almost 4 wk post Natale ablation - heart always fast

As stated, I am almost 4 weeks post my ablation by Dr. Natale. I came home on the same antiarrhythmic of sotalol 80 mg q.12h. I have had a strange sensation in my chest in that it feels like a wheeze (tho it does not sound like it) if I breathe in deeper than usual, which one really does quite often - who breathes shallowly as a rule? This breath causes me to dry cough, sometimes spasmodically and taking a while to stop. Even if I talked, sometimes that would be enough to start it. Since beta blockers are thought by many to cause cough & if not cough, they for sure have listed about 5 respiratory conditions which can be aggravated if taking BBs, they are contraindicated in those with these resp problems.

Since Dr. Natale had spoken of moving me to Inderal later after getting off the antiarrhythmic (to help keep controlling a moderate hand tremor), I asked my cardiologist since I had a visit with him 1 1/2 weeks after my ablation if I could try moving to this already to perhaps help lessen the cough. He also ordered a chest x-ray, which revealed no acute findings, but did note evidence of paraseptal emphysema. The Inderal is the long-acting (LA) version 60 mg once a day, & he did prescribe this. I know it is a beta blocker too, but it is 60 mg a day & the sotalol was 160 mg total for the day (I think, unless 80 q.12h would be like 80 LA version would be??). My cough reflex has gotten a bit better most of the time, but not always. But, the Inderal is not doing the job like sotalol was in keeping things calmer & I am feeling pretty uncomfortable & tired and weird sometimes because my pulse remains in the 90s just about all the time. I have had some tachycardia (181 bpm), and Curry in Austin told me looked like I had some early beats on my transmission for the week this week. I have also had 1 or 2 afib episodes.

I am wondering if I should ask Natale's office to see if I should get back on sotalol 80 mg q.12h again. The first time I was put on it was in the hospital in my hometown & I had no bad events; the 2nd time was after the ablation while in hospital in Austin & also no bad events. I have been off of it & on the Inderal 2 wks now. I wonder if I could go on sotalol like before, but start it at home instead of going to the hospital. I will ask Curry (Natale's nurse) too, but so far I have not received but a word or two from her since getting back home & having some problems. Natale knows I am on the Inderal & did not say anything about this being a bad idea.

Does it seem like an okay thing to stay on Inderal LA 60 mg qd if I am having pulses from 90 to 97 continually? I know there was the possibility of the heart reacting to the ablation for 8 wks to 3 mos, but I thought they meant afib now & then, not constant high pulse & low BPs. I feel like I am running on empty & feeling tired a lot & I do feel that racing in my heart & trembly feeling in my body. Maybe I should take my portion of natural dessicated thyroid out & go back on full synthetic like they put me on at the beginning of my discovery of having afib. As it is, my synthetic dose was lowered a bit a yr ago so I could add in a tiny bit of natural dessicated thyroid so that I would get some of its extra benefits. I could just take out the natural dessicated & go back up to the higher synthetic T4 pills, which probably are easier to take without risk of getting hyper, though I would miss out on other benefits of dessicated.

Any thoughts/input are appreciated.

This post from 2015 covers this common effect from Ablations. It as a common effect that is remedied by Beta-Blockers or Calcium Channel Blockers, usually at a low dose.
[www.afibbers.org]

And here is an Abstract from a Medical Study
[www.ncbi.nlm.nih.gov]

" Post-AF ablation high sinus HR was associated with a significantly lower clinical recurrence of AF after catheter ablation."

Quote
The Anti-Fib

And here is an Abstract from a Medical Study
[www.ncbi.nlm.nih.gov]

" Post-AF ablation high sinus HR was associated with a significantly lower clinical recurrence of AF after catheter ablation."

Hi Anti-Fib,

Does that sentence in quotes above mean what I think it means - I don't have to go read the abstract - this sentence distills out what I could use from it? And, secondly does high sinus HR mean - as in my fast pulse rate of 90-98 on the Inderal LA 60 mg qd? So, it is a good sign?

I don't need to change anything now? I just even took a Xanax bec I feel so hyper - it is close to bedtime, so I hope to get some uninterrupted sleep as well as calm down first.

I will go to the other sites, but wanted to ask you this right off.

Thanks

Quote
The Anti-Fib
This post from 2015 covers this common effect from Ablations. It as a common effect that is remedied by Beta-Blockers or Calcium Channel Blockers, usually at a low dose.
[www.afibbers.org]

And here is an Abstract from a Medical Study
[www.ncbi.nlm.nih.gov]

" Post-AF ablation high sinus HR was associated with a significantly lower clinical recurrence of AF after catheter ablation."

Ok, Anti-Fib - I read everything & one thing is that my resting heart rate before antiarrhythmics tended to be a bit high bec I do not have a thyroid anymore & took natural dessicated thyroid & tended to have higher rates esp when pulse was taken at dr visits, where I had a lot of information to discuss.

So like I say, sometimes mine has even been 98 & I DO FEEL UNCOMFORTABLE, racy, weak, tired, a bit scared about it. I can't really say what my pulse was day to day before all the AF bec I rarely checked it. But drs thought it was unusually high for someone who exercised a lot like me, but I told him I was not a runner - just a walker, yoga, & Pilates, moderate biking, several other activities focusing on strength & flexibility, but nothing too aerobic that would cause me to have the low resting heart rate. I tend to be on the anxious side.

An elevated resting heart rate is 100% normal after an ablation. Everyone experiences it and it can last a surprisingly long time, upwards of a year.

It's perfectly normal.

Quote
Carey
An elevated resting heart rate is 100% normal after an ablation. Everyone experiences it and it can last a surprisingly long time, upwards of a year.

It's perfectly normal.

To this I say: I understand people say the heart rate may even run high for a year, but apparently runners whose previous "normal" was 50 are okay with a new "normal" of 70, but don't you agree it is hard to live with 90 & above without feeling the way I am? How would you like to feel weak, racy, trembly much of the time, and for a year! - it is like feeling hyperthyroid - tired & racy at the same time.

Have you thought about increasing the dosage of the Inderal LA? 60mg is a smaller formulation of the Drug. Maybe try it at 80mg/day? I would contact Natale's Office, 90-100 HR is too high, especially if it makes you feel that uncomfortable.

Quote
The Anti-Fib
Have you thought about increasing the dosage of the Inderal LA? 60mg is a smaller formulation of the Drug. Maybe try it at 80mg/day? I would contact Natale's Office, 90-100 HR is too high, especially if it makes you feel that uncomfortable.

Thanks, I did contact the nurse following me at Natale's & we came up with the following formula since I already have the sotalol 80 mg on hand. I had dropped the sotalol early bec of my mysterious cough, but will just have to keep experimenting with all variables as usual.

I will cut my sotalol in half for 40-mg doses to be taken twice a day & stay on the Inderal LA 60 mg in the morning. Sounds kind of weird to do both, but that is what my nurse said to do. She also said to take an EKG one week after restarting the sotalol (I have been off it 2 wks & on the Inderal only). And, I am to monitor my BP once a day & let her know if I have a drop.

What time of day should I do my once a day BP for her? before lunch maybe - as I take thyroid meds & cardiac meds in morn & cardiac meds at night too now with restarting sotalol BID. Should I be fairly consistent on time of day for this BP, or would it be better to vary it?

Hi Madeleine,

One thing we discussed by phone is that if the temporary period (though sometimes with longish time frame), in which post ablation elevated heart rate tends to occur (especially after index ABL), becomes a nuisance for you then you can discuss with your NP at Austin if you can take a low dose of either a beta blocker or calcium channel blocker that can help slow it down just a bit for the time being. You are already on propanolol now on Dr Natale’s orders during the blanking period as we discussed last week.

While there is not a problem with the mildly elevated post ABL HR over the transient period of time it usually lasts before returning to roughly your prior typical resting HR pre-index ABL, if it is too annoying for you at this time then discuss with Natale’s staff about perhaps adding a modest dose of calcium channel blocker since you said you don’t want to be on more beta blocker than is necessary. But don’t do this unilaterally!!

Make sure you get any combo of propanolol and either diltiazem or verapamil fully approved by Dr Natale’s office, as I’m not entirely sure they will recommend that at this point, especially because it is still so early since your ablation and the HR will tend to gradually lessen over the coming months to a more acceptable level, in any event.

A final consideration you can discuss with your endocrinologist too, is to lower your thyroid dose a mild to modest degree. You levels are somewhat on the robust side as it is, and the combo of the desiccated natural porcine-based thyroid meds you take in order to add in more actual T3 dosing, since you have had your thyroid removed, plus this desiccated formula being in addition to your synthetic T4, could well be contributing in combination to some degree of a more revved up energy you feel and possibly this may be bumping up your HR a modest degree as well!

In fact, this could be your best initial good move, in my view, and see if just slightly lowering your total Thyroid hormone replacement dosing (especially cutting down a bit on the T3 component by lowering the desiccated dose some).... and just see if this doesn't help lower that feeling of being ‘too fast’ that you are sensing now??

You can always go back to your original thyroid dosing if you are too tired on the reduced thyroid or if it doesn’t help with the HR lowering. Keep in mind, though too Madeline, that for those who really need daily thyroid replacement hormone therapy AND who have a history of active AFIB, it’s most often the wise course to try to take only the very lowest dose of combined T4/T3 that you can get by with, even if you have to compromise the thyroid therapy beneficial results, at least just a bit, in favor of not risking too much cardiac stimulation that might gradually undermine your heart stability even after a successful ablation. Excess thyroid is one of the relatively few known independent triggers for AFIB/AT/AFL so its best to err on the side of caution especially right after an ablation before all the ablation lesions are well buttoned down and have become fully mature scars.

Anyway, this is all food for thought, and be sure you bounce it all off Dr Natale’s office (and your Endocrinologist regarding thyroid dosing changes, which seems to be you best first step) in possible becoming more at ease with your post ABL heart rate while it remains temporarily higher than you prefer.

Cheers!
Shannon

PS I’m driving home from Phoenix and pulled over on the road to dash this note off so apologies for any typos.

Quote
Madeline
To this I say: I understand people say the heart rate may even run high for a year, but apparently runners whose previous "normal" was 50 are okay with a new "normal" of 70, but don't you agree it is hard to live with 90 & above without feeling the way I am? How would you like to feel weak, racy, trembly much of the time, and for a year! - it is like feeling hyperthyroid - tired & racy at the same time.

I don't know why you think others don't experience the same high rates. They do. The people who have a HR in the 70s following ablation are probably taking beta blockers. I've been through this six times and every ablation left me with a heart rate in the 90s that took many months to very slowly return to normal. I've heard the same thing from virtually every single person I've ever known who had an ablation.

Honestly, I didn't really notice it unless I felt my pulse or took a Kardia reading. You sure about your thyroid levels? Having a pulse in the 90s shouldn't leave you feeling weak, racy, and trembly. That sounds like hyperthyroidism.

As for when to take your BP, it doesn't really matter much. Lunchtime would be fine. Taking it at the same time every day would add consistency but don't sweat it if you take it earlier or later some days. It won't matter.

Quote
Carey

I've been through this six times and every ablation left me with a heart rate in the 90s that took many months to very slowly return to normal. I've heard the same thing from virtually every single person I've ever known who had an ablation.

Honestly, I didn't really notice it unless I felt my pulse or took a Kardia reading. You sure about your thyroid levels? Having a pulse in the 90s shouldn't leave you feeling weak, racy, and trembly. That sounds like hyperthyroidism.

I read that people's heart rates can increase 10-20 beats, so I figured if endurance athletes pulses were in 50s on average, their pulses would be in 70s after ablation.

I do feel it though, having my pulse in the high 80s to 90s.. I feel a rapid feeling in my chest. I feel racy & at the same time tired, running on empty sort of. Now, it is not as bad as it may sound. I get things done, but I just don't feel relaxed.

I am going to see the endo's NP next week. I cannot get labs for thyroid levels again unless I want to pay out of pocket because Natale got them in Austin on day of ablation & insurance won't pay for more for another 3 months. Thing is, they did not tell me they were going to do this & they told me to take my thyroid meds like usual that morning. However, when taking natural thyroid hormone aka natural dessicated hormone you are not to get a blood draw short of 24 hr after taking medicine because of its direct effect from T3, rather than being converted from T4 slowly into T3. Therefore, my levels they got that day were skewed. That said though, I do have levels from last May & have been monitored by my endo & my cardiologist for the last year on this dose. I am thinking it is possible that my meds may be having a stronger effect on me now that I have dropped the sotalol 80 mg BID even though I started on Inderal LA 60 mg. I take the tiniest pill they make of this natural thyroid hormone that I add to my synthetic (I used to be on all NDT med before afib). So we will just have to experiment & see what I need to do. My other option is to change the cardiac meds again.

Quote
Madeline
I cannot get labs for thyroid levels again unless I want to pay out of pocket...

You can order labs yourself and pay for them out of pocket at a discount to list price. Here is a list of companies that will allow you to do this <[www.apoe4.info] The way this works - you set up an account with one of these companies. Then you choose and pay for the labs you want. They will give you access to a PDF of lab orders (or send it to the lab directly). You take the order to either Labcorp or Quest (different order for each) and get your blood drawn. In a few days the intermediary will send you an email saying your results are ready. You logon to your account and view or download the PDF of your results.

New Century Labs has been the least expensive, in my experience (a Quest reseller). This is not available in a few states, like NY.

Thanks, George. They had a special for August & I got it as today is the last day! TSH to satisfy the drs & FT3 & FT4 for me.

Following my first ablation in 2009 my resting heart rate was much considerably higher than before. Also after the blanking period and I resumed light exercise I noticed that my heart did not react the same as it did prior. This was much more noticeable as time progressed and my exercise became more intense.

My resting heart rate had almost returned to its normal rate at this time which was about 6 months in. However, my reactive heart rate to exercise did not. I could still exercise with intensity but it took longer for my heart rate to climb. So instead of my heart rate jumping up quickly it was more gradual. For an example as a cyclist I could not sprint or accelerate as quickly as I could prior as my heart could not keep up with the effort. But I could still reach the same intensity it just took longer. This also changed as time progressed but never to how it was before the ablation.

My resting heart rate was approximately 85 bpm after 1st and 2nd Ablation. It went down to mid 60’s after 6 months. Last Natale Ablation was 2016. I have also learned that Fear and Anxiety are your enemies. Do not check your Heart rate every 30 minutes!

Thank you all for the information about your heart rates. I had no idea that people may not feel much difference with a heart rate of 90. I was not really checking pulse often, but my thing was more that I was feeling racy & tired & wondered why, so I checked stats. I also did not really know the pulse rate was going to rise & stay like that for a while especially up to a year. I thought one was possibly going to have a few afib episodes or not & that was what they meant by extra activity after the ablation.

My problem could be thyroid, but it is odd because I have been on the same dose for a year now. Could the ablation have had an effect on how I handle thyroid meds for a while - possibly & since I am thyroidless I am totally dependent on proper replacement. Another thought is that I stopped my sotalol 2 weeks after my ablation because of the cough I talked about. I was started on propranolol ER (extended release) 60 mg, but I went from sotalol 80 mg BID down to that. (I had been saying Inderal LA, but I really have the generic; it is just easier to type Inderal). So Natale's nurse came up with keeping me on the propranolol & adding the lower dose of sotalol back also since I was feeling odd. Will see if I keep to that or change thyroid meds or if my cough gets better so we can decide what is best. Just a roller coaster ride of options.

It is also interesting reading about people possibly having more trouble if they have a low resting heart rate. I wonder why those of you who are this way & exercise so much which seems very healthy would be penalized with more heart conditions. I thought I exercised a lot, but not compared to what I read here. I do not do a lot of high intensity aerobic exercise, but I will say I do a lot of varied exercise, which I really enjoy. I usually am one of the top performers in the classes I attend, so am not a slacker kind of exerciser either. I look for quality & attention to detail in any form of exercise, knowledgeable & careful instructors, and of course fun. I have escaped back surgery so far though I do have 3 bulging discs in 3 different areas & have to be careful as I have gotten pain from this. Just another management thing. I did break my arm on a biking trip one time too, same arm I broke as a child flying off a trapeze on the school playground. oops, I a rambling & not staying on point for my afib stuff.