Post-ablation 10 Day Mark Experiences

Hi guys, new to these forums and first time poster.

I was diagnosed with afib or PAF to be more precise back in February, after 2 quite long episodes of afib (roughly 10-14 hours each) a month apart. Saw a cardiologist within 4 to 6 weeks and we agreed that ablation was the best way forward, considering my age (35 at that time, turning 36 prior to the ablation) and that I was generally fit and healthy heart wise and otherwise. In the month or so leading up to my ablation, I've experience high blood pressure and I've been monitoring it myself (regularly sitting at 130/95 or higher. This is largely due to stress, I think as I lost my father a few months ago too. I'm due to see a consultant about this on Thursday when they will hopefully prescribe me something to bring my blood pressure down until I'm feeling less of a stresshead.

So, I am now in to my 10th day post ablation and it's been a slow process so far. The fatigue and tiredness after was tough but gradually subsided. Initially, I was experiencing all the usual afib symptoms post ablation, for about 36 hours and they eventually settled. The 2 days following, I had a single 'flutter' each day but nothing more.

The reason I actually joined yesterday was that I'd had a rather sleepless night due to palpitations. No irregular heartbeat but just racing, pounding heart in my chest which was unsettling. It's also something I'm aware is to be expected in the 2-3 months following ablations but I'd wanted to come on here for advice and a bit of reassurance.

Last night, I slept much better and had a little bit of exercise today (a walk) and did a bit of tidying in our (wife and I) spare room. Had a bit of pain in the back of my neck, something I often get, and attempted to lie back on the couch which resulted in several quick flutters in my chest. I sat straight up and walked about for a bit. I decided to try lying down in bed to alleviate the neck pain and no sooner had my head hit the hay, my afib came back for the very first time since ablation. It's been going on for about an hour and a half, and I have to admit it feels somewhat demoralising. I know it can happen but doesn't make it any easier.

Also, with regards the neck pain. I was thinking 'oh great, a new bloody trigger' but having read up, the vagal nerve appears to have some association with many people and afib. Prior to this, my two main triggers were alcohol and vomiting. But the vomiting and the alcohol were usually related. And meanwhile, it now makes sense that vagal nerve could have been playing a role in the afib reaction to the vomiting.

Anyway, just looking for a bit of reassurance regarding the afib following ablation as I'd begun to feel positive after 4-5 days. Anybody else experienced similar things following their ablation?



Edited 1 time(s). Last edit at 07/02/2017 03:35PM by DavrosT.

Welcome DavrosT

Yes blanking period activity is not infrequent. Since you got your ablation so early after diagnosis you may not yet have learned of the blanking period but this denotes the first 90 days post ablation when the variable rate of scar formation and maturation growing out of the initially mostly uniform degree of fresh burns, and it is not until the bulk of the intended scars from the ablation lesions are more or less fully mature scars that we can more accurately determine the likelihood of long term success of the index (or initial) procedure.

Thus, since it takes a minimum of 8 weeks for the vast majority of ablation lesions to form scars durable enough to block AFIB triggering from the ablated focal sites or regions that are isolated, experience shows to give a total of 90 days post ablation as the blanking period during which any recurrence of atrial arrhythmia is not inherently counted as a true recurrence indicative of needing more ablation work to remain free of all AF/AT indefinitely.

Since the real blanking period of 8 weeks is when the bulk of scar maturation takes place, then regardless of how active one's blanking period has been, the main thing you want to see is a dramatic slowing of any real arrhythmia triggering past the end of week eight. The blanking period is really a statistical range and will vary a bit plus or minus 8 weeks depending on individual variations in healing and durable scar formation. Some may go totally quiet by 6 weeks and less often some may not finish with what are still late but temporary blanking period flutter circuits out to 12 weeks, or a bit longer.

So all that you describe is perfectly normal and expected activity and may well still return to durable NSR by the end of your 90 day post ablation date.

It is very common for the first week to 10 days to be mostly quiet with maybe a few blips or short runs of ectopy from the fresh burns. After all, you did just have a branding iron inside your chest for a few hours! But often any real blanking period arrhythmia activity as AFIB or as AFlutter can start up from a week to two weeks after ablation. Sometimes an active blanking period can require an electro-cardioversion (ECV) ... or even two ... in the first two to seven weeks and still you may well enjoy years of unbroken NSR once the blanking activity suddenly goes quiet ... usually by end of week 8 to week 10, generally, at the outside. Except for a few outlier afibbers whose final blanking action might go on as late at 13 to 14 weeks post ablation and still they are good for the long haul. But that is a much less common scenario.

Most often, any increase in activity past 8 to 9 weeks, especially if it is accelerating in number of episodes and/or duration or becomes persistent ... then you can pretty much put it in the bank you will need a follow up ablation not long after the 12 week formal blanking period is over ... the sooner the better actually, provided you made very discriminating and excellent choice of a highly skilled full time expert ablationist to begin with.

If you did not have a highly experience ablation EP with thousands of AF ablations under his or her belt in your index ablation, and you realize you are going to need another procedure sooner rather than later, the single most important decision a patient will have to make is to insure you partner with as ablationist with the truly elite level of experience in addressing challenging cases for any second or follow up procedure. Go for the EP with the greatest track record you can possibly access for yourself and do NOT automatically assume the EP who did the first ablation is a good option for round two!

Also, at your age and very young AFIB history, I strongly advice you to embrace with dedication and gusto 'The Strategy -Metabolic Cardiology' protocol found in the 10th article down from the top list of our very helpful 'Self-Health' articles offered freely and found within one of the 6 yellow horizontal links titled 'AFIB Resources' in the heading area at the top of this same forum page. Read this 28 page document and learn to restore heart calming electrolytes like Magnesium, Potassium and companion amino-acid L-Taurine to your daily routine.

Explore many of the articles in the AFIB Resources section as well as any of our 141 archived issues so far of The AFIB Report newsletter that is currently on sabbatical while we finish the third and final phase of our big website redesign overhaul.

And ask questions as well as use the advanced search function on this Afibber's Forum to find many past posts and threads on nearly every question you will ever think of that have likely already been answered countless times here in our Forum archives!

Please let us know more about your ablation, who did it and in what hospital. Was it ,RF energy used to do a standard PVI or pulmonary vein isolation ablation or perhaps Cryo ablation PVI??

Be well and fast healing, DavrosT!

Shannon



Edited 1 time(s). Last edit at 07/04/2017 06:56PM by Shannon.

Hi Shannon (and anybody else reading),

Thank you for your fantastic - and comprehensive - reply.

I will check all those resources you've mentioned. I was given some great information prior to my ablation but you know what it's like, no matter how many times your doctor tells you something you think you might be the special case so I'm glad to have you reiterate what I've already been told with a great deal more detail I might add!

So, I had my ablation done by Dr Todd & his team at the Liverpool Heart & Chest Hospital. We are very, very lucky in Liverpool, UK to have a world class specialist heart facility and I was seen very promptly due to this.

I had Cryo ablation PVI and I am told it was acutely successful. They were very happy with their work so that's promising news.

David

Good to hear David!

It seems you are off to a good start and by adopting the self-health and electrolyte repletion recommendations throughout this special forum and website you will only stack the deck in your favor long term and really help the post ablation recovery processes as well.

Best wishes and keep in touch!

Shannonf



Edited 1 time(s). Last edit at 07/05/2017 10:23AM by Shannon.

David,

I've been considering my options should I decide to have an ablation so your comment about Dr Todd's facility being world class was of great interest to me. It would be much more convenient for me than Dr Ernst in London.

Can you give me more details? Does Doctor Todd use 3D imaging and map all the chambers of the heart or does he just ablate the nerves round the Pulmonary Vein? Does he use magnetic catheter navigation? Do you know how many ablations he has done and how many he does per year?

I'd be grateful for any information you can give me.
Thanks
Sam

Hi Sam,

As far as I can remember, 3D imaging was used to map the heart. I'm not sure re: magnetic catheter navigation but I believe he has personally completed many hundreds of ablations, with his team no doubt many more again.

I can only give you generalizations though, but Dr Todd has his own website (the Heart Rhythm Doctor) and as far as I am aware you can contact him there. I've included links to his own site and also the LHCH. He and the hospital both do NHS and private procedures and/or operations.

[www.lhch.nhs.uk]

[www.heartrhythmdoctor.co.uk]

I hope this gives you some of the information you're looking for.

Thanks

David

Thank you!

Sam

On his website he says he has been a consultant since 2003 and has done over 200 ablations a year since then, which would give him a total of almost 3000.

200 a year means he does about 4 a week. Maybe Shannon can comment on whether this makes him a good enough choice?

Gill

I hadn't even seen that part saying how many he'd done. I was confident it was easily up to 1000 but as I didn't know for definite, I didn't want to say! Surely even a coupe of thousand would make him top-of-the-line?

It certainly could be one indicator DavrosT, but confirm how long he had done 200 a year and if that includes only him and not other operators at his center too. In addition make sure the number quoted as their own personal volume of ablations only includes AFIB and left atrial flutter ablations in the left atrium and no stat padding is going on by lumping in the often more numerous and much simpler and easier right atrial-only SVT or CTI Flutter ablation cases

You would not believe how often published stats on a website like this often include 'the centers' total output without at all making that clear and/or include all right atrial-only ablations too to make the number of implied AFIB ablations look more impressive. Also find out, for good measure, if he does persistent and long standing persistent cases and if so, roughly the percentage those kind of cases make up his total AFIB case load. In addition, if he answers yes to doing more advanced cases too beyond CRYO alone for AFIB ablation, ask what methods or approach he or she uses to address more challenging cases of advanced AFIB/Atypical left atrial flutter.

It's not easy to build up a consistent 200+ annual caseload of AFIB ablations, If the EP is very young it makes it even more doubtful, but not impossible if they work in a high volume center, to have earned a reputation long and good enough to inspire 200 consistent cases, or more, year after year of patient load. The majority of AFIB ablationists world-wide still limit their procedure to a PVI-only approach!

Your EP may be very good with CRY- only ablation that can indeed work well for earlier stage paroxysmal AFIB (PAF)! And at times at a middle stage a PAF, but the odds of increasing non-PV triggers in Afibbers the longer time frame and more advanced their AFIB manifestation becomes, in addition to needing a durable PVI as well, means that CRYO-alone ablation is not the ideal choice for the lions share of these more advanced cases.

Recent studies indicate upwards beyond 30% of those normally classified as early stage PAF in the first several years of AFIB and with PAF episodes lasting no more than 4 to 8 hours long, are nevertheless found to have more non-PV triggers that are likely to require more work being done before too long.

The fact that still most AF abolitionists still do not offer Non-PV trigger detection and ablation is a major limitation that every prospective ablation patient should be aware of before signing on the dotted line. For me and many others in the know, this would be an automatic deal-breaker for choosing any EP.

Be well,
Shannon



Edited 1 time(s). Last edit at 06/17/2018 03:53PM by Shannon.

Hey again all,

So, I am now 15 days post ablation and I've had one episode of irregular heartbeat (though my heart rate was lower than it has been during previous episodes. This happened last Sunday. It seemed to 'right itself' a couple of hours later after my heart rate went up after a heavy meal.

Since that point I've noticed potential new 'triggers', I suppose you could call them. Leaning forward, moving down or back too fast seems to cause my heart to try to do something, if that makes sense to anyone? It feels like it's trying to go into afib but not quite getting there. These aren't actually things that I noticed 'triggered' me before or caused me issues. Is this a normal occurrence for anyone else, a couple of weeks post ablation? Also, I seem to experience occasional hiccups, and if my upper body is slightly slumped, the same thing happens. Again, totally new!

My previous triggers I haven't noticed, as I haven't touched any alcohol yet and I've not vomited!

I've gradually starting feeling more lively and have started to get much more exercise but still mostly taking my time.

Thanks guys.

David

An EP in London once told me that ablation might not prevent AF from starting but it should prevent it from sustaining itself.

In the 14 years since my ablation in Bordeaux I have sometimes felt as though AF tries to start up, or even DOES for a few minutes but then I go back into normal rhythm. I have always assumed that AF was starting but that the burn scars were doing their job and preventing the AF from sustaining itself.

Gill

DavrosT,

Those descriptions you cite above are all very familiar to most afibber's who have had an ablation during their blanking period. Your heart is going through a lot of healing from the inflammation due to the lesions created inside during the ablation, and periodically your heart may have ectopic runs of PVCs or PACs as well as possibly short runs of AFIB or AFlutter.

Just watch for a substantial subsidence of any activity once you are past the 8 week post ablation mark, which is what you want to see.

And I strongly recommend you avoid all alcohol for a very long time. Like it or not, alcohol is cardio-toxic to pacing cells and especially in these first 6 months post ablation I strongly advice total abstinence ... that will obviously kill two 'trigger' birds in one shot in your case by eliminating the trigger of vomiting too which, apparently, is also 'triggered' by alcohol as well!

After 6 months if you are still hankering to drink, and you have been rock solid with no arrhythmia at all, then start with very small doses of only occasion imbibing and don't overdo it or you may well pay for it.

Some can resume occasion very modest alcohol post ablation without significant consequence, but others find that before long their hearts start to get squirrely and feels unsteady when they begin to drink more often and larger volume of alcohol during each session. Not a good idea for a former Afibber to overdo it.

Shannon

Shannon,

Thanks again for your reply, I was hoping it may just be another symptom of the post ablation period when my damned heart is trying to heal itself. I expected things to be "touch and go" at times but it's much different when you're actually experiencing it. Is it obvious that I'm impatient to hit that 8 week mark? haha.

I've begun using potassium, magnesium, taurine and omega 3. Tracking down some of the other things mentioned in "the Strategy" has proven a little difficult (or expensive" but I'm hoping that this will at least give recovery a helping hand.

D