Ectopics after ablation

Hello,
I had a Natale ablation on 11/20. (All went well). A few days ago at the the 60-day mark, I discontinued my Flecainide. Since then, I’ve noticed some ectopics and they seem to be getting worse with each passing day. Is it common to get ectopics after stopping the Flecainide and still being within the blanking period? I had stopped the Flecainide 5 days prior to my ablation and never had an issue so I’m thinking it’s more about my heart not being completely healed yet and the Flecainide was masking these blips. Thank you.

Yep, this is perfectly normal and nothing to worry about. The ectopics could even continue past the blanking period but that doesn't mean they're going to be a permanent affair. As long as they don't progress to sustained afib, the ablation was a success. Do you own a Kardia and are you sending recordings periodically to the nurse practitioner? What do they say about them?

It's common.
My way to understand this is as follows:

1- Something (mysterious, in many cases, or often very hard to find) causes some cells to misfire in your atria, kicking ectopics and, instantaneously, afib.

2- Ablation goal is to isolate the misfiring cells, in order to prevent afib. It does strictly nothing to treat the underlying causes of your afib.

3- Ectopics after ablation are an illustration of point 2. There may still be cells misfiring somewhere, but they can't lead to afib. Just ectopics. Annoying, discomfortable, but harmless.

4- As long as afib does not come back, ablation is a success. Dealing with ectopics is another fight.

Some people may disagree with my opinion, which comes from my own experience, but I believe sharing it might help in some way.

Interesting topic IMO.

Whilst there are some posters who claim never to have had a single missed beat after a successful ablation (and lucky them indeed!), my take is that most folks whose ablations are successful (in preventing reoccurrence of AF for 8-12 years or more) continue to get pretty much as many ectopics after the ablation as they did before it (e.g. Gill from the UK here on this forum). And I'm definitely one of the latter (ablation Aug 18 in Bordeaux). That makes me wonder how can an ablation be successful when one still gets a lot of ectopics after it? Maybe a strong clue is in what Prof Jais told me after my ablation 18 months ago - i.e. that as he ablated (mine was a index PVI procedure) he noticed the wavelength of the AF (I was in AF during the procedure - it started up as the transeptal puncture was made) gradually and subtsantially increased/lengthened as he kept ablating. In other words in my case - and I suspect many or even most others - the ablation proves successful in that it makes it far harder for AF to become established in the atria after ectopic beats. Developing this further, maybe the real expertise in ablating is to be able to make durable - i.e. deep (enough) and tightly-packed/well-placed lesions to make it a lot harder for the atria to fibrillate but at the same time NOT cause any other collateral damage such as PV stenosis.

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maybe the real expertise in ablating is to be able to make durable - i.e. deep (enough) and tightly-packed/well-placed lesions to make it a lot harder for the atria to fibrillate but at the same time NOT cause any other collateral damage such as PV stenosis.

Well said.

Ectopics after an ablation are the norm, but when they occur, what is the usual length of time that a series of ectopics will run? A few irregular beats on occasion or hours in a row?

Some of it may be due to “missed” spots, especially in the long term post-ablation. In the short-term, however, odd beats can simply be due to swelling of the atrial tissue that hasn’t gone down. It got burned (or frozen). Hence the blanking period. Really I wouldn’t worry too much about PACs or short SVT runs until after 6 months. If it’s bad then, you might want to consider bringing it up with your EP and possibly medicating it with a low dose AAR to see if that helps.

I know how annoying they are, and I still get them at times. Nothing like a double or triple PAC when you’re running up a hill in the summertime to knock the wind out of you! For me it’s always a reminder that I’ve screwed something up with electrolytes of hydration (usually the latter).

A comment from the peanut gallery (a non-ablatee). I commonly wake up in the wee hours and I have several routines I do to get back to sleep (I go to our basement, so I don't disturb my wife). I will usually do some yoga, breathing exercises and then meditate and will frequently go back to sleep during meditation. Many times I will put a strap on and record my heart, beat to beat (r to r). In the tachogram (heart rate vs time graph), I can distinguish between PVC's and PAC's because my strap doesn't "see" PVC's, therefore they are reported as a beat that is half as fast (or twice as long if looking at beat length in milliseconds). I can therefore distinguish between PVC's and PAC's. For me, approximately 25-40% of my ectopics are PVC's, which won't lead to afib. Without a monitor, I can't tell the difference - for example on my radial pulse. Moral is that some of what you feel may be PVC's & I'm sure the ratios vary by person.

I ended up going to the hospital as the ectopics were becoming very bothersome. The EKG indicated PACs occurring at a rate of around 2-3 per minute and short durations of arrhythmia bit not AFIB. The doctor seemed to be confident that this was related to the ablation and the healing process. They recommended that I start taking the flecainide again for a short period of time while my heart continues to heal. After popping 100mg of flecainide, the palpitations stopped within an hour and I’m feeling perfectly normal again. I’ve notified Texas and Natale’s nurse agreed with the strategy and will review my case on Monday. All records from the hospital visit were forwarded. I’m really hoping this is in fact related to the healing process and nothing of any real concern.

I hope you'll soon be fine. I wish you the best.

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bkimura
I ended up going to the hospital as the ectopics were becoming very bothersome. The EKG indicated PACs occurring at a rate of around 2-3 per minute and short durations of arrhythmia bit not AFIB. The doctor seemed to be confident that this was related to the ablation and the healing process. They recommended that I start taking the flecainide again for a short period of time while my heart continues to heal. After popping 100mg of flecainide, the palpitations stopped within an hour and I’m feeling perfectly normal again. I’ve notified Texas and Natale’s nurse agreed with the strategy and will review my case on Monday. All records from the hospital visit were forwarded. I’m really hoping this is in fact related to the healing process and nothing of any real concern.

I had my ablation about the same time as you (12/2/2019). I had horrible ectopics starting the second week after ablation. Almost almost always in the afternoon, and I would get runs of 15 ectopics in a row for a couple hours. It was definitely tied to adrenaline, but again, only in the afternoon. Sort of odd. I've been on 100 mg twice a day of Felcainide since the ablation. And about a months ago my EP said to start taking a 12.5 mg dose of Metropolol at noon. That really calmed things down for me. I'm hoping that the afternoon ectopics go away and I can be med free in another month or two. I can tell that they are getting fewer (even though the meds are in play, I can just tell). All signs point to them getting less and less over time, if you listen to others on this board. I've had a heavier than average atrial ectopic burden than many, but even mine are settling down. Hopefully yours will too. I'm curios if yours are at a certain time of day or induced by anything in particular (i.e. stress, food, sleeping, etc).



Edited 1 time(s). Last edit at 01/26/2020 05:35PM by keeferbdeefer.

My PVCs average 15.3% burden starting ten days after my ablation but I believe it’s almost full time since I returned from overseas and stopped Multaq.

It’s pretty interesting. My living room is approximately 15-18 feet from an electric pole with a bucket like transformer on top. It’s in the side of my property line. I have another one about 200 feet away across the street. I had very little (I didn’t even notice) PVCs when I am away on vacations. When I always return it’s worst. I get poor cell reception in my home so something is going on. I came down with my first AF while living here.

I wouldn’t be surprised if the EMF is a contributing factor. I bought a EMF meter and it beeps when I passed my fluorescent bulbs so I replaced them. I lend my meter to the neighbor whose house is across the street next to he other transformer. He is not a scared type because he trains the swat team. He sold his house right i lended him my meter.

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susan.d
I wouldn’t be surprised if the EMF is a contributing factor.

Susan, my understanding is that there are data suggesting that EMF's can activate what are called voltage-gated calcium channels (VGCCs) at a cellular/mitochondrial level. I think there are some data suggesting calcium channel blocker meds can block this effect. There are also case reports of some individuals who are much more sensitive to this than others.

Well GeorgeN I have been always sensitive. My GP told me all he has to do was breathe on me to get an iatrogenic reaction. I just recently returned from overseas and my PVCs are worst. Perhaps partly because I stopped Multaq but I believe the two EMF are a factor.

There are mixed opinions on low level EMF suppressing AF:
[www.eplabdigest.com]

[clinicaltrials.gov]

[www.ncbi.nlm.nih.gov]

[www.heartrhythmjournal.com]

So many sites:

[www.google.com]