Ectopics 6 months or more after ablation?

Hello all --

I had an ablation for lone afib done by Steven Hao at CPMC last June 27. I had had monthly afib bouts lasting 10-15 hours for about 3 years, becoming more frequent a few months before the procedure.

According to Dr. Hao, the procedure was uneventful. I believe my recovery was fairly normal, with a few blips and trills lasting a few seconds here and there. This activity seemed to gradually decrease up to approximately months 8-10, which were very, very quiet. And that made me happy.

But -- in the last couple of months (months 11-12), the ectopics have increased in frequency again and, most distressingly, in duration. They've also become more distinct. Still, they don't last more than 10 seconds at a time, and no more often than maybe a couple of times a week.

Coincidentally, for my 1-year followup, I had a 24-hour monitor on last week, which captured one of these trills -- the most distinct one yet -- June 9. I had another today which seemed to last longer.

Of course, I'm wondering what the significance of this is vis-a-vis the success of my ablation. I found this in the archives [http://www.afibbers.org/faq.htm]

Quote

....A survey of over 600 afibbers who had undergone a total of 950 radio frequency ablation procedures (LAFS-12) was carried out in October 2008. The conclusions reached from that survey are presented below.....

• The incidence of post-procedure ectopics (PACs and PVCs) even 6 months or more following the procedure was high at 50% for completely successful ablations and 71% for failed procedures, a difference that is statistically significant. There was no indication that having undergone a right atrial flutter ablation prior to or during the left atrium ablation reduced the incidence of ectopics.
• The incidence of post-procedure tachycardia (SVT and inappropriate sinus tachycardia) was 12% for completely successful and 44% for failed ablations. Having undergone a right atrial flutter ablation as part of or prior to the left atrium ablation did not affect the incidence of post-procedure tachycardia.
• The incidence of post-procedure flutter was 7% for a completely successful ablation and 41% for an unsuccessful one. Having undergone a prior right atrial flutter ablation made no difference to the post-procedure incidence of flutter perhaps indicating that most of the post-procedure flutter was left atrial flutter.

....

I presume my experiences qualify as ectopics?

Does anyone have any more recent information about what having ectopics some months after an ablation means?

Will they keep getting stronger and more frequent, or do these things come in waves with some active months and some not?

______________
Lone paroxysmal vagal atrial fibrillation. Age 62, female, no risk factors. Autonomic instability since severe Paxil withdrawal in 2004, including extreme sensitivity to neuro-active drugs, supplements, foods. Monthly tachycardia started 1/11, happened only at night, during sleep, or when waking, bouts of 5-15 hours. Changed to afib about a year ago, same pattern. Frequency increased over last 6 months, apparently with sensitivity to more triggers. Ablation 6/27/13 by Steven Hao.



Edited 1 time(s). Last edit at 06/18/2014 10:22PM by Iatrogenia.

Hi Iatrogenia,

Nice hearing from you again and glad things are going quite well. The increase in ectopics with the duration and frequency you mention is not that unusual
Even this far out from the ablation and may well niot have much, if anything, to do with your procedure.

Many people notice a kind of almost seasonal periodic manifestation to a jumpy heart, even when there is no outright arrhythmia.

I used to notice a similar increase is such activity including actual flutter, or many years ago AFIB episodes when I was still prone to those before my first ablation, would tend to increase in frequency and duration around May through July and into August somewhat.

It could be greater dehydration and electrolyte challenges during the hotter months? It could be any number of reasons , but they do not always imply an increase progression of your underlying arrhythmia tendency.

However, its so possible that such an increases could be associated with gradually waking up of some mischief or reconnections of previously ablated areas but that is more likely when you are having small runs if flutter or AFIB and not just ectopics of such short duration. Redouble your 'PAC-tamer' efforts and if you don't have an AliveCor monitor for a smart phone I would get one and see if you can't get a better idea of what is going on.

Did you have any actual runs of flutter or AFIB, even of short duration at any time last the end of the 2nd month of the blanking period post ablation.

Any actual arrhythmia episodes of greater than 30 seconds past the two month post ablation period increases the likelihood that at some point in the coming months up to the first two years you might require a touch up to fully put all these remnant issues back in the bottle for the long term.

At this point though it does not sound like anything significant is really going on so I wouldn't worry too much. Avoid caffeine and alcohol if you've been imbibing in either and increase your magnesium / potassium intake for now as well and see if things don't quiet back down again?

Best wishes,
Shannon



Edited 1 time(s). Last edit at 06/19/2014 02:37AM by Shannon.

Iatrogenia

I have been in nsr for over 11 years since my ablation in Bordeaux. The first year after the ablation I had a few ectopics but the number has increased almost every year since then. I sometimes get over 9,000 on a 24 hour Holter. The docs say they are a nuisance but not harmful.

They used to be very uncomfortable, like being kicked in the chest every few seconds and I was considering asking the team in Bordeaux if they could do any further work to stop them. But first I decided to try supplementation, starting with magnesium, then adding taurine, and finally potassium. The difference was huge - I thought that they had stopped, but a Holter showed that they were still happening. I just could hardly feel them any more.

That has been the situation for about 5 years now - lots of ectopics but I hardly notice them. They do seem to come in cycles, build up to a climax then I get a very quiet time till the cycle starts again.

Gill

Iatrogenia - My post-ablation experiences with PACs and actual AF breakthroughs occurred as a result of low intracellular electrolytes... marginally low on magnesium and definitely low on potassium and confirmed by Exatest evaluations.

For me, it's a constant that I must be very diligent with keeping the intake of those nutrients optimized from both food and supplements. I don't dare become negligent in that regard. If I hadn't realized that connection and duplicated the reversal in years 4, 5 and 6, post ablation, I'd probably have signed on for the second ablation.

There are many hidden or stealth excitotoxic substances that occur commercially prepared foods that can also be culprits. Be sure you are drinking pure water free of chemicals. Anything that causes silent (systemic) inflammation is also likely to be a trigger as well.

As is discussed in Nancy's recent thread on EMF exposure, consider that as an interference as well...especially if you have prolonged exposure to WiFi, "smart" meters, cell phones, etc. Sensitive hearts do react.

Jackie

While recognizing individuals, I offer my own experience. A year post-ablation I had odd, swallowing-instigated a-fib. Magnesium supplementation eliminated that. I won't bother with the whole story, but the cause/effect relationship even convinced my very traditional EP. I can now sense an "aura" if my magnesium levels are posing a threat to NSR. I then increase magnesium for a few days and return to stability without any a-fib.

Ectopics are a different story. I had a few months of fairly regular ectopy, often during or following exercise. This was entirely mitigated by increasing potassium, which I supplement in the form of Knudsen low sodium veggie juice. If I have few ectopics, I double my daily Knudsen and the issue disappears. This has worked consistently for two years.

We're all different, but I'd surely give potassium a try.

Good luck.

If you don't have a Cardy Meter, do consider getting one. Uncomfortable heart activity most definitely increases when your potassium is low and or high.

I agree with that. If I ever do get ectopics, Potassium pretty much always works and quickly too.

Do invest in a Carymeter to guide your potassium supplementation to Iatrogenia, as it will definitely increase your understanding of what foods and how long the potassium supplements raise your potassium levels to good effect since there seem to be a close correlation between saliva/serum potassium readings and clinical response in terms of a quiet heart, implying too that with potassium, ... unlike with magnesium the blood potassium levels correlated closely with IC potassium status as well, at least in a functional way.

Magnesium can be another kettle of fish with often perfect serum mag levels coexisting with way too low IC magnesium levels and a lot of ectopic as well as AFIB/Flutter tendencies. This is a major reason why so many smart and skilled EPs and Cardios still feel Magnesium supplementing is unreliable.

Then never measure IC magnesium and only go by serum Mag and when they get a mixed bag of results with people with perfect serum levels still rocking with string AFIB just like that of those with low serum Mag, its easy for them to assume measuring and correction serum Magnesuim is not a reliable way to stabilize the heart and in a way they are right.

The just are not looking at the right marker in IC magnesium. Plus with the wide intra person variability in the amount of magnesium intake they need and in what forms such as oral is okay for some but for many afibbers if totally inadequate by itself, you can't blame the MD who has no time nor inclination for doing long term Magnesium adjustment protocols in patients. many of whom will not really be compliant with such a long term process that requires real dedication.

Its far easier to resort to just drugs with tighter 'yes or no' effects and parameters of use. And when those fail a good ablation process is still the gold standard for getting and staying on top of this beast. However, insuring good electrolyte status both before and after an ablation is a very wise thing to dedicate oneself to insuring if you want to maximize your time on this earth with as quiet a heart as you can negotiate in this bargain with life.

Shannon

Thanks for all the answers!

I spoke to Dr. Hao's nurse, she said ANY afib whatsoever is a concern, so she sent me an event monitor to use for a month.

Ironically, since I posted here -- absolute quiet! No cardiac blips, bloops, or trills at all.

So go figure.

PS Over the last several months, I've mysteriously developed a sensitivity to tyramine and am avoiding those foods.

______________
Lone paroxysmal vagal atrial fibrillation. Age 62, female, no risk factors. Autonomic instability since severe Paxil withdrawal in 2004, including extreme sensitivity to neuro-active drugs, supplements, foods. Monthly tachycardia started 1/11, happened only at night, during sleep, or when waking, bouts of 5-15 hours. Changed to afib about a year ago, same pattern. Frequency increased over last 6 months, apparently with sensitivity to more triggers. Ablation 6/27/13 by Steven Hao.

Hi Latrogenia

I just noticed this post after I responded to your earlier one in my post.

Rgds
Heather

Hi Latrogenia,

I had my ablation almost 4 months ago with Dr. Hongo at CPMC. For over 3 months now, I have been having PACs and skipped beats off and on all day and night. When I listen to my heart with a stethoscope every morning at 5:30AM before getting out of bed, I can sometimes have a skipped beat and/or PAC every third beat; other times it is quiet though my HR is always between 82-90bpm now when it was 65 before ablation surgery. I spoke with Dr. Hongo's office a couple days ago, and because I am having no afib or aflutter, he is taking me off my 37.5mg of metoporolol. I'm now on 25mg so it should be interesting to see if my condition gets worse.

I'm currently taking 525mg of DFH magnesium glycinate and 120mg magnesium hydroxide from drinking concentrated WW. My stools are so loose that I can't go any higher. I had been taking 900mg of DFH potassium glycinate but my nutritionist told me to stop because my kidneys were having a hard time processing it. But he said to continue with drinking my morning glass of low sodium V-8 juice and eating plenty of potassium from food. When I told him I was getting hard heart beats and ectopics, he said my blood volume was too low and to add 1/4 tsp of sea salt in some water and drink it twice a day and to gradually increase this to 1/2 tsp twice a day. I have been hesitant to do this since everyone on this website says sodium is bad.

My nutritionist spent 4 hours at my home one afternoon doing EMF testing (electromagnetic frequency) and found that my computer monitor was putting out high levels of EMFs that were shutting down the communication between my body's cells. He also found that a microwave tower two miles away was bombarding my bedroom with EMFs that are affecting my sleep and heart. He told me to sleep in a different room and to use a grounding sheet or mat to sleep on (in fact, he gave me one of his). I have been sleeping in the new room for 5 nights now and my sleep has improved a bit, but not like I had hoped. But, according to some studies I read, it can take up to 8 weeks to see sleep improve with a grounding sheet. The good news is that his ART testing showed yesterday that my intracellular magnesium and potassium levels are finally in the normal range--something that hasn't been the case for over two years now. I am finally making my own HCl and my digestion is working on its own (with supplements of zinc, iodine, B12, ??) and the mag and K are getting into my tissue!! He says moving into the new room and using the grounding sheet contributed to this change. I've also been detoxing my liver, kidneys, and lymph system for 2 months now (and continuing), so that and using phosphatidylcholine and serine to repair my cell membranes has worked.

This has been a long road for me, and it is far from over. I know you had a bad withdrawal from Paxil and I had a horrible withdrawal from Klonopin, which I'm speculating contributed to my digestion issues and adding of too many glutamate receptors, which can affect the heart and sleep. I think it and some other toxicity issues triggered the switching on of some mutated genes in my case, and could be true for you too. For about $100, you can get genetic testing done at 23andme.

I'll be praying that your heart stays calm and just adding more potassium and magnesium works for you.

Blessings,
Nancy M