Post Ablation Medications & Blanking Period Questions

I had my ablation November 18th and so far so good with no AF episodes (knock on wood!). During this last month on occassion I have had some real quick beats for about 5 seconds or so and then a slight pause then back to NSR - I am not sure what those are? Are they ectopic beats, PACs, atrial flutter or something else... or something to be concerned about, or normal during this period?

My other question is about post ablations meds during the blanking period. I was prescribed the following:
-Eliquis 5mg 2x a day for 30 days
-Mutlaq 400 mg 2x a day for 30 days
-Sucralfate and Pantoprazole Sodium for espohogus healing(?) for 60 day
-Also still take a low dose Bayer aspirin once a day

I go back tomorrow for my follow up with my EP's NP and am over my 30 day period (but still on the above meds until I see her). I would like to come off the Eliquis and Multaq tomorrow. I am just wondering if the Multaq is keeping any AF episodes at bay or from recurring or if the quick little bursts I am having occassionally will get worse once I am off it. Also should I be concerned about stopping the eliquis? (I am healthy overall and CHADs score is 0 or 1 because I am female).

I know everyone is different and on meds for longer periods during the blanking period. Thanks in advance for any insight.

Those 5-second bursts are nothing to worry about. They're ectopics, most likely PACs, and as long as they remain brief like that they're utterly meaningless and will probably go away eventually on their own.

Your meds are pretty typical, but why the aspirin? Your EP prescribed it, right? That's rather unusual so it wasn't prescribed by a previous doctor and you've just continued taking it without his knowledge, right?

You can stop the Multaq anytime you like. The only way to know when it's time is to try it and see what happens. You'll know within a few days whether it was a premature decision. If those short ectopic episodes become longer and more frequent, you'll want to resume the Multaq and try again a few weeks later.

But don't even think about stopping the Eliquis tomorrow, or even for the next two months unless your EP specifically okays it. Your CHADS score doesn't matter much at this point.

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Carey
Those 5-second bursts are nothing to worry about. They're ectopics, most likely PACs, and as long as they remain brief like that they're utterly meaningless and will probably go away eventually on their own.

Your meds are pretty typical, but why the aspirin? Your EP prescribed it, right? That's rather unusual so it wasn't prescribed by a previous doctor and you've just continued taking it without his knowledge, right?

You can stop the Multaq anytime you like. The only way to know when it's time is to try it and see what happens. You'll know within a few days whether it was a premature decision. If those short ectopic episodes become longer and more frequent, you'll want to resume the Multaq and try again a few weeks later.

But don't even think about stopping the Eliquis tomorrow, or even for the next two months unless your EP specifically okays it. Your CHADS score doesn't matter much at this point.

Thanks Carey for your response! It is very helpful!

My original EP in Orlando recommended the aspirin once a day versus Eliquis and my EP here in Boise when I moved was fine with that too. The nurse in the hospital after the ablation said to continue that aspirin as well and the EP knew I was on that prior to the ablation so I will confirm with the NP today about that. As far as not coming off Eliquis, in your opinion you think I should stay on it for at least 3 months post ablation - even though I am no having any active AF, but probably OK to come off at that 3 month point? Is that common prescription for most post ablation due to the risk of stroke being higher during the blanking period or something? I was not on any meds prior to ablation (except the aspirin and diltiazem on demand).

Also what about supplements? They took me off Magnesium post ablation and I was also taking calcium for osteopenia but am off that for now as well - any thoughts on going back on calcium and magnesium supplements again and affects on the heart? thanks again for all your insight and support!

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Ingrid
As far as not coming off Eliquis, in your opinion you think I should stay on it for at least 3 months post ablation - even though I am no having any active AF, but probably OK to come off at that 3 month point? Is that common prescription for most post ablation due to the risk of stroke being higher during the blanking period or something?

Yes, it's standard practice for patients to remain on an anticoagulant for the entire blanking period regardless of whether you have active afib, a low CHADS score, or anything else. Exceptions are sometimes made, but you definitely shouldn't be making that exception yourself. The worst consequence of stopping Multaq is you go into afib, but the worst consequence of stopping Eliquis is you die (or worse). Don't rush that. Wait until your EP specifically okays stopping it.

And I would definitely ask again about the aspirin. I can't imagine any reason for taking it from what you've told us, and combining it with Eliquis just unnecessarily increases your bleed risk.

As for the supplements, I have no idea why they took you off them so better ask about that too.

Thanks again Carey - appreciate your response and insight!

So glad your doing well. Carey gave you some good info so nothing to add. So far as the supliment's go I don't understand why they wanted you to stop.

Thank you @rocketritch appreciate your message! hope you are well and happy holidays to you and a happy and healthy 2021 to you!

Ingrid - glad you are doing better now.

One note on the supplements... calcium and magnesium. I’m sure you are aware that magnesium is very important for heart rhythm stabilization... and that often, it boils down to taking enough of the right form of magnesium... that is - one that is known to be easily bioavailable so the intracellular levels are optimized. Taking calcium supplements when you are trying to optimize magnesium can work against that goal... as calcium is known to 'dominate' over magnesium and can help promote arrhythmias.

Check the various supportive articles at this link: [duckduckgo.com]

There are nutrients such as bone morphogenic proteins found in supplements that can help stabilize and support bone structure without having to add significant amounts of calcium (and thus the magnesium issue.) I can elaborate more on that if you are interested…so send me a PM with your email address. I realize we’re into the Holiday Season, so no hurry.

Also taking optimal amounts of Vitamin D along with Vitamin K2 MK7… which is the menquinone 7 form… that helps direct circulating dietary calcium into bones where it belongs…which lessens both the risk of arterial deposits and also the ratio imbalance of Mg to Ca which can influence arrhythmias and/or ectopics/palpitations, etc. Once your heart is settled down after the ablation, you can begin to look into these. In the interim, it’s best to continue magnesium supplementation but stop calcium supplement and get minor amounts from food intake.

I had a history of self-promoting Afib by taking physician-directed calcium supplements (to help ward off osteoporosis in post-menopausal women) that were not balanced out by magnesium. Once I stopped the calcium and significantly increased the magnesium, over time, my daily afib stopped. Alas, it wasn’t a permanent solution and I did have the ablation procedure, but it was an important ‘lesson’ to research the complications of supplemental calcium and I’ve shared that here in archived posts.

Best to you,
Jackie

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Ingrid
Thank you @rocketritch appreciate your message! hope you are well and happy holidays to you and a happy and healthy 2021 to you!

Thank you Ingrid.

I'm feeling really good. I've taken up hiking after a short hiatus following my last ablation. Did a little over 13 miles today. Almost 5 yesterday and almost 6 on Tuesday..

We got 20 inches of snow here last week so hiking has been not only challenging but beautiful as well.

Topic is blanking period—I’m 3 months post second ablation. I hope I’m still in my blanking period. Last week ecv twice with >200 hr AF. Yesterday 188 hr sinus tachycardia that self converted twice quickly each time and today’s 177 atrial sinus tachycardia that self converted within a few minutes but left a residual feeling of tiredness. With my PVCs I didn’t notice how high my hr was. It wrecked my day. I wanted to shovel a huge pile of dirt into my wheelbarrow and plant flowers. I’m too wiped out. Hopefully tomorrow. My NP said I’m at the end of my blanking period and it’s a watch and see for now.