia and then everything fell apart and I hadn't had a full day of NSR until after the second ablation. And before anyone says it I do take my supplements, I eat cleaner than anyone I know and I'm very careful trying to beat this. It's just so disappointing. I need to be better. My wife starts chemo next Friday and I need to help her now and focus on getting her better. I don't know if I can handle taking care of us both.

Oops. I hit post before I was done. Has anyone had this much trouble post ablation and has it resolved itself? I felt so good for 10 days and my only concern was the ocassional ectopic. I thought the flutter was behind me. I dread having another operation and I can't afford one now that my insurance has changed. That's why I had them squeeze me in before my insurance rolled over. Now I have to pay 10% for inpatien rather than a $200 deductable. Sorry for rambling, but I'm at work and this is all that's keeping me from screaming.

Mike,

Sorry to hear about your post-ablation problems. Flutter is actually quite common after an ablation and, according to my surveys, resolves itself within 3 months in about 50% of cases. If you have not already done so you may wish to read my post-ablation protocol.

[www.afibbers.org]

Hans

Thanks Hans.

Hi Mike

I also have had a second failed ablation ,before the first one i never had

a/flutter just A/fib so i seem to have inherited it after the first proceedure.

im interested in your post because my heart rate is all over the place as

well and although on Sotalol for 4 months now it is ineffective and diltizem

has been added as well which controls it for a while then off it goes into the 125 zone which i hate

a holter moniter a day ago showed me to be in both flutter and fib with a heart rate of mostly over 100 bpm i saw my cardio and had an EKG done, it

was 115 bpm so he upped the dose of diltiazem to 240mg a day.

he says he just doesnt know what to do with me next.
So it goes on ,another ablation ?
I just dont know what to do for the best.

for the record i did Have 3 months of normal sinus rhythm this time so know how it feels to be normal but im getting low on hope of ever being fixed

Hi Janet,

Sorry to hear about your failed ablations. I got only 10 days NSR this time, but there were daily ectopics, but they were at least preferable to this. I was really hoping this was fixed with this ablation. I emailed the AtrialFibline about this new bout of flutter. They responded after getting in touch with my EP tried to reassure me that this is not unusual and in 50% of the cases it resolves itself, yada, yada. I've heard it all before so it's hard to have high hopes.

So far I've been in flutter for over 34 hours. I don't know what to do. I only have 5 days FMLA left and with my wife out of work I can't afford to take off anyway. Yesterday at work was hell. I sit at a desk and take phone calls, but felt like I was running a marathon. Today isn't much better. I don't know how much more of this I can take. I'm financially ruined over this and can barely afford my prescriptions and supplements, none of which seem to help anyway.

Isn't it nice, Janet, how the ablation can sometimes create new problems. I was told when I had the flutter on Dec 23 that if this persists they can do yet another ablation. Unfortunately for me I have no money to pay for it since my insurance changed and I'm sure they won't do it for free.

Anyway, I wish you luck with your flutter/tachycardia. I too am taking 240mg diltiazem a day and at the moment my rates have been 115-140 all day. Do you have dizziness on standing and walking a few steps? That started for me today. I try to psych myself while I'm sitting still that it's nearly tolerable, but getting up and moving in the slightest takes it to another level.

What was your heart rate before the ablation? Mine was usually under 70 before and after the first ablation, but was in the high 80s after the second. I also noticed a 10-20 point increase in my systolic blood pressure. I don't know what's going on.

Hi Mike

I know we are only two of many still suffering the huge disruption to our lives but when its just yourself you feel alone and vunerable i know i do.
I have blacked out 3 times so the diltiazem needs to be taken with caution even though it does lower the heart rate eventually.
I feel all the things you mention but life goes on so i try to do deep breaths to calm me down, and pretend to people that i am normal like they are even though as you say its a struggle

Before my first ablation i had a HR of 60-65bpm in and out of A/fib, after the 1st ablation which seemed successful but then wasnt it
Only lasted 12 days then i got Flutter as well with symptoms like yours higher heart rate, higher BP, i was put on Amiodarone which gave me high liver enzime readings and early pnuemonia, so i refused to take it after two months and a second ablation went ahead.
As ive said it worked well for 3 months or so with the medication Sotalol but still with heart rate in the 90's a lot of the time but NSR then suddenly it went normal and remained so until 17th December when i was woken in the middle of the night with A/fib and Flutter in the 125 range,i was due to se my cardiologist so he did a EKG and Holtor Moniter both showed 100% A/fib/Flutter 125 BPM and highish BP.
I feel for you and your plight seems as bad as mine, sometimes I find myself wondering if its all worth it the constant struggle the proceedures the drugs, if i didnt have such a lovely family to support me i would probably get very depressed,
I will try everything i can to overcome this, lets find a way Mike

Good Luck
Janet

Thnks Janet. I got a small breakat 3Am when my pulse actually got to 84 and I was is NSR. I went to sleep hoping this was over, but woke at 7 to flutter and a pulse of 130. This is where it has remained all day. I thought maybe an epsom salts bath would relax me, but when I got out of it I nearly passed out. After a few minutes I checked and my pulse was 138 and BP was 98/48. I'm thinking now I should have never gotten an ablation. It seems that they have made things worse. It's bad when I actually miss the days of mild afib. Then it was only an annoyance, not life-altering.

Sorry to hear about your experience with amiodarone. I only took it for 3 weeks and it made me miserable. When I refused it they prescribed drondedarone, but every time I took it it put me in flutter. I told the EP, but I don't think he believed me and wanted me to continue. I stopped taking it, but after the first ablation the EP talked me into it, telling me how important it was for the healing phase. I don't see that it has helped me at all. Back in June when I had flutter/tachycardia after the first ablation my cardio gave me digoxin on top on the multaq since I refuse to take beta blockers.

Anyway, I'm calling the EP's office in the morning and see what they have to say. Better yet, maybe this will run it's course and be over. I just have to get better by Friday to take my wife to her first chemo. I just hope this can be resolved for Friday and next weekend so I can take care of my wife. It's her turn to be card for. God knows she's been caring for me over the past year.

Hi Mike,

I had my first ablation on 9/12/11 with Dr. Natale. I also had never had aflutter before, just afib but I developed flutter a few days after the surgery. My afib has always been intermittent (I read my operative report and when I went in I was in NSR) but this aflutter was constant. It was so difficult - I know exactly what you're going through! I understand the despair you feel. My HR was up there around 140s and we tried Multaq and Diltiazem. The Multaq made me sick. I wound up having one cardioversion which lasted days. Meanwhile, the tachycardia as you know causes lightheadness and exhaustion.

Then we tried Sotalol and Diltiazem (still needed it to keep the rate down). I'd been on Sotalol for 2-3 weeks and still the HR was hard to control without Diatizem. I was having breakthroughs all the time. Then out of the blue, approximately 6 weeks after my surgery everything fell together. My HR went down and stayed down. An EKG showed that I was in NSR so they took me off Diltiazem. I went that way for five weeks, still on Sotalol. At about the fifth week I had another aflutter episode - HR way up, out of the blue. Back on Diltiazen. It lasted about a day and I was back in NSR again. Off Diltiazem (feels like a merry-go-round but nothing merry about it).

So the last episode occurred just about the three month window of my surgery. Now Dr. Natale's office wants to do a touch up because it was at the three month time frame where they believe if it worked I should have no flutter. But I've been fine since then, so I'm hopeful I won't need a second one. They are going to wean me off the Sotalol this month and see if I stay in NSR. Wish me luck!

Hang in there Mike, it does get better!

Hi Mike

I should have never gotten an ablation. It seems that they have made things worse. It's bad when I actually miss the days of mild afib. Then it was only an annoyance, not life-altering.

I totally agree with that Mike and am also sick of people saying give it 3

months, give the heart time to heal, well nearly 5 months on mine hasnt

healed so im in the 50% it doesnt work for

You have been given a lot to cope with and now your wife is ill as well, life is definately not fair.

Please keep posting your progress or you can email me if you like,I am

happy to be a sounding board should you need one ,im in New Zealand by
the way, where are you?
I will be thinking of you and hoping you come good before your wifes chemo starts

Janet


Hi Maria

i had wondered how you were doing as i followed your posts when you

were having the problems you mention, you and i have been on exactly the

same medications and had similar experiences, mine had become normal

about 6 weeks after ablation

An EKG also showed that I was in NSR so they took me off

Diltiazem, nearly 4 months passed and i was fine ,thought i was cured but

no back it came and now its all over the place just like Mikes.

I wish you luck Maria but dont have your confidence that we will all get

better, its more we get better for a while thats all!
But i wish you good luck just the same ,you could be in that other 50% it works for

Janet

mike if you would like to email me id love to hear how your getting on, just realised nobody could see my email address

janet

Mike , Janet, Sorry to hear about the troubles you are having. I too have been having irregular episodes after my 2nd ablation. Even though I am not cured I still enjoy hearing about the success stories of others especially after they snatched NSR from the jaws of afib long after the accepted dates of 3 to 6 months to achieve success. It gives me hope That it can still happen for me. Being persistent prior to my first ablation I knew that it was probably going to take 2 or more ablations to expunge the beast.

My first ablation took me from persistent to paroxysmal. The second took me to mostly free of afib (I think) to aflutter that I find much more tolerable than the afib I used to get. Things are better but not fixed yet. I see my Doc tomorrow and get the results from my Holter monitor. We'll see where it goes from there.

Keep the Faith

Luck to us all

Adrian