Are we more susceptible to adrenergic ectopics after ablation?

Random ectopics during the healing process are a known thing. But do those of you who have gone through an afib ablation feel that stress and any kind of physical activity created more ectopics during the healing process?

PVCs: Drinking (natale agreed it happens), eating, bending over, lack of sleep (difficult to sleep with a pounding heart), dehydration, lifting and stress are my triggers. According to my zio patch, my active pvc days are 27-28% of my hr. It’s a freak show. Magnesium does help me. Natale suggested magnesium and coq10

I just seem more susceptible 18 days after the procedure and am wondering if out hearts are trigger happy at this point. Maybe it wears I off as healing completes

Your heart is definitely trigger happy 18 days after an ablation. And yes, it wears off as healing progresses. Stress and physical activity never had any effect on me (I once did a 50 mile bike ride in hilly terrain 3 days after an ablation), but everyone's different.

Three day’s later? Wow. I’d be afraid iI’d bleed out. Lol

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Carey
Your heart is definitely trigger happy 18 days after an ablation. And yes, it wears off as healing progresses. Stress and physical activity never had any effect on me (I once did a 50 mile bike ride in hilly terrain 3 days after an ablation), but everyone's different.

It's weird because stress and physical activity in the morning produce zero ectopic beats. Afternoon is a different story. Slight elevations in adrenaline bring lots of ectopics. I'm expecting it to get better over time. Thanks.

There's no danger of bleeding out. And yes, I had the blessings of my EP to do the ride.

At 18 days you’re atria are still quite swollen. Anything can cause ectopics. Stress, activity, the weather on Mars. Don’t pay too much attention to it. Just ride out the blanking period and report anything really upsetting to your EP.

Agree with Wolfpack and Carey, don't pay any more attention to ectopics than necessary ... as it's usually not necessary to fret over them at all. Though, for sure, frequent runs of mixed ectopy, especially primarily PVCs, will demand a certain level of attention just cause they can be a big annoyance to say the least. This can be so, even through they are essentially benign in vast majority of cases (100% true when the excess ectopy is limited to PACs) ... unless the person is having consecutive runs of PVCs alone greater than 6 to 7 in a row with no intervening Sinus beat, which will earn the person a full work up for possible VT ( Ventricular Tachy) ... Or if ones runs of PVCs is reaching roughly 20,000 PVCs a day, or more, In which case, that will usually earn the person the option to get a PVC ablation in order to dramatically reduce recurrence of said long runs of PVCs.

Shannon

Thanks for responding. The most curious thing about mine are that stress and physical activity only bring about ectopics in the afternoon. Never in the morning. It’s like clockwork. As soon as 2:00 pm hits and if I move around too much or have a stressful presentation, bam, tons of ectopics. Maybe my heart is tired by this time from the healing process?

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wolfpack
At 18 days you’re atria are still quite swollen. Anything can cause ectopics. Stress, activity, the weather on Mars. Don’t pay too much attention to it. Just ride out the blanking period and report anything really upsetting to your EP.

Could be cortisol levels. That is very cyclical.

At any rate it isn’t something to worry about for at least another month and only if it’s causing serious discomfort.

Was reading about it a little and cortisol is highest in the morning and high when under stress. Interesting, my ectopics are very low in the morning and high late in the day when under stress. It's pretty mysterious and a bit contradictory. I was at a movie last night and I had to ask a guy who was talking to be quiet. I have had to do that before and I don't get anxious about it really. Just a pet peeve of mine. Anyway, last night I thought my heart was going to explode as I leaned over to tell him. I actually thought I'd gone into afib but it was just (I think) the weirdest ectopics. Like thud, thud, normal, normal, normal, thud, thud, normal, normal, normal, for like ten minutes. Then it all settled down. Good grief. It's like the slightest stress in the afternoon is a huge issue for my heart. Three weeks post ablation tomorrow. I know, it's still early in the recovery.

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wolfpack
Could be cortisol levels. That is very cyclical.

At any rate it isn’t something to worry about for at least another month and only if it’s causing serious discomfort.

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keeferbdeefer
Was reading about it a little and cortisol is highest in the morning

yes that is usually the case but for some it is reversed— I know this because I have had 24 hour cortisol monitoring and mine is lowest in the morning and highest in the evening.

Cortisol is an interesting point by you both. I find a tiny bit of stress (mental or even a very tiny bit of activity) can trigger ectopics, but if I walk briskly or drift into more of a cardio situation, I rarely have ectopics. I've been real careful about getting my heart rate up just three weeks after ablation, but maybe I should start a light workout regimen, My EP said it was fine even after a week. I was still nervous to do it though. Maybe the exercise is lowering cortisol.

The salient point is that cortisol levels are cyclical so it stands to reason that cyclical ectopy could be related. Ignore the absolute timing of when minima and maxima should occur and just embrace the cyclical nature. Also realize that cortisol is produced by the adrenal glands and adrenal fatigue may play a role. That is to say chronic stress messes with the glands’ ability to properly produce the stress hormone, cortisol, and may cause adrenaline to be released instead. That’s rocket fuel for the heart. You may want to look into some of the Ayurvedic herbs for adrenal support, such as Holy Basil and Ashwagandha. It’s a stretch for sure, but it does affect some of us.

As always, give it time.

I think you should stop obsessing with ectopics, which are a perfectly normal part of the recovery process, and get back to exercising. I mean, really, you seem to be letting this fear consume you and there's nothing to fear.

Prior to ablation, I've never had stress induced palps. At least I don't think so. Hoping it's just my heart being in the healing process and being more trigger happy that usual. Yes, I have started exercising again. Starting this morning.

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wolfpack
The salient point is that cortisol levels are cyclical so it stands to reason that cyclical ectopy could be related. Ignore the absolute timing of when minima and maxima should occur and just embrace the cyclical nature. Also realize that cortisol is produced by the adrenal glands and adrenal fatigue may play a role. That is to say chronic stress messes with the glands’ ability to properly produce the stress hormone, cortisol, and may cause adrenaline to be released instead. That’s rocket fuel for the heart. You may want to look into some of the Ayurvedic herbs for adrenal support, such as Holy Basil and Ashwagandha. It’s a stretch for sure, but it does affect some of us.

As always, give it time.

I'm just about at four weeks post ablation. Can't really say my afternoon ectopics are settling down. I feel great most of the day and can workout comfortably in the morning, but I can get long (twelve or more) runs of single ectopics beat separated by single pauses if I just get up to walk around in the afternoon. It'll settle down by around 9:30 pm. I read below that runs like that can be dangerous. I can get thuds and two count pauses or singles for long runs. If I move my torso or cough they will kick out of a run like that. So I'm not stuck in it. But will stay in it a long time unless I adjust myself. Still baffled by the time of day thing. And having not improved in over a week. Am I still hoping for too much, too soon?

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Shannon
Agree with Wolfpack and Carey, don't pay any more attention to ectopics than necessary ... as it's usually not necessary to fret over them at all. Though, for sure, frequent runs of mixed ectopy, especially primarily PVCs, will demand a certain level of attention just cause they can be a big annoyance to say the least. This can be so, even through they are essentially benign in vast majority of cases (100% true when the excess ectopy is limited to PACs) ... unless the person is having consecutive runs of PVCs alone greater than 6 to 7 in a row with no intervening Sinus beat, which will earn the person a full work up for possible VT ( Ventricular Tachy) ... Or if ones runs of PVCs is reaching roughly 20,000 PVCs a day, or more, In which case, that will usually earn the person the option to get a PVC ablation in order to dramatically reduce recurrence of said long runs of PVCs.

Shannon

Edited 1 time(s). Last edit at 12/28/2019 04:39PM by keeferbdeefer.

The ectopics you're experiencing are most likely PACs, not PVCs, and therefore 100% not dangerous. If you've got a Kardia you can capture an example and post it or email it to me and I'll tell you what they are if you're not sure.

And yes, you're expecting too much too soon. Ectopics can go on for a long time after an ablation and there is no "they'll be gone by ______" date anybody can tell you. Most likely they'll be mostly or entirely gone by the end of the blanking period, but there's no guarantee.

Borrowed a Kardia from my ex wife. Believe it or not, she likes me being alive. Lol. I'll post up tomorrow when the afternoon ectopics hit. Thanks Carey.

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Carey
The ectopics you're experiencing are most likely PACs, not PVCs, and therefore 100% not dangerous. If you've got a Kardia you can capture an example and post it or email it to me and I'll tell you what they are if you're not sure.

And yes, you're expecting too much too soon. Ectopics can go on for a long time after an ablation and there is no "they'll be gone by ______" date anybody can tell you. Most likely they'll be mostly or entirely gone by the end of the blanking period, but there's no guarantee.

I agree with previous answers. In my case, I'd say Wolfpack has given the true cause of my ectopics : the weather on Mars. Ha ha ha.
When it's vagal, it may come from everywhere, the vagus nerve being incredibly long. Shouting may cause ectopics. Exercising brutally too. Moving right to left or left to right side in bed, eating too much (two slices of bread may be too much, but not always), and so on...

When leaving bed at 6AM, I clearly feel my stomach reflux. I guess my LES is particularly weak when waking and standing up. So, I've to be careful when leaning forward and other quick body moves. I avoid then eating my breakfast at once, as I have to drive my car to go to work. I only eat when I'm there.
Things are then usually quiet in the morning.
Ectopics tend to come back in the afternoon. Cortisol or weather on Jupiter, I don't know.
It may get even worse in the evening and early night when I go to bed.
Early morning hours may be annoying : if I awake around three or so, without quickly getting back to sleep, it's likely I'll have ectopics. But not always. It's likely related to the Moon or a barking dog in the neighbourhood.

I usually have no problems while exercising (reasonably), and for me it's crucial. Ectopics are harmless for a healthy heart, so I do my best to keep my heart healthy.
But I agree : ectopics are annoying. I may have them in organised forms as well as like some sort of chaos (I'll post some tracings if I find some time to do it), and I live with that...
If ectopics were really dangerous, I'd not be still alive to tell.

keeferbdeefer - I've had three Natale ablations... spaced out over time... 2003, 2014, 2015... and post-procedure, I had very little to none ectopic activity...with the exception of the one in 2014 when I went back into Aflutter while on my flight back home. I was electrocardioverted soon after arriving home and once again, no trouble with ectopics as far as I was aware.

In about a week, after each procedure I went back on my typical daily protocols for balancing electrolytes... ie magnesium, potassium, taurine, CoQ10 and several other supplements. Keeps my blood pressure normal as well.

It can take time to replete or maximize your intracellular levels of magnesium so that may be something that you'll need to work on.

Just try to relax and enjoy an afib-free heart.

Be well,
Jackie

About 17 months after my 2nd Natale ablation, I started getting disturbing ectopics that went on everyday all day for many months.
Finally Shannon had me go get a 12 lead ekg so Natale could properly review, instead the AliveCor recordings.
He diagnosed it to be bigeminy (PVC's), nothing to worry about per se,but the doctor at Rapid Medical told be to go to the ER right away. I told him I'm in contact with the best EP on the planet and will defer to him.
Anyway this went on for 6 months with little reprieve in the frequency and I was cornered as was Shannon that this could be an underlying blockage. Eventually they subsided for many months but reared their ugly head again for 4-5 months.
My eventual stress test a few months later was stopped short due to the escalating frequency of PVC's but the PA told me the good news was there was no signs of any blockage from the stress echo preliminary findings, so she upped my beta blocker to 50mg (metropolol) which eventually calmed my heart within a few weeks.
That was 18 months ago and mostly ectopic free, I'm now 63 yo battling this since my early 50's.

That's my story and I'm sticking to it.

Best,

McHale

Here are some tracings.

Ectopics (PACs) in regular pattern (bigemini)


PACs and PVCs


Ectopics (PACs and PVCs successively) in bigeminal pattern


Two more chaotic tracings, often turning to full afib



And finally, afib

Yep I was getting close to 20,00 a day and a PVC ablation was becoming a strong possibility so I contacted Dr Natale's nurse. Thankfully my stress echo showed all normal valve functions and blood flow velocities, normal ejection factor and chamber size etc...of my heart. All it took was a little more BB to calm those monsters.

McHale

Would another ablation do you any good?

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Pompon
I agree with previous answers. In my case, I'd say Wolfpack has given the true cause of my ectopics : the weather on Mars. Ha ha ha.
When it's vagal, it may come from everywhere, the vagus nerve being incredibly long. Shouting may cause ectopics. Exercising brutally too. Moving right to left or left to right side in bed, eating too much (two slices of bread may be too much, but not always), and so on...

When leaving bed at 6AM, I clearly feel my stomach reflux. I guess my LES is particularly weak when waking and standing up. So, I've to be careful when leaning forward and other quick body moves. I avoid then eating my breakfast at once, as I have to drive my car to go to work. I only eat when I'm there.
Things are then usually quiet in the morning.
Ectopics tend to come back in the afternoon. Cortisol or weather on Jupiter, I don't know.
It may get even worse in the evening and early night when I go to bed.
Early morning hours may be annoying : if I awake around three or so, without quickly getting back to sleep, it's likely I'll have ectopics. But not always. It's likely related to the Moon or a barking dog in the neighbourhood.

I usually have no problems while exercising (reasonably), and for me it's crucial. Ectopics are harmless for a healthy heart, so I do my best to keep my heart healthy.
But I agree : ectopics are annoying. I may have them in organised forms as well as like some sort of chaos (I'll post some tracings if I find some time to do it), and I live with that...
If ectopics were really dangerous, I'd not be still alive to tell.

Here's mine. I had to provide a link. They happen mostly in the afternoon if I exercise a little. Once I sit down and chill, they go away. Heavy exercise in the morning or after 8:00 pm, no problem. I believe these are all atrial. So that's "good".

[ibb.co]



Edited 2 time(s). Last edit at 12/29/2019 03:43PM by keeferbdeefer.

Looks like bigeminal PACs.
Before knowing what they were, I thought I had bradycardia with heavy beats...

They're annoying as Hell. I kind of miss once a month afib compared to daily runs of PACs for four hours each day. Time will tell if they settle down. They've been like this for a couple weeks though.

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Pompon
Looks like bigeminal PACs.
Before knowing what they were, I thought I had bradycardia with heavy beats...

Edited 1 time(s). Last edit at 12/29/2019 05:44PM by keeferbdeefer.

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keeferbdeefer
Here's mine. I had to provide a link. They happen mostly in the afternoon if I exercise a little. Once I sit down and chill, they go away. Heavy exercise in the morning or after 8:00 pm, no problem. I believe these are all atrial. So that's "good".

[ibb.co]

Those are PACs in a trigeminal pattern (every third beat). They're harmless. For most of 2017 I experienced PACs in a bigeminal pattern that would go continuously for weeks at a time, so I know how annoying they can be. That went on for almost 8 months.

The afternoon pattern is interesting. I would suggesting experimenting with your habits. For example, try skipping lunch for a day. Does it still happen? Have a full-size can of low sodium V8 in the early afternoon. Does that help?

I'll experiment a little. I got them a tad early today, before lunch time. But always due to a slight elevation in heart rate as I get up and walk around. Except in the morning when working out is no trouble. So weird.

Were you a candidate for another ablation Carey, since you were getting so many PACs for so long?

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Carey

Here's mine. I had to provide a link. They happen mostly in the afternoon if I exercise a little. Once I sit down and chill, they go away. Heavy exercise in the morning or after 8:00 pm, no problem. I believe these are all atrial. So that's "good".

[ibb.co]

Those are PACs in a trigeminal pattern (every third beat). They're harmless. For most of 2017 I experienced PACs in a bigeminal pattern that would go continuously for weeks at a time, so I know how annoying they can be. That went on for almost 8 months.

The afternoon pattern is interesting. I would suggesting experimenting with your habits. For example, try skipping lunch for a day. Does it still happen? Have a full-size can of low sodium V8 in the early afternoon. Does that help?

Edited 1 time(s). Last edit at 12/29/2019 06:47PM by keeferbdeefer.

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keeferbdeefer
Were you a candidate for another ablation Carey, since you were getting so many PACs for so long?

Sure, but the PACs weren't what made me a candidate. It was the afib and flutter that occurred on top of the PACs that made the ablation necessary. PACs only rise to the level of annoying.

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keeferbdeefer
Would another ablation do you any good?

From my experience, the good thing is PACs coming in such patterns (bi or trigeminal) never turned to afib. They're awful, but both my EP and cardiologist don't worry about them.

The reason I'd maybe try a fifth ablation is I've still afib 2 to 3 times/month (avg 54min this year). I would not do for ectopics.

Went to see my EP at the five week post ablation mark. I mentioned all the afternoon ectopics and he said he sees a higher than pre ablation burden of PACs in about 20% of his patients. Not a high percentage. The afternoon only thing for me is a little unique. Mind you this is the top EP at the top cardiac facility in St. Louis. He does perhaps thousands of these a year. Anyway, it's not that common as far as he's concerned but he hopes another couple months will settle these PACs down. He did prescribe a 12.5 mg dose of Metropolol at noon each day. I did so today and must say I've had zero ectopics. For me, they were clearly due to adrenaline, but only if the adrenaline was in the afternoon. The beta blocker seems to be doing the trick. Just that little amount. Hopefully it can keep things calm as I heal and can then stop the meds eventually.

Interesting. 12.5 mg is a trivially low dose so the fact that it's effective for you is a good sign. I think he's right that the ectopics will settle down in the coming weeks.