Ablation Bordeaux 2006 and 2007 AF returned in 2019 ablated locally on 14 December 2020

Hello affibers
I had two ablations done at Bordeaux. In 2006 and 2007.
AF came back in 2019. Because it was not possible to travel in 2020 I had ablation done locally in country where I live. Doctor was recommended by the team from Bordeaux, due to the fact that he worked with Bordeaux team for 4 years.
This ablation was more extensive than two previous ones.
I am on Felcanaide 100mg it was prescribes after I had breakthrough AF 5 days after ablation. I do not have ectopic betas or PVC or any other. I also take more medications than before all other ablations because anxiety,due to the very symptomatic AF elevated my blood pressure and it needed to be under control.However blood pressure shoot very high post ablation I had calcium channel blocker added to beta blocker.
After my two ablations in Bordeaux I did not have any post ablation symptoms and felt really good.
NowI suffer from severe fatigue as well as shortness of breath even after several slow steps. The dyspnoea is worst at night I can not sleep flat on bed as I used to, but need to use two or three pillows to prop myself.
I wonder if the symptoms I have were experienced by ablatees from this forum.
Could you please share your experiences.
Thank you.
Aldona.

How long has it been since your last Ablation?

Hi Aldona,

As a retired paramedic, I am very concerned to hear about your recent history of shortness of breath and inability to sleep lying down. This could be a serious symptom; and to be safe, a call asap, to your doctor or ER to get their opinion seems important here. If I still had my ambulance I would likely insist you come along for a ride to the ER with me, as shortness of breath can have many underlying causes and be very serious. Not to frighten you, but please I strongly encourage you to make medical contact.

Take care,

Jeff W

14 December 2020. So it's two weeks now. I was told it was very extensive ablation. RPV reconnected and also there were many foci in right atrium and on the back wall of right atrium that needed ablation.

You need to be seen by the doctor who did the ablation. You shouldn't be experiencing these symptoms 2 weeks after an ablation. I would strongly recommend that you be on the phone to that doctor first thing Monday morning and make it explicitly clear that you're experiencing serious symptoms. If they can't/won't see you immediately, then I would go to the ER/A&E at the nearest large hospital available.

I agree, call your Ablation Dr. asap. Otherwise, whats your HR? Oxygenation level? (if you have an Oxymeter). Also what are the dosages of your beta-blocker and calcium channel blocker?

Hi Aldona,

I'm very sorry to hear of your prolonged shortness of breath (SOB ) usince your recent ablation that includes spiking BP. and if you haven't done so already, I too second the recommendations of Jeff W., Carey and AntiFib to seek medical attention ASAP .., starting with your EP! I just now read your post this morning.

I have a few questions in light of your symptoms ... did your EP (or his NP) give you a course of Lasix and potassium starting soon right after your ablation for a number of days to help bleed off any potential excess fluid retention that might have been due to the irrigated ablation catheter plus other ablation related fluids given?

And did you have any significant weight gain in the first few days post ablation? I'm assuming too that your EP did use an irrigated RF ablation catheter? ... and if so then very likely he or she used a foley urinary catheter as well to further insure reduction of any excess fluid build up in the immediate days post-ablation ... do you recall if that is the case?

If you are not sure about an irrigated catheter being used, and if you don't recollect being given any diuretic such as Lasix (and perhaps potassium tablets too) in the few days after your procedure make sure you bring up this issue with your EP and staff as such a possible oversight could be contributing to your no doubt no fun at all shortness of breath.

It is possible that these symptoms either totally, or in part, could be due to excess fluid overload from the RF irrigated ablation catheter typically used during your recent ablation (ABL) ... although it is rare with modern irrigated catheters that only produce a lower heparinizeda saline flow rate of: ~ 15mls/min of fluid (compared to the older original Thermocool Catheter of circa 2008 that put out ~ 30 mils/min of saline fluid) ... for enough fluid build up to occur to cause the kind of severe SOB you have described, Aldona, for this to cause any sustained shortness of breath symptoms ... that doesn't mean your symptoms can't happen in rare isolated cases.

This post-ABL protocol is also likely to have been used mainly because it is common standard-of-care practice to carefully assess post ABL weight gain, and include a post-ablation course of the diuretic Lasix and possibly potassium tablets too for several days after the ablation (if required) ... not to mention frequent use of Urinary Foley catheters too to further help reduce excess fluid retention.

Foley cath's used to be considered standard too for many years ... though Foleys are thankfully not needed as much now with the recent exception for those ABLs featuring a modern new collagen plug-type groin puncture device (Vascade) that obviates the need for a Foley all together.

In any event, Aldona, do get this all sorted out ASAP with your EP (or other experienced physicians if EP is on holiday) as your symptoms can also potentially reflect a more
dangerous condition as noted above by Jeff, Carey and AntiFib.

However, due to these symptoms arising so soon after your recent ABL around two weeks ago, and considering too your noted recurrence of arrhythmia occurring some 14 years after your initial two back-to-back successful PVI ablations in 2006/2007 ... leading to an understandably more extensive 3rd very late recurrening ablation ... then even more I would suspect a fluid overload issue may be the likely culprit for your very uncomfortable SOB episodes this last couple of weeks. And if this is true, it should be a pretty straightforward fix as well once sorted out with your EP.

Keep in mind, too, that spiking BP call also cause excess fluid retention as well ... so whether or not the spiking BP came first (chicken or egg?) or may initially had gone unnoticed until further increase in SOB revealed that as well, is certainly worth considering.

Bottomline, if these symptoms are directly related, as seems likely, with post ABL retention of excess fluid overload that can direct create transient SOB ... then this all may well resolve with a longer course of IV or oral Furosemide (Lasix) and possibly additional potassium tablets for a week or so longer ....

Then again, if your SOB and spiking BP symptoms prove not to be associated with post-ABL fluid retention, then all the more reason to get this issue resolve today one way or another!

Best wishes,
Shannon



Edited 3 time(s). Last edit at 12/28/2020 11:16AM by Shannon.

Thank you for all your responses to my post. In past two days I have noticed definitive changes in my SOB for the better. Currently I am on 50 mg Lopressor, 5 mg of calcium channel blocker Amlodopine, Xarelto 5 mg and Felcanaide added after breakthrough AF post ablation. The protocol of ablation was this same as it's applied in Bordeaux. I did have catheter during and after procedure for 24 hours to dispose of all fluids via urine. All was measured carefully to established amount of fluid expelled I was not given any diuretics or potassium supplements. I was never given them after my previous ablation. One week after this ablation USG of heart, ECG and lung exrays were done before my check up visit with doctor who performed my ablation. The results of the tests were good. I do not have any kind is eadema in any part of my body. My blood pressure now is good. Today I had quite an energy and will to do something..I think that things are turning for the better however I was surprised by the SOB as I never experienced this previously. Last night I slept with out waking up. I think that the symptoms I have experienced were due to the very invasive and extensive ablation this time. There must be some serious inflammation from all burns and I hope it settles soon. My resting pulse is 61-68 I think it's pretty good as I read that many people have elevated pulse for several months after ablation. Currently it's a vacation season here. It's absolutely not possible to get hold of surgeon as well as my cardiologist as well as my family doctor is out of surgery till 4 January. When she cames back I will seek counsel. I will purchase the machine measuring oxygen levels in a meantime. SOB is now occuring when I exert and pulse rises above 85 or more but this is normal I think. As far as I remember I had to ,very slowly introduce, after 2 previous ablations, to any form of exercise that was rising the heart rate.