Back in AF 3 weeks after ablation at Bordeaux......

OK so still firmly in first month of 3 month blanking period after ablation for PAF by Prof Jais but still feeling a bit down.......

Still being pretty raw after 25 mins of burn time my atria definitely feel a little more tender fibrillating than they did pre-PVI!

Hadn’t posted before about my recent ablation yet as I hadn’t wanted to tempt fate!

Although if one does have to get AF after an ablation it’s better best getting it after 3 weeks rather than 3 months after..........

Had hoped that PVI even if and when partially reconnected (and my reading says that even folks for who an ablation is successful will quite often have some degree of PV reconnection) would have been enough to stop AF getting started but that theory is - for the time being at least - out the window at least where I’m concerned . My best hope now is that it’s the post-ablation inflammation that’s precipitated this episode of AF and/or is enabling the atria to maintain this episode of AF. What do you guys think??

Never had an episode start mid-afternoon before either. I wouldn’t mind but it had been 10 weeks since I’d had an episode before I had the ablation!

Best wishes to all,

Mike F



Edited 1 time(s). Last edit at 09/12/2018 03:25PM by mwcf.

4 hours in and still feeling very rattley and sharp - not pre-conversion soft and gentle like it used to after a couple of hours..... took extra 200mg Flecainide at start always converted within 4 hours in the past. This episode feels worse and more dug in than any I’ve had before. Not looking good at all IMO.

Can’t help thinking a touch up is going to be needed.........

Mike,

Sorry to hear. My thoughts are with you.

George

Bummer. Do you have a Kardia? Curious if it's afib or flutter.

Thanks George. Still in AF. I recall Shannon saying a few years ago that a cumulative AF burden of 6 hrs or more during the blanking period means you’re almost 100% going to require a touch-up. I’m at nearly 5 hrs now.......although clutching at straws maybe one longer episode isn’t as bad as several shorter ones?

Bummer indeed Carey! No Kardia or the like.

Anyway looks like I’m likely dug in for the longest AF episode I’ve ever had..... Bummer indeed.



Edited 2 time(s). Last edit at 09/14/2018 05:37PM by mwcf.

Still fibbing...... Weird thing is that as I type I’m lying here almost entirely asymptomatic at a 96% rock solid regular 50BPM - still got that AF feeling in my chest though.....But as soon as I get up now and walk around its turning more irregular/feels all over the place at 65-ish with shortish few second runs at 160 but not at all symptomatic almost feels more like a riotous mix-up of ectopics rather than AF. Certainly different to pre-ablation! I guess if this doesn’t sort itself out within 48 hours I’ll need to be looking into a cardioversion......

Hope you self-convert. That’s definitely a strange description but I guess being mostly asymptomatic helps if even a little.

Quote
mwcf
Thing is it’s definitely AF when I lie down but always changes to a fast regular rhythm of around 160BPM whenever I’m up and about for a few minutes say going to the loo.

I'd put money on the fast regular rhythm around 160 being flutter. Mixed afib and flutter is common so having both isn't surprising. I had both and they definitely intermingled.

I’d go with that Carey,but the thing is this morning (7-23am here in U.K.) I’ve got steady regular 80BPM lying down (asymptomaric) that switches to slow (60 bpm’) AF when up and around, and vice versa. Right now - except for the AF a lot less asymptomaric - I’m worse after ablation than before it.



Edited 1 time(s). Last edit at 09/13/2018 06:24AM by mwcf.

Really sorry to hear what you're going through.

If you haven't already done so email Prop Jais and tell him what's happening.

Mike, I"d go in for an ECV and not wait 48 hours. I assume you are on OAC. Or at least ask Janis what your strategy should be.

Hi folks,

Thanks George and Sam - yes my doc friend was with you on the no messing about waiting re ECV George and yes Sam I’m keeping Prof Jais up to speed.

Went to local doctors this am and got nurse to do several ECGs. Then saw both docs (one is a friend - who really went to work organising for me to go to ER for ECV). Then it was arranged for me to go to ER. Got there and saw a really impressive registrar/trainee cardiologist who also liaised extensively as required with his EP boss (who is the EP who does ablations at my local hospital).

Thankfully converted to NSR at 2pm whilst at ER without any need for ECV.

As I’ve posted here since 2-45pm yesterday to 2-30pm today I’ve had two distinct flavours of arrhythmia - one a riotous all over the place jumbled affair that felt a lot like AF - but not like any other AF I’ve ever had before - and one running solidly regular at 80BPM that still just didn’t feel right (I’ve had the latter occasionally in the past and have posted about it here before).

It turns out that what I assumed was AF or AF with some flutter was all just a continuous massive flurry of salvos of atrial ectopics (I actually said if felt like that in my earlier post of 5:56pm). Looking at 6 ECGs taken 8-30am this morning whilst this was ensuing down at the local docs, the spacing between the ventricular complexes of all of the slower and the faster 2 to 10 beat runs of ectopics is identical. Nothing irregularly irregular at all. Most of the ECGs electronic opinions stated it was ST, AT and atrial escape complexes. I could never have imagined that ectopics could be as intense and almost as debilitating as AF. Upon close investigation one can see short runs of fast evenly spaced (i.e. between ventricular complexes) atrial ectopics interspersed with the few beats of NSR - the less the amount of NSR beats the rougher it obviously felt. When I felt a radial pulse of 45-50 what I were counting were the NSR beats: the short runs of fast ectopics were hardly perceptible at my wrist but I could see my chest jumping slightly with them.

The regular 80BPM deal I was particularly pleased to get on an ECG at ER as I got that and NSR after converting for comparison purposes. The 80BPM thing looks like NSR but runs faster than normal resting HR for me and just doesn’t feel quite right. The ECG shows a slightly ragged line - particularly on V1 - between ventricular complexes whereas in NSR no such raggedness. The upshot with 80BPM thing is that it might be the atria trembling but not fibrillating?! No one seems to be certain except that it's hemodynamically stable and not too much of anything to be concerned about.

Anyway feeling a bit stressed and delicate still with an ectopic every minute or two and will be taking it from now on - no more plumbing in tight cupboards or similar twisting and straining tasks for me for a while!

Thanks for keeping me company throughout this,

Mike



Edited 3 time(s). Last edit at 09/18/2018 06:01PM by mwcf.

Hi Mike - I'm glad you did convert and that you now have clarification on what the activity was. Most likely, every heart is slightly different in response to the burns and irritation. I'm sure it was not at all pleasant. Hopefully, that will settle down and you'll have a smooth recovery for the remaining time.

Sending you good positive thoughts and kind regards,
Jackie

Thank you Jackie - your kind and positive thoughts are appreciated.

Happy you self converted.
My first two weeks following PVI were atrocious. It was like you describe. I went to the ER and I had afib, my average HR running between 85 and 160 bpm. I self converted and things began settling down.
Then, I mostly had runs of ectopics, the slower the HR, the worst the sensation.
Since then, I've never had long lasting afib. My episodes are always short (less than 2 h), and I convert spontaneously.
When I had my touch-up, the EP saw that one PV had slightly reconnected. He said it was frequent after a cryo ablation, especially with the right (if I remember correctly) PVs.
I wish you a peaceful blanking period.

Quote
Pompon
the EP saw that one PV had slightly reconnected. He said it was frequent after a cryo ablation, especially with the right (if I remember correctly) PVs.
.

Interesting, did he tell you why that is?

If I remember correctly, he said it was because of the configuration of the atrium and the position of the veins. It seems the contact of the cryoballoon is not perfectly even in some places. I'm sure he said this kind of issue appears usually with the same veins.

Mike

I once had to go to A&E after knee surgery, when painkiller Tramadol gave me what I thought was AF. The A&E docs looked at the ECG and said yes, it was AF. I was devastated after about 10 years of NSR since ablation in Bordeaux. I took 5mg of bisoprolol, which I always carry with me, and was back in normal rhythm quite quickly

However.....

...a few days later I saw the consultant EP and he looked at the ECG. It was not AF, but many runs of ectopics. I think it takes a real expert to tell the difference.

Hope everything settles down soon for you.

Gill

Thank you Pompon, jpeters and Gill.

Gill, interesting to learn about your own similar experience! Now I've seen the difference myself on the ECGs its not so hard to tell. On my ECGs from this last incident there is nothing irregularly irregular. This last incident I had was fast runs of atrial ectopics interspersed with the odd beat or two of NSR. Still felt pretty lousy!

Cheers,

Mike

I am an otherwise healthy 67 year old male with persistent afib which began 15 months ago when I took the standard purgative prior to a colonoscopy. When I went in for the procedure, I wasn't feeling well and they informed me I was in afib. I consulted with a cardiologist a few days later who put me on metoprolol, xarelto and lisartin and told me I'd have to come in for a stress test later. The metoprolol rapidly put me into CHF and the lisartin/metoprolol combination actually raised my systolic bp to the 180 range where it had been running in the 120's prior to medication. The cardiologists solution was to put me on a titrated dosage of metoprolol in the hospital and doubling the dosage from the original. I could feel my heart literally flooding with fluid and could not sleep except in an elevated position. They also put me on cardizem (diltiazem) which made sleep impossible. When I was released, I stopped the metoprolol and felt better after a few days and fired my cardiologist.
The next cardiot I went to put me on amiodarone and digoxin which spun me into a

I am an otherwise healthy 67 year old male with persistent afib which began 15 months ago when I took the standard purgative prior to a colonoscopy. When I went in for the procedure, I wasn't feeling well and they informed me I was in afib. I consulted with a cardiologist a few days later who put me on metoprolol, xarelto and lisartin and told me I'd have to come in for a stress test later. The metoprolol rapidly put me into CHF and the lisartin/metoprolol combination actually raised my systolic bp to the 180 range where it had been running in the 120's prior to medication. The cardiologists solution was to put me on a titrated dosage of metoprolol in the hospital doubling the dosage from the original. I could feel my heart literally flooding with fluid and could not sleep except in an elevated position. They also put me on cardizem (diltiazem) which made sleep impossible. When I was released, I stopped the metoprolol and felt better after a few days and fired my cardiologist.
The next cardiot I went to put me on amiodarone and digoxin which spun me into another round of CHF even worse than the last. I only took two amiodarone pills but the CHF still lasted 3 months until it flushed from my system. Four months in I had a cardioversion which failed completely. After 6 months, I had an ablation which lasted one blissful month in NSR before my afib returned. I was taking cardizem/fleicanide for control and the neuropathy from the fleicanide gradually inched up my legs until they felt like concrete blocks from the knees down at which time I stopped all drugs.
I apologize for rambling but, as I'm sure many vagal afib sufferers are aware, I discovered from this site the individual nature of afib and how SOP with drugs doesn't work for vagal afibbers. I've tried every protocol on this site with no success and am considering another ablation but my EP moved away right after my procedure and there is no one qualified locally anymore. Can anyone recommend an EP in the Sioux Falls, SD, Minneapolis, MN, Denver, CO or Chicago, IL areas who does good work and actually listens to patients?

Hi Mike, just dropped in and found your post. After my first ablation at Escorts hospital India I was back in AF within an hour or two however after a couple of weeks of settling down I was AF free as long as I didn't do any hard exercise or jogging so if I wasn't a sporting type I would have believed the ablation had finally been successful. I had my second ablation, this time in Bordeaux, simply because I wanted to get back to who I was pre AF enjoying jogging the hills with friends. I was back in AF within two days of that second ablation whilst still being in the hospital and had a third ablation 3 days later for what was now Left Atrial Flutter, most probably brought on by the damage of the initial ablation. AF free as I left the hospital the next day I was soon back in AF on the plane back to Hong Kong. Back in Hong Kong I was back in regular NSR and stayed that way unless I tried to start jogging again, which I did because I was feeling so well. I then decided I had to have another go at ridding myself of AF so I went back to Bordeaux for ablation No4 by Prof Hocini which was successful for about 3 months and then I started getting Bigeminy, Trigemini and Quadgimy??? which then turned into none stop Left Atrial Flutter which was probably worse than AF because it never stopped for the next 3 months or so when I luckily managed to get an early slot back in Bordeaux. Professor Jais was the doc and I could tell he was struggling to sort the Left Atrial Flutter Out and I guessed in the end he decided to call it a draw and the procedure was over. Back in my room and an hour about later in comes Dr Jais and says quite honestly that he got most of 'it' but there was one spot that was just too thick but not to worry as he had speeded my heart up to 300BPM which made the AF break out again but I would never be able to get to 300BMP by exercising. That was good enough for me back in 2010. I can still jog the hills but at a very much slower pace, always conscious not to push my luck. The bottom line is that there is a chance that you are still recovering and as long as you live like 90% of normal people the AF will settle down and not break out as mine didn't as long as I didn't push it. P.S. Prior to my first trip to Bordeaux ( or was it the second) I had no AF from the day I booked the appointment until a few days before I was about to fly to France from Hong Kong more than two months later. Just to make sure I was doing the right thing I purposely exercised myself into AF, the only time I was happy to be in that hideous affliction. Barry G.