Ablation -tachycardia

I had an ablation on June 29 and all going well until this morning, Sunday July 4. (day 5) I woke up to a racing heart that my apple watch says is over 120, but is more like 170. I was told to come back in if I had afib that persisted for very long, but was really given no guidelines about how much is too much, or for how long. I would have to go to emergency room today because of the July 4 holiday. I was taken off of sotalol and am on nothing for afib or heart rate. I have not had this heart rate problem before. I basically don't know how long to wait, before I go in. I am on eliquis and I feel ok.
Before the ablation, my afib episodes usually lasted 6-7 hours. Thanks for any help.
Is there any problem if I take a sotalol?

Hi, your still very very early in your blanking period, I’m sure this is just your heart being a little bit aggravated by being burnt, I wouldn’t worry too much unless it lasts a while,
Carey or one of the other more knowledgeable posters here can probably tell you more,
But for now maybe just relax and hopefully it will be a small bump in the road👍🏻👍🏻👍🏻

Juggsy right. Too early. You are fresh in the trauma dept. call the office and ask what you should take.
Need a rate control should it not terminate which i bet it does. We all have our own hell stories
The one thing i do now is drown myself with water and use alot of mag. All day! Every day
Tom

Thank you! Only problem is I can't call today or tomorrow (7-4, and 7-5 federal holiday in US). The rate has gone down from about 160 to about 130 and I am drowning myself in water and have taken some mg.

Ive had so many episodes that strike on a fri or even out of town. Wife and i went to Asheville last yr
Air BB awesome! Went to breakfast first morning; boom! 145. We left and drove home. I walked up our stairs and converted
We drove back the next day 2.5 hrs
You ll be ok. On eliquis. Someone must be on call! ER just gonna rate control you with diltalizem iv. I still think you ll convert
Lets see what Carey thinks. Hopefully he ll chime in. Is it afib or tach/flutter?
T

How long is too long to wait before going to ER. (it is 6 hours now. Can I wait 10 hours, 12 hours, 24 hours?) I am also hoping I convert! This feels more like tachycardia than afib but there may be some extra beats in there. I havent had flutter before that I know of. I know everything has changed now. Rate is back up to 160

Now about 8 hours in it is afib with a pulse a little over 100.

Well 100-110 is better. Your EP has to have someone on call. Being protected by eliquis buys you time
Im not the one to say how long. Waiting is an anxiety creating scenario but in reality you probably can wait a long time
Tomorrow is monday. In 2008’i was left in afib 5 days! No eliquis then. Cardioverted after a TEE. If its not converted then get on the phone. If you need peace of mind then can always go to ER
Are you in a small town? I wish Carey would interject There are many cases that require a cardioversion shortly after ablation. Does not mean failure. But hang in there i know it’s horrible. You should have been given an anti arrhythmic like rythmol or flecanide. Ive converted using diltalizem and propananol in 3 hrs
T

Jennifer,

During my first run of afib - 6 years documented with over 200 episodes, I had 24 of them last for more than 24 hours (longest - 72 hrs). I only went to the ER once for a conversion, the rest converted on their own. I was on Plavix and Toprol, but I don't recall what my heart rate was when I was in afib. This was back in 2001 - 2007.

I am thinking you can wait a bit without worrying too much. If you still have a rate control drug, take it and relax.

Something was said in recovery about cardioversion for afib but I was given no guidelines or parameters. I'm in Bloomington, IN, with a excellent cardiology team. Just no way to get them without going to ER today or tomorrow - because tomorrow is the federal holiday. If this is all normal and expected, then I am cool with it, although I feel a lot better now that my heart rate is down.If my heart rate goes up again or the afib continues for hours, I will go to ER. In the past before ablation I would suspect that my afib is about over. But I have no way to gauge. I did take sotalol earlier although they took me off it after the ablation. I took 1 dose about 4 hours ago.

Im very familiar with Bloomington and IU. My entire family originated from Martinsville my Grandfather was the mayor 1950-54
I sure hope you click back to nsr. But yes youre good for quite a while when anticoagulated. So take solice in that. I ordered a magnesium called Angstrom Magnesium
Its liquid. I take that some along with mag gly. Its on Amazon. We ve all been where you are! It ll end. Shannon told me once he flew from Amsterdam to Hawaii at 177! Youll be ok!
Gonna Pray for you.

Thanks! I drive through Martinsville all the time! I'm taking magnesium bisglycinate but I still have to be so careful not to take too much or I have extreme intestinal problems.Thanks so much.

With your heart rate now down close to 100 there's no need to visit an ER. You can wait days if necessary. Even back up in the 150-170 range you can still wait days, though I wouldn't recommend doing that to yourself. Taking the sotalol should be fine as long as they didn't stop it for some specific reason such as a widening QT.

The blanking period esp. the 1st few weeks can be kind of crazy...between day 3 post ablation + day 12 i had 6 afib attacks.....all converted in about an hour through 1x150 Propafenone chewed but pure crazyness then pretty much total bliss so don't sweat it too much...the heart is just adjusting itself.

Jennifer how are u doing?
T

I ended up going to ER on the fourth of July which was so delightful. No one had any idea what was going on and it took hours and hours. I already knew this is what would happen. They were getting 130s for HR and gave me metopropol. They were very confused because they were counting my afib beats at 130s and my random regular beats at 90. Finally I just went home and at home it was 130 rate but it converted at 4 am with NSR and 74 pulse. I finally got in touch with my doctor and they gave me some guidelines and a script for metopropol. Here are the guidelines they gave me "Max heart rate based on your age is 151 bpm. I would try to avoid going to the ER unless she has heart rate >140 bpm for several hours (like 6-hours). Of course if you have chest pain or feel like you are going to have syncope ER is appropriate. She can take metoprolol as needed if heart rate is >140 bpm for >15-minutes."

So today is July 8 and I have been in afib again since midnight. I know this is normal but I am so depressed. I work full time and I can work with afib, but it's hard. I didnt get up during the night to check the rate, but I know it was 130s for a while. It is more like 110 now. Before the ablation I had episodes every few months. I know this is just a waiting game, but I feel hopeless right now.



Edited 1 time(s). Last edit at 07/08/2021 11:15AM by jennifer92151.

Yes you re going thru hell and hate it for you. But June 29 not very long ago so it’s possible that your irritated heart is just adjusting while healing. Metropolol will not convert you
Only slow rate. I guess it might help but they should give you an anti arrhythmic for a month. Has your EP suggested it? Ask! Propafanone or flecanide are the 2 most common
I understand the depression but this will end. Did they put you on ppi s for esophagus? Your on eliquis. You may have to raise hell. Get your ep on the phone tomorrow

It's been a little over a week, so this is pretty much par for the post-ablation course. This is also why many EPs prescribe an antiarrhythmic for the first month or two following an ablation. I'm a little puzzled why they didn't, particularly after you called. They could always go with something very mild with minimal side effects like Multaq. The next time you talk to them, you might want to ask about that.

Thank you. I have been messaging with my NP and her nurse has called me several times today. I was in afib about 15 hours and then it switched to straight tachycardia with no afib. The heart rate is around 130. The ER doctor had prescribed metoprol so the NP said to take it as needed for the fast heart rate. It did nothing for me on July 4 and nothing changed until my afib was gone. Today so far it has been about 4 hours since I took the metoprolol and it has done nothing at all. Heart rate has not changed or decreased. I took flecanide for a couple of years, but finally started having long pauses in my heart beat, so went off of that and was on sotalol when I had the ablation. I also wonder why they did not prescribe an anti-arrhythmic after the surgery. They specifically took me off the sotalol. This high heart rate thing is new to me, and very worrisome, but I am glad the afib is gone, at least for now. So I have either been in afib or tachycardia since midnight last night, about 19 hours so far. I have to work all day tomorrow so I am hoping it will be gone by then. Oh and yes I am on PPI for esophagus and hate it. And yes, I am on eliquis.
Thank you!

Ok well you could be in flutter or afib to flutter then back. Morphing. Not uncommon. Did they ablate right side flutter?
If not could be that but i had many afib episodes not irregular so who knows. Your EP needs to get involved!

I wasn't told they did right side flutter. I have not ever had flutter that I know of.

Ok then you musta never had right flutter Maybe they can get a fresh ekg while in the bad rythm
Do you have Kardia? The ekg will confirm afib or by chance flutter Flutter is a regular rythm unlike the erratic afib
And usually fast and not likely to convert spontaneously

Yesterday (july 8) I had afib from 12 am until about 2 pm when it turned into tachycardia 120-130. I took metoprol at 4 pm. Went to bed in tachy of about 130. I felt afib all night. Sometime after 4 am I converted to NSR with normal pulse. I have messaged the EP about taking sotalol (or something else) for the afib. I think the metoprol does nothing for me. I think the afib needs to be controlled and that will control the pulse rate. I hope it is all just gone now, but not hopeful.

Awesome!!! Im no one to talk lol but try and be calm positive and strong. I still think your 6/29 ablation is so fresh that youre having these episodes. They may very well calm down or become farther apart and shorter. Water!!!! Magnesium!!!! Ubiquinol!!!
Hope you can rest. Try and get your mind on good happy things. Im beginning to work on my own anxieties! We can do it!
Tom

How much ubiquinol?

I do 200-300 per day spread out with food. Hey! Now im in tachycardia as of 14 hrs ago
Tom

I've been in Afib since last night at 10, so 19 hours now. So far tachycardia not as bad, I took sotalol last night and this morning. No one ever got back to me about whether or not it was ok. I'm sorry about your tachycardia.



Edited 1 time(s). Last edit at 07/11/2021 05:08PM by jennifer92151.

Quote
jennifer92151
I've been in Afib since last night at 10, so 19 hours now. So far tachycardia not as bad, I took sotalol last night and this morning. No one ever got back to me about whether or not it was ok. I'm sorry about your tachycardia.

Does your Ep know you are taking sotolol with a history of having pauses? It’s a strong drug to risk experimentation. IMHO. I had to go off of Sotolol when my pauses started under the advice of my EP’s NP.

[www.uofmhealth.org]

You should not use sotalol if you have asthma, low potassium, or a serious heart condition such as severe heart failure, long QT syndrome, slow heartbeats that have caused you to faint, "sick sinus syndrome" or "AV block"

I couldn't reach them Friday. I had the pauses on flecainide. Have not had a problem with sotalol except it wasn't working as well lately. When the doctor released me from hospital he said kind of as an after thought, I think I'll take you off sotalol. Didn't sound like a serious decision, certainly not a warning. I have none of those conditions you mentioned. I know I should have asked first. I do think it has helped with my heart rate as I have not had much tachycardia with this very long afib session. It seems more tolerable than the first two. I will talk to them tomorrow. I am really hoping this resolves soon.

When the doctor released me from hospital he said kind of as an after thought, I think I'll take you off sotalol.

I don’t know why some doctors speak mute. I had asked my local ep before my flecainide overdose if I can take 300mg and he said no. Had he expanded his answer to include “because your weight doesn’t qualify the recommended dose,” I would had saved myself getting a flecainide overdose and the icu visit.

Perhaps you should ask him.

Now I just say “can I buy a vowel? “ if I don’t get answers or a complete sentence.



Edited 1 time(s). Last edit at 07/11/2021 10:38PM by susan.d.

Quote
jennifer92151
Have not had a problem with sotalol except it wasn't working as well lately. When the doctor released me from hospital he said kind of as an after thought, I think I'll take you off sotalol. Didn't sound like a serious decision, certainly not a warning.

You should be fine. Talk to them but I would continue taking it if I were you.

Yeah, I have been messaging them, but a long response time. I am still in afib and tachycardia since Saturday, so going on 48 hours. Today the nurse did call and said that I can take sotalol but that they don't think it will help, but if I do take it regularly, twice a day, they want to do an ecg in 3 days. Otherwise they say all of this is normal and of no concern. They think the tachycardia is actually flutter, and not dangerous. So I do not want to go in for an ecg, so I told them I woiuldn't take it. NP also said that after an ablation, the symptoms often get worse before they get better. So I guess I will tough it out.

I think it's flutter too, and I agree the symptoms often get worse before they get better, but that's kind of a lame answer.

If I were in your shoes, I would take it.

This last episode of afib, flutter?, tachy? started Saturday evening and stopped this morning about 6 am, so about 56 hours if I did the math right. I only took sotalol twice at the beginning. So I'm good for now, but am fully aware that it may be back. Ablation was 2 weeks ago today.

If I were you, I would continue the sotalol on a daily basis until you can talk to them. It's better at preventing episodes than stopping them, so until your EP gives you a better option, I would choose staying in normal rhythm with a drug you know is safe for you rather than just trying to tough it out for the next 4-6 weeks. But sotalol is kind of a heavy hitter and there are drugs like Multaq that are "milder" that might work for you. You might want to ask them about something like that.