Six days post-ablation, heart rate too high?

Hi Everybody,

I had my ablation last Wednesday at Southlake Hospital in Canada and was very pleased with my care there. Dr Khaykin said he had ablated the afib and aflutter in both right and left atria. He said I had gone into afib as soon as the catheter had gone into my heart and then twice more. They had to cardiovert me three times during the procedure. I felt as if I was recovering nicely, pretty tired and weak but starting to feel better, and I got curious yesterday and put on my heart monitor - my resting heart rate was down around 50 before the ablation, but yesterday was at 85 for most of the day. Today it is running between 90 and 95. Has anyone else had this happen? I am taking 150 mg of Rhythmol bid and Xarelto 20 mg once a day - which I am scared about - they told me there was an antidote but now I read here that in practice there really isn't.

So two questions -1) Does anyone have any insight or advce about the high heart rate? 2) Has anyone switched from Xarelto to Coumadin? Is it easy to do?

Thanks for any advice you can give.

Marg

Marg,

An elevated post-ablation heart rate is usually a sign that the ablation has been thorough and will turn out to be successful.

Hans

Thanks, Hans. That's reassuring. It was just that I started feeling worse today at the same time as my heart rate went up. I am not sure what is normal in recovering from an ablation. I am still not feeling up to being out of my bed for more than a few hours a day. I see that Tom P. was out walking for 1.5 miles on the fifth day! And the instructions they sent home with me said I could return to work on the second or third day! I could hardly get out of bed then! Could it be that the three cardioversions and the sedative that goes with them have made it take longer to get over the whole thing? (I was under conscious sedation during my ablation, but there were certainly times when I was totally "out" and I think that must have been when they were cardioverting me.) The nurse did say that I had quite a chemical soup inside me and that I should drink lots of water in the next few days to get rid of it. Also I had no trouble with the six hours of lying still after the ablation - I was sound asleep for most of the time. I'm just wondering why it is taking me so long to get over it. If anyone has an ablation story similar to mine, I would love to hear it.

Thanks,

Marg

Hi Marg, everything you are reporting is commonly experienced. Some of us have a bit less tiredness the week or two after and some of us more... No worries, just take it easy and be kind to yourself... Ditto the high heart rate and it may well stay that way for 6 months to a year with it slowly returning closer to your prior baseline region, or pretty close, over time .. it is normal after an extensive ablation.

The only curious thing for me is your report of three cardioversions during the procedure. Did your EP mean three shocks in a row were needed to try to get your heart to convert from AFIB or Flutter into NSR? Or did he imply three separate cardioversion were done at different stages of the ablation, as if so, that would not make much sense to me?

Ideally, the end point they shoot for is a natural conversion to NSR directly as a result of the ablation work done that ends the arrhythmia, but that doesn't always happen, particularly with the first ablation and so they sometimes will just ablate until they get your AFIB to convert to an elongated flutter and then just cardiovert you from there to NSR and call it a day for the initial ablation if they aren't able to get you all the way back to NSR directly from the ablation.

That doesn't necessarily imply more work might be needed down the road, but in some cases it can suggest such a touch up might be reguired. Hopefully, you will have many years of AFIB free NSR... Take it easy!

Shannon

I had mid-40s resting pulse before ablation. In the first few days after my ablation, it was around 80.

Now, 7 weeks post-ablation, mine has settled into the low 50s.

About where I am too, gehauser (we were both at Mass General I think). I'm almost 2 mths out and heart rate is mid 60s whereas before ablation it was maybe 58-60 and for a while ran up to 75-85.

Hi Shannon,

Thanks for your reply. I was pretty groggy when Dr. Khaykin spoke to me, but my understanding was that my heart went into afib three times during the procedure and they had to cardiovert three separate times - I thought because they didn't want my heart fibrillating while they were doing the work. I know they like to put you into afib at the end to see whether there are any more places to ablate, but didn't think they wanted you in afib thoughout. I will ask him about it when I see him, but that won't be for three months. I see from the report that it could be interpreted as three shocks all in a row.

Quoting part of the report - " All pulmonary veins were isolated in sequence using Biosense irrigated tip catheter. All pulmonary veins were interrogated using a variable deflectible Lasso-Nav catheter. No potentials were seen around the pulmonary veins or the posterior wall or the left atrium at the end of the procedure. The patient went into AF with catheter insertion. Lines were drawn across the roof, septum - right and left, gutter and CTI as well as thoughout the CS, but cardioversion x 3 were required to maintain SR. Veins were rechecked and isolation was insured in SR. Bidirectional block was present across the CTI. .....
Summary Findings: Successful Pulmonary Vein Isolation. Successful Atrial Flutter Ablation."

Thanks again,

Marg

Thanks for your replies, gehauser and afhound. It seems like today my heart rate is settling down some - 78 now. So I hope I am starting to be on the mend. It's so wonderful to have this forum to turn to when worried about these things. So good to talk to others who have been there.

Marg, I am 16 weeks post ablation and resting HR still hovers around 80, I was 62 / 64 preablation.......at times I have recorded mid and low 70's but it goes back up in other readings.....I cannot tell though, in other words no adverse effect........yes I walked beginning day 3 after my ablation, just a mile to 1.5.....I was back in the gym day 15 working out lightly........per my EP's OK.....sorry you are on Xarelto, but hopefully off it soon, I was taken off warfarin at the 7 week mark..........let's hope Hans is right that the higher HR post ablation is a good sign! I am doing real well, feel 100%.......had a blip last week after a fair amount of 14.5 alcohol red wine.....had a 2 min episode the next morning.....but stopped magically! hope your IQ higher than mine.........supplement!!!

Tom P

Elevated heart rate after an ablation is normal, and it will take a year to settle down to your new normal.

I had my ablation before I found this web site (6 yrs ago) and I asked my Dr. before the ablation if they could do the ablation while I was in afib or not. He said that he could put me into or out of afib a will and that it was needed to see where to ablate. I didn't fully understand this at the time and still don't, but it worked beautifully.

Recovery seems to vary widely and I guess it's based on age plus level of health and fitness. I felt at 100% on day two when I went home on a Friday and was working full time on Monday.

Can someone explain how that works and why that is (how a successful ablation makes the heart rate higher for a while)? Maybe there's some relation between the very low heart rates many of us have and the AFib in the first place.

As for me, if and when I get my ablation, I actually hope my heart rate stays a little higher than it is now (low 60's would be nice). Around the time I was diagnosed with AFib (after it started happening a lot) my heart rate got down into the low 50's (at the time I attributed that to training for a long-distance bike tour). Previous to that time, my heart rate always was in the low 60's when they tested me for checkups (without fail).

8 weeks post ablation and my heart is pretty much at normal resting rate.. and has been since week one. I was in excellent shape prior to the ablation but...had problems with chest pain from inflammation. Everyone's different, and I bet an initial high or low rate really doesn't predict anything - after all, each patient is the recipient of different skill levels, amount and location of burns and type of patterns used (single or blending, i.e. "perpetual motion" used by some ablationists), and so on. It seems more likely to me that sustained heart rate changes are a result of an imbalance of the autonomic nervous system pacing input - which would resolve over time for most persons.

Dianne,

People involved in vigorous endurance exercise, such as long-distance biking, have very low heart rates (bordering on bradycardia) and are about 5 times more likely to develop afib than are more sedentary individuals [afibbers.org].

The association between elevated post-procedure heart rate and ablation success was discussed in ablation/maze survey 2008:

The most frequent post-procedural change was an increase in heart rate (experienced by 57%). This increase was most common among afibbers who had undergone successful procedure(s) (67%) and least common among those whose procedures had failed to cure the afib (41%). This difference was statistically significant (p=0.04). A decrease in heart rate was fairly rare among successfully ablated afibbers (10%), but more common (26%) among those whose procedure had failed.

The reason for the increase in heart rate after an ablation is that a significant portion of vagal nerve endings is damaged during the RF ablation procedure. Because the vagal nerves imbedded in the myocardium serve as “speed controllers” counteracting the adrenergic influence, a reduction in the number of effective vagal nerves would be expected to lead to an increased heart rate. Thus, it is possible that a more “aggressive” ablation, as indicated by a higher heart rate after the procedure, is more likely to be successful. However, this is speculation on my part and obviously assumes that the “aggression” is directed at the right spots on the atrium walls and pulmonary vein ostia.

It is generally assumed that the increase is temporary, however, this may not always be the case. A mini-survey (2006 survey) of 25 afibbers who had experienced a significant increase (average of 20 bpm) in post-procedure resting heart rate revealed that for 13 out of 25 respondents (52%) the heart rate was still significantly elevated a year or more after the last procedure. From personal experience I know that a substantial increase in heart rate (to 90 bpm or higher) can be very uncomfortable, so it is to be hoped that afib researchers will eventually address this problem.

Hans

afhound99 Wrote:
-------------------------------------------------------
> About where I am too, gehauser (we were both at
> Mass General I think). I'm almost 2 mths out and
> heart rate is mid 60s whereas before ablation it
> was maybe 58-60 and for a while ran up to 75-85.

My ablation was at Cleveland Clinic October 2012.

Diane - this report by well-known MD researcher is worth reading if you didn't see it the first time posted here.

LANCET VOL 340: SEPT 19, 1992, pp. 712-714

Extraordinary unremitting endurance exercise and permanent injury to normal heart

WILLIAM J. ROWE, MD

This hypothesis is that permanent cardiac injury could develop in some endurance athletes despite the absence of coronary atherosclerosis and ventricular hypertrophy. The proposed mechanism by which this injury could arise involves two physiological "vicious cycles". The first vicious cycle would occur between severe ischaemia and high catecholamines, the second would be between coronary vasospasm (induced by high catecholamines) and endothelial injury. The likelihood of the injury becoming permanent might increase if there is insufficient time between bouts of endurance exercise for regression of ischaemia and endotheliat repair. Furthermore, magnesium ion deficiency, which can be induced by exercise, could exacerbate these vicious cycles and also contribute to catecholamine-induced thrombogenesis. In addition to ischaemia, there are several mechanisms, including the effect of free fatty acids liberated by the lipolytic effect of high catecholamines, that could cause direct myocardial injury.
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