Ablation results - 3 days after

After 9 months of afib and a-flutter, I had an ablation (PVI, flutter) at Cleveland Clinic (main campus) on Oct 23 by Dr Tchou, accompanied by Dr Abraham. They said my afib ablation was straightforward but they had a bit of difficulty with the flutter ablation because the flutter line was tucked in a corner.

It was a 6 hr procedure with conscious sedation. There was little pain except during the burning, but they would stop each time I moaned so it was quite tolerable. Worst part was lying with legs still for 6 hrs after a 6 hr procedure (gave me bigtime backache), but after my still period I got the pressure bandages off and the urine catheter out and moved around so my back pain resolved. Best part was watching the heart monitor with the steady heart rate during and after the procedure.

Had a little bruising (silver dollar size) around heart catheter insertion sites on right groin.

Pre-procedure resting pulse was in the 40s (avg about 45) and post-ablation was in the upper 60s (avg about 67), but 3 days post-ablation it seems to have settled into the low 50s.

I am 3 days post procedure and have had no afib or flutter. A few ectopics, but very few. Pretty ecstatic about the procedure success thus far and the minimal pain and suffering I experienced. Prior to the procedure, I was having about an hour/day afib, with episodes of flutter (120-150 bpm). Two months earlier I was having 7 hrs/day afib, but stopping the Evoxac I was taking for dry eyes and mouth reduced the afib burden tremendously.

I was Dr Tchou's second case of the day, and both the previous one and mine each lasted 6 hrs. I don't know how he does two 6 hr procedures with a 1 hr break in between - he is superman! Cleveland Clinic's "Patient First" motto is all over the place, and all the staff really practice this - I was quite impressed with the care I was given there.

Thanks to all on this group for sharing their experiences - it helped a lot to know what to expect.



Edited 4 time(s). Last edit at 10/27/2012 12:25PM by gehauser.

Great to hear Gehauser!

Sounds like you are off to a great new start! Take it easy and heal up..
Shannon

Were you put on a post-procedure anti-arrhythmic drug? Some EP's put you on an anti-arrhythmic drug for about a month after the procedure to give the heart time to heal (not sure if they all do though).

Welcome to the club! Best wishes for permanent NSR.

Tom

Diane98683 Wrote:
-------------------------------------------------------
> Were you put on a post-procedure anti-arrhythmic
> drug? Some EP's put you on an anti-arrhythmic
> drug for about a month after the procedure to give
> the heart time to heal (not sure if they all do
> though).


Ordinarily Dr Tchou prescribes an AAR post-procedure. We discussed it. Dr Tchou decided that an AAR would further reduce my heartrate, which was in the mid-40s pre-procedure. So he suggested we skip the AAR, and I agreed. So no I am not taking AAR. I am continuing with warfarin for about 3 months until my followup with Dr Tchou.

FYI, I was not taking an AAR before the procedure either - it was just the way things worked out as I wandered from EP to EP. The first EP put me on Multaq, which failed, then he ordered Amiodarone, which I refused and sought a 2nd opinion EP. The 2nd EP referred me to Cleveland Clinic for ablation, and 2nd EP was reluctant to put me on any AAR (amazing how different EP opinions can be!). In Aug, on my own, I stopped the cholinergic drug (Evoxac) I was taking for dry eyes/mouth, and my daily afib disappeared for 3 weeks. During this time I had my initial visit with Dr Tchou at CC, and he said we could start AAR pre-procedure if I wanted, or I could explore my "cure" for awhile. He scheduled me two months out for an ablation, but he said I could call it off any time up to the procedure date. Due to my success with stopping Evoxac, I never started AAR in this two months leading up to the ablation. Of course, the afib gradually came back after 3 weeks with no afib, but it came back at a much reduced daily burden, and it was off/on again a couple more times. By that time, it was ablation time.

In summary, after the failed Multaq back in March-April, I was never on an AAR again, pre- or post-ablation. I hope to maintain that trend!



Edited 3 time(s). Last edit at 10/27/2012 12:23PM by gehauser.

Hi Gehauser,

Im curious with such a low normal average heart rate pre-ablation, what is you age and are you a long time distance athelete or in very good cardiovascular fitness??

If not, do you have any issues with dry skin, particularly on the elbows and heals of your feet as well as in general, any problem with stubborn weight gain that hardly responds to dieting or attempts to lose it, any excess tiredness and fatigue, particularly in the mornings but that might improve some with a second wind in the last afternoons to evenings? How is your blood pressure too and Cholesterol levels?? Higher BP, particularly the diastolic number, and higher Cholesterol are a common manifestation of an underactive thyroid system .. as it a chronically low resting pulse rate without significant aerobic training effect as an explanation.

By any chance have the outer third of your eyebrows disappeared or thinned out significantly over a long period of time or perhaps as long as you can remember? In other words do your eyebrows stop before the get to the outer edge of where your eyeballs end at the edge of your outer eyelids when drawing and imaginary vertical line straight up across the eyebrow area from the outermost edge of you eyelids?? Also any issues with constipation? Cold extremities like hands fingers and feet or delayed Achilles tendon reflexes?

These are just a few of the many physical signs of low thyroid and if that is an issue, there are things that you can do to help support that which in turn can help make the heart more steady .. if indeed that turns out to be what is driving, in total or in part, your low pulse rate and as long as you make these adjustments carefully with the add of a knowledgeable functional medicine or BHRT MD.

Shannon

Do you know why many EPs do prescribe AAR after ablation? Seems many people might skip further AF without any AAR.
I've also heard different times for the scars to form on the ablated tissue - from weeks to months.

I am not on regular AAR Rx post-ablation although I have used flecainide PIP on a couple of occasions for afib. This is because of kidney problems for flec. and I don't tolerate Multaq or Rythmol. I did take flec. a couple of other times because I had so many ectopics I thought I was in afib, and it did take care of the ectopics, too.

Shannon:

My heart rate was in gradual decline for 10 years prior to Jan 2012, dropping from avg of 65 to 55. In the 9 months of 2012, it has dropped from avg of 55 to 45. So I am very concerned that I will have to get a pacemaker in 2013.

I am 60 and never was a distance athlete. I am a fit person but not extremely so. I played soccer and jogged regularly from age 33-50 and was in great aerobic shape (stopped soccer 10 yrs ago when Meniere’s showed up). Since then I have kept fit with elliptical walker aerobics, weights, and stretching in the gym 2-3 times per week. I stopped these workouts though when I got afib (they triggered my afib), and I have settled for brisk walking 1hr/day since Jan 2012. Thus, my low heart rate is not explained by extraordinary fitness.

But I don’t think it’s hypothyroidism either. My TSH is 1.35 (Aug 2012), low side of normal, which I think means I may tend toward hyperthyroidism? I have had some skin dryness in the past (not now), but no weight gain or unexplained morning fatigue. I have actually dropped in weight from 192 to 172 over last 9 months of afib because I had meal-induced afib and was not working out (I always gained weight when working out as my appetite is bigger and I am putting on muscle).

BP is typically 125-130 over 70-80. I have had borderline high BP (145/85) but control it with the diuretic I take for Meniere’s disease. I have low HDL and high LDL, but not dramatically so. My eyebrows have thinned in the outer third though. No constipation issues or cold extremities or delayed Achilles reflexes.

I had shingles in 1999 (was exposed to my buddy's kids who had chicken pox), and since 2002 I have had a couple autoimmune conditions (starting with Meniere’s). I have always suspected the dormant zoster virus as a potential cause for these. I wonder if there might be a viral connection in my bradycardia too. Odd stuff keeps happening – just last nite I had an ocular migraine for about 20 minutes - never had one of those, or any migraine, before.

For now, my post-ablation heart rate seems to be in the low 50s, which is better than the mid-40s I had pre-ablation.

Recent stress test shows no ischemic stress. Recent sleep study shows mild central apnea (not obstructive). That is about all I know at this point.

I will be sending weekly heart monitor results to Dr Tchou, and he is fully apprised of my heart rate trends over last 10 yrs (it is now in his notes), so I hope he can advise me on the bradycardia. It might be worth noting that my potassium had fallen to 3.7 in his pre-ablation blood tests, lower than my previous low of 3.9, and lower than the 4.5 I had last summer with the K supplementation I am doing.



Edited 2 time(s). Last edit at 10/29/2012 07:49AM by gehauser.

Hi Gehauser,

I was interested in hearing about your ocular migraine. After my ablation, I had them for about six months but none since. If you do a Google search, you can find several studies indicating that ocular migraines can be associated with transseptal puncture during ablation.
I wish you a speedy recovery.

Laura

llois Wrote:
-------------------------------------------------------
> Hi Gehauser,
>
> I was interested in hearing about your ocular
> migraine. After my ablation, I had them for about
> six months but none since. If you do a Google
> search, you can find several studies indicating
> that ocular migraines can be associated with
> transseptal puncture during ablation.
> I wish you a speedy recovery.
>
> Laura

Very interesting, Laura. Thanks for that tip and for sharing your experience - I found several such studies now.