Post Ablation Heart Rate Variability (HRV)

Hi Afibbers,

This is my first post here so a big HI to you all.

I had my first PVI ablation a little over two months ago. One change I have noticed since the procedure has been a big drop in my average HRV score. In the month prior to the procedure my average HRV was 35ms and my average resting heart rate was 59bpm. In the month post the procedure my average HRV has dropped to 13ms while my average resting heart rate has increased to 69bpm. (I have been on Sotalol 80mg twice a day during all this time period. I am a nearly 53 y.o. male and was first diagnosed with Afib almost 3 years ago).

I have taken this data from recordings on my Oura Ring.

I am curious to know whether any of you have similar data? And if you do, what insights can you offer? From what research I have done a low HRV score is not necessarily a good thing.

Any thoughts or insights would be very welcome. Also if anyone has any questions on my Afib or Ablation experience I am very happy to share anything I can.

Mack.

Welcome Mack and don’t worry one little bit about these transient changes in HRV or resting HR post ablation.

If you do a quick advanced search on Afibbers forum for heart rate increase or elevation (which is also a good idea to search for when looking for answers to many other such frequent AFIB or ablation-related questions) you will see legions of reply’s going back to our forums inception, and all reassuring the recent ablatee that a mild to modest increase in post ablation HR is not only fully expected, but is actually a good sign that effective ablation work actually occurred during the ablation in your left/right atria.

Your increase from 59bpm to 69bpm is nothing at all, and without the beta blockage component of your 80mg BID of Sotalol onboard your post ABL HR could well be an additional 15 to 25 beats higher at this early stage post ablation without any concern whatsoever! Especially while you are just nearing the end of your blanking period.

The elevated HR is from some of the pacing cells in your cardiac myocytes that got zapped or stunned during the ablation and those cells will regenerate gradually over time and with the recovery of that cellular pacing function, your HR will gradually slow down again towards pretty much near your prior resting HR give or take a few beats.

Ditto with HRV ... this is a topic you can now toss in the circular file cabinet (or can). And FYI, when you go off the Sotalol and lose that modest HR suppression effect of the roughly 50% strength beta blockage effect of the Sotalol, you may experience a modest additional rise in HR for a while, but it too will start coming down before too long towards ultimately your prior resting HR range.

Since this is your first ablation, and it sounds like the ablation was limited to mostly a PVI only, the HR elevation isn’t likely to be too long in duration. Maybe 4 to 9 months on average for a first simple PVI-only ABL.

The elevated HR might last as long as 2 yrs, on the outside, after a more extensive expert ablation process that was completed, say over two or more procedures within one to three years time frame. But even when such an extended ablation process is required, one’s elevated HR will tend to start to slow down some within 4 to 6 months after the final ABL and you won’t find it much of a nuance anymore at all once it drops back to roughly where you are now as it is continuing to slow down toward your former resting HR prior to starting your ablation process.

Cheers!
Shannon

Welcome here, Mack.
Just to add my own experience to what Shannon said...
Before my first ablation (PVI) 40 months ago, I had a resting rate around 50bpm (I'm a biker). A couple weeks after the procedure, it was around 70bpm, slowing down gradually and falling around 60bpm before my second ablation.
I'm now approaching the end of the blanking period after my 4th ablation (I'm nearly 4 months off) and it's slowing down one more time. I'm still above 70bpm, but I've stopped all meds (rthythm drug and betablocker). With bisoprolol, It was around 65bpm.
As Shannon said, my resting HR is higher than before, but I've had extensive ablations. I must add I'm just going back to some biking after nearly 6 months without exercise, so it'll likely take some time before being in good condition.
As long as my heart is beating in NSR and within the "normal" range, I don't worry about it!
I hope this helps.

Hi Shannon,

Thank you for the reassurance - it is very helpful. It is really good to know this and I can now view the whole thing in a much more positive light. I guess I was being somewhat impatient, so I'll take it easy and let time do its thing.

Mack.

Hi Pompon,

Thank you also - the reassurance is very helpful. I sure hope that 4th ablation works for you - no one should be off their bike for that long!! Good luck with the recovery.

Mack

My HR was in thee 90's immediately following my index PVI ablation in August 2015. My normal resting HR is about 50. I'm a daily jogger/runner. It took a few months before it settled back down to normal, so if you're only 2 months post ablation I wouldn't draw any conclusions whatsoever about what the future holds. In all likelihood it'll go back to right where it was before. Mine did. Honestly I don't recall exactly how many weeks this took, but I can tell you that I experienced all sorts of odd ectopics up to a year after the procedure. Clearly there is healing going on inside the heart that can have some long time constants. I think the major swelling and edema subsides after the first 3 months, hence the blanking period and need for anticoagulation for that period of time, but there is probably some patient-dependent factors as the durable scar tissue sets up around the vein antra. Patience is key. Supplementing the key electrolytes in the best available forms as we so often recommend here can't hurt either. Good luck!

Wise words wolfpack. As always!
Cheers from over the pond,
Mike

Hi Mack,
After my first ablation in 2008 my resting heart rate was in upper 80's low 90's.(before 1 st ablation it was low 60's) . This rate persisted well over a year and then gradually slowed down. Interestingly enough after my second ablation in 2018 my rate did not go up a lot. Also I remember that when i came for follow up in Austin after my first procedure Nurse said that elevated resting HR is some how an indication of successful procedure. So stay positive.

Deniss

I’m a non ablatee, so haven’t paid huge attention. However I recall that ablating part of the vagus nerve connection to the heart may account for the HR elevation. Also this is part of the reason for ablation success. Years ago recall reading a paper where they induced afib in dogs and were able to reverse it with vagus nerve ablation.

George

Hi Wolfpack,

Thank you so much for the feedback. I am glad you brought up the ectopics - I am getting a lot of these at the moment and they can be quite disconcerting. I tend to get a few days when they are bad and then maybe one good day before they build to bad again. Also you mention anticoagulation treatment for three months - mine was discontinued at the two month mark - I guess different physicians decide differently on some of these things. Anyway I take solace in knowing that time is likely to lead to improvement. Thank you once again.

Mack.

Hi Deniss,

Thank you for the helpful feedback. I see that you had approx. ten years between your first and second ablation - I am curious to know if they were ten years afib free (and medication free?), and how did circumstances evolve to require the second ablation? I hope that the second one has been successful.

Mack.

Hi George,

I will look into the vagus nerve ablation concept - there is much that I have yet to get my head around on this! Thank you for your insight.

Mack.

Quote
Mack
Hi George,

I will look into the vagus nerve ablation concept - there is much that I have yet to get my head around on this! Thank you for your insight.

Mack.

Here are two searches on the topic:

w dogs <[www.google.com]

humans <[www.google.com]

George

Those searches are reassuring, because they are searches showing interesting results which might be useful for the future of AF ablations.
But they show that the road to a cure is still long and difficult.😞

My 3rd ablation for Atrial Tachycardia and a clean up of the pulmonary veins was on 12/19/18 in Austin. I am still experiencing random elevated HR increases of over 100% at rest. Just this morning I was sitting on the couch watching a televised church program and it went from 64 to 120 and then bounced between the 80s to low100s for over 45 minutes. They’ve determined it’s sinus from the strips I’ve sent in but the why it’s happening is the real question I need answers too. No one in Austin thinks it’s a big deal but the symptoms I experience are no different then if it were 180 bpm. It’s handicapping me living my life.



Edited 1 time(s). Last edit at 03/24/2019 04:33PM by ajr1960.

Hi Mack,
Yes I had 10 years Afib/meds free. As I mentioned on this forum already I had exactly 10 years between two episodes: My last episode before my first ablation was March 8 2008 (International Women's day ))))) And my first reoccurrence happened March 8 2018 ( Obviously women's day had something to do with it )))))))....... . My reoccurrence episode was not very long (1.5 hours) and happened at night ( I was awaken by it which before never really happened). I called the ambulance to document it but those people came without cardiac monitor and took me to the hospital and they were not in a hurry like they did not believe it was serious. Before nurse in a hospital came to me with 12 lead EKG I converted which really made me mad since I wanted to record it and contact Natale office. Then second episode erupted after my fishing day in a kayak at Jones Beach NY. Then I was able to document it. Second episode lasted 1.5 - 2 hours as well. And then i had episode #3 2 weeks after second one again after fishing trip in a kayak. So before my second ablation I had just 3 short episodes. I guess I took aggressive approach but I do not regret it.
At consultation Dr Natale thought that most likely my PV still isolated because it was unlikely that they reconnected after 10 years and I should expect other areas to be ablated like LAA. But it turned out that I had 2 of my PV reconnected and he found triggers in posterior wall. My LAA produced just ectopic beats so he just delayed it.

Deniss



Edited 3 time(s). Last edit at 03/25/2019 02:59AM by dartisskis.

Hey Shannon, From your response it appears that HRV results are dubious. Is it because of the device accuracy? I ask because recently my Garmin Fenix 6 starting reporting this feature and mine is also super low (46-50) I've had two ablations and the Watchman and this far I'm in NSR ( not sure due to Dr. Natale's suggestion that my Linq isn't necessary). Regarding HR before and after it's about the same (prior 38 and now 39/40). My ablations happened in 2018.

Arnold