Recent Ablation Worries

Hello forum. Let me start by saying what a great thing it is to have a forum like this to help us through these heart issues. I've been lurking on here for months awaiting my own ablation, learning what I can, but have some questions and will endeavor to be helpful to others now that I have my own limited experience. So thank you in advance.

Quick back story is I am a 49 year old male. Very good physical health, but not a super athlete by any means. Work out 3-5 days a week, basic cardio and some weights. That's it. I've had paroximal afib for ten years. Started out once a year for about nine years and would last maybe 12 hours. I would convert on my own. In the last year it has graduated to twice a month or more but for only 2-4 hours, converting on my own as usual. I also would get long runs of PACs as verified by an event monitor. My triggers in the early years were cold foods, full stomach, large bites of food. Clearly a vagal nerve issue. It became less predictale in recent months though and would pop up for no reason at all. Sometimes while sleeping, or driving, or eating of course, but more rarely eating. Angio CT showed no blockages and my heart is structurally great.

I had PVCs as well, and was successfully ablated for those last year. So I went in for afib ablation ten days ago. My EP is a very experienced and well respected EP here in the St. Louis area. He did by PVC ablation and knows all my triggers and history. I've been on Flecanide 100 mg two times a day for a couple years but it never did much. I'm still on it for another few weeks until my EP takes me off it.

Here's my concern finally. I read many cases where a person's heart rate goes up 10-20% after afib ablation, settling down after many months. My normal resting rate is about 60-65 and didn't move much at all after ablation. Was in the very low 70s day of and day after ablation. And now sits at around 65 again. I feel pretty good though. During the day I feel great. I get a little tired at night (I'm not working out in any way for at least a month). Around 5:00 pm I get a few PAC runs (might be PVCs, not sure), but hey are mild and short lived. Nothing more than that. But it's only day ten.

I'm curious if I'm overly concerned about this unchanged heart rate. I know only time will tell, and month three is really the one to watch. I raised the concern to my EP when he visited me in the hospital, and he said a rise in HR doesn't always happen. I'm sure that's true, but it's tough to deny the studies and anecdotal evidence on this forum. I see him in three weeks but I'm worried and would like some feedback from others in the same boat. Thank you!



Edited 2 time(s). Last edit at 12/11/2019 08:58AM by keeferbdeefer.

Hi Keefer, welcome to the forum.

Although an increased heart rate is typical after an ablation, lack of it isn't something I'd worry about. That's particularly true if you're still taking flecainide. Are you also taking a beta blocker by any chance?

Hello Carey. No beta blockers. Just the Flecanide. I'm also on 5mg 2 times a day Eloquis for a month, but noting else. Have to say I really like my heart rate where it is. Just don't want it to drop further or indicate lack of burn penetration. I hear a rise in heart rate may indicate a good burn on the vagal nerve. Again, just from reading stuff.

My heart rate also changed little after an successful ablation.

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Sam
My heart rate also changed little after an successful ablation.

Thank you for that feedback. Day eleven and I'm getting more ectopic beats. Sort of annoying. I've read that after ten days this can happen, and then maybe slow down over time as well. I maybe get four an hour when under some stress at work. I'm trying to mitigate the stress of course.

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Carey
Hi Keefer, welcome to the forum.

Although an increased heart rate is typical after an ablation, lack of it isn't something I'd worry about. That's particularly true if you're still taking flecainide. Are you also taking a beta blocker by any chance?

Just a quick follow-up Carey. I've not read that Felcanide will lower heart rate. Have you or others found that it does ever so slightly? Perhaps enough to offset a potential rise due to the afib procedure itself.

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keeferbdeefer
Just a quick follow-up Carey. I've not read that Felcanide will lower heart rate. Have you or others found that it does ever so slightly? Perhaps enough to offset a potential rise due to the afib procedure itself.

Yes, it can lower heart rate slightly. It did for me.

Not sure where you heard that the increased heart rate after ablation indicates the vagus nerve was burned but that's not true. Vagal nerve injury would be a very unusual complication in an ablation and not something a competent EP would ever allow to happen. The increased heart rate is presumably due to the irritation and inflammation the procedure causes.

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Carey

Just a quick follow-up Carey. I've not read that Felcanide will lower heart rate. Have you or others found that it does ever so slightly? Perhaps enough to offset a potential rise due to the afib procedure itself.

Yes, it can lower heart rate slightly. It did for me.

Not sure where you heard that the increased heart rate after ablation indicates the vagus nerve was burned but that's not true. Vagal nerve injury would be a very unusual complication in an ablation and not something a competent EP would ever allow to happen. The increased heart rate is presumably due to the irritation and inflammation the procedure causes.

Not burned in a bad way. But that the ablation burns more likely permeated to the vagal nerve. It was on this forum that I read it. I’ll try and find it. Something about the vagal nerve “richly permeates the sinus node” and so decreasing vagal tone in the SN via burns leads to higher heart rate temporarily. John Mandrola, EP. Was posted back in 2015.

I would take Mandrola's opinions with a big grain of salt. I have no idea why he's talking about the sinus node because an afib ablation doesn't touch that either. Inflammation from the burn lines is more than enough to explain the elevated heart rate. The vagal nerve doesn't need to be involved.

I’ve read here many times that one hallmark of a ‘good solid’ ablation is a significantly elevated heart rate for 6-12 months after an ablation and that that is due not least to de-enervation of vagal nerves around the PVs.
My HR only went up a few BPM and only for a few weeks after my Bordeaux ablation. Sam from Ireland who was also abated in Bordeaux around the same time as me also comments similarly above. And his was a long procedure with a lot of burns required (mine just a ‘straightforward’ PVI plus a linear burn somewhere else (can’t remember where exactly but opposite coronary sinus)). But I do remember Prof Jais emphasising he burns only what he feels he absolutely needs to and no more than that.



Edited 1 time(s). Last edit at 12/15/2019 08:35AM by mwcf.

My HR didn't go up significantly after ablation either. My rate is in the 50's.