Post ablation problems continue...

OK, so it's been about 10 days since my PVI and things are improving but weird. The day after I was discharged I had a one-hour long episode of what now appears to have been atrial flutter at 160 bpm. (I'm on flec and diltiazem). I had strange creaking noises coming from my upper respiratory tract (since the procedure) - and when the noise and pain (with bloody mucus) got worse I started taking amoxicillin and it stopped the noise, pain, fever and mucus flow. I'm still taking the amoxicillin. However, this tuesday (23rd) I had a 6 hour long 150 bpm flutter episode and it set me back a couple of days, recovery-wise. I took myself off the flec, so far so good. Doc wants me to stay on flec with yet another rate drug...nope.

During all this time I've been having profuse night sweats...up to four times a night. They were nearly gone (one night clear after 4, 3, 2, 1 episodes the previous four nights), but now they're back after Tuesday's 6 hour flutter.

Anyone else have such issues? I'm sure getting tired of all this.

Tom

Tom,

Unfortunately, having flutter after an ablation is not uncommon and may require another ablation to fix (Shannon is the expert on this!). It was a good move to get off the flecainide; it can make flutter episodes much worse. You may find the following excerpt from my first book of interest:

"Intravenous verapamil or diltiazem (Cardizem) can be used to control the heart rate during an atrial flutter episode, but does little to speed up conversion to normal sinus rhythm. Electrical cardioversion, on the other hand, is usually quite successful (95% success rate) at achieving conversion at relatively low energy outputs (10-50 joules). Class IC antiarrhythmic drugs such as flecainide and propafenone have been used in attempts to restore sinus rhythm, but they are usually not successful. The problem being that as they lower the heart rate the AV node often switches to a 1:1 conduction ratio. This means that a patient who was doing tolerably well with an atrial contraction rate of 300 and a 2:1 or 4:1 conduction ratio (giving a pulse rate of 150 or 75 bpm) may all of a sudden find himself with a pulse rate of 220-240 bpm."

Hans

Tom, bummer......but this may all resolve and eventually be behind you.......I had alot of flutter during my 7 years....many times ending up in flutter prior to cardioversion....at one time they thought I only had flutter...but I did'nt.......flutter according to my EP is stubborn and hard to convert without EC..........so I had my flutter ablated during my PVI 8/21....my EP said "I'll get rid of your flutter on the way out"......after the procedure he said I went into flutter during the PVI......and then he ablated it....flutter is in the right chamber and to my understanding requires only on burn.........seems to me that I would end up in flutter after trying Flec or Propafanone...in other words it made afib turn into flutter

I do not know why a flutter ablation is not automatically a part of a PVI.......but many do not get a flutter ablation

Hang in there, Praying for you everyday..........

Tom P

Hi Tom P,
Thanks for the thoughts...
Prior to the PVI, I've never had flutter (to the best of my knowledge - and I recorded much of my past afib on an EKG). According to my EP, he didn't burn outside the left chamber, so the right chamber (previously benign?) shouldn't just suddenly generate flutter, I would think. But what do I know...

I had also read that flecainide can organize transient afib into flutter - so maybe that's what has happened. In any case, the only reason my EP has me on flec is because I mentioned that the beta-blocker toprol had caused problems. I read a study of minor proportion that indicated the use of both rate and rhythm control drugs after an ablation can up the success rate slightly - I think that's why he wants to use the drugs. I have to try otherwise, since I've been in flutter now twice WITH the drug (I won't let him know I dropped it tho'). I'm hoping this is just the blanking period blues and I'll be OK down the road.

I'm glad to hear you are progressing well, keep it up!

Tom

Hi TomB,

Sorry to hear of the continued hassles, I know its no fun but hang in there, it can still sort itself out without necessary meaning any more work is going to be needed anytime soon.

And Hans is right, Flec and Flutter do not tend to make good bed fellows!

That is what I discovered the hard way around 3am on a late May 2008 morning in the small central Holland town of Nijmegen ( well known along with Arnhem as the locations of the famous ill-fated WWII battle called 'Market Garden' for you history buffs) when I woke with a strong AFIB and took a PIP Flec which converted that into a 'No fun at all!!' 1 to 1 Flutter at around 225 bpm, complete with a feeling like an elephant was crushing my chest and great difficulty breathing which, by the next day, after a very temporary partial chemical cardioversion using a big bolus of IV Amioderone in a local Ziekenhuis (hospital), had morphed into full time 24/7 AFIB with mixed flutter for the long haul until I got my first ablation two and a half months later in Austin.

The Calcium Channel blocker route without Flec sounds better to me. Especially if you are getting any mixed AFIB signals with the flutter, but even still with flutter only too. But If you don't get good rate control with Diltiazem or Verapamil alone when in these flutters, then talk to your EP about adding in a very small dose of Toprol such as 12.5mg max ( or a more tolerable for you Beta-blocker but only in the smallest possible dose .. as a normal dose of BB rarely is much fun with a full CCB dose on board).

A small dose of Toprol or similar combined with a healthy-sized dose of Verapamil or Diltiazem can often settle down a more symptomatic and all over the map flippies. Even though that wont do anything for converting you back to NSR.

Would you describe the night sweats you have as like a cold sweat or a hot sweat??

Take it easy and keep in mind that things may still settle down on their own.
Shannon

Hi Shannon,
I agree with everything you said.. the Flec seems to be wrong at several levels, especially when prescribed as a means to reduce potential problems.

My night sweats have been neither hot or cold, I just wake up soaking wet. I have had three changes of bedding available and sleep on towels. I am sure that this is a result of the obvious infection I have been fighting, which is now seemingly resolving via amoxicillin. That dang 6 hour flutter episode set my recovery back a couple of days...but last night the sweats were hardly noticeable and the preceding day I didn't need to nap - so I'm getting better (I think). I believe I had some sort of resp infect starting up prior to the ablation, (I felt like I was coming down with a cold and I did have one night of mild sweating but I felt good at the time of the ablation) and the procedure allowed it to flourish. Whew, it's been a weird week for sure. My BP and temp ranges are returning to pre-ablation NSR status and my pulse rate is only about 5 bmp higher than before.

If the sweats do happen to persist, I'm going to see my cardiologist as I don't want an infection to settle in the heart.

Tom

Hi Tom,

Glad to hear it seems like the night sweats were from an infection that is quickly clearing up. The Diltiazem will keep your heart rate lower than it likely will be without any drugs for the time being .. depending on just how much burning they had to do. But eventually in the vast majority of the cases the baseline elevated HR without any cardiac drugs on board will come back down to more or less pre-ablation ranges.

Shannon