Cardioversion 2 weeks post ablation?

I had my ablation for flutter and afib May 16. A few days later I started having some short afibs. My heart rate usually stays below 100 at rest but sometimes goes 100-110 for a bit. During the months waiting for my ablation I took no meds except Eliquis. A primary reason for me having the ablation was to not have to take rate or rhythm control drugs. I track my ECG on an Apple Watch and a Kardia device. The doc/nurses have asked for me to send them several of these tracings each day. Some show afib but some sinus. Yesterday a nurse wrote that I should start taking some diltiazem and then they want to schedule me for a cardioversion "if my heart remains in persistent afib". Has anyone had a cardioversion just a few weeks after an ablation for Afib? Why is she saying I have persistent Afib when the devices often show sinus?I have asked to speak with my doc directly but since it is a holiday weekend I probably will not hear back until Tuesday. thanks

I've had a cardioversion two days after an ablation. That's not uncommon at all and nothing to be concerned about. I'm a little surprised they're only recommending diltiazem before the cardioversion and not an antiarrhythmic, but I'd go ahead and try it. (Diltiazem is a rate control drug, not an antiarrhythmic.)

I don't know why she called it persistent afib. Persistent afib is defined as afib that doesn't stop without intervention for a week or more. Maybe she was using the word "persistent" more generally.

After my Ablation i went 3 day's perfect then in the next 9 days following the perfect 3 i had 6 Episodes yes 6 in 9...the worst 9 day Afib period i ever had.....that i was able to KO each episode in around an hour chewing a 150mg Propafenone pill then Bliss till now 3.5 years later so don't worry too much although i would suggest even after a successful Ablation you might get episodes for a while like you, Carey, I + many others have gotten so until you hopefully get to where you need to go.....get a PIP to help you bridge to that point + to keep you out of the ER also which is great for peace of mind that cannot be understated.

All the best...Keep the faith

Thank you....so you were able to stop the Propafenone? Do you take an anticoagulant?

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bneedell
Thank you....so you were able to stop the Propafenone? Do you take an anticoagulant?

No.....i only took the blood thinner for a period of time a few months or less after my Ablation.

The Propafenone drug is very much mainly used as a need only every few days or weeks ect. whenever an ind. has an Afib episode starting. It is swallowed or in my case Chewed right after the heart first starts going wacky then it stops the episode cold as the PIP (pill in pocket) term comes from.



Edited 1 time(s). Last edit at 05/29/2022 02:53PM by vanlith.

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vanlith
The Propafenone drug is very much mainly used as a need only every few days or weeks ect. whenever an ind. has an Afib episode starting. It is swallowed or in my case Chewed right after the heart first starts going wacky then it stops the episode cold as the PIP (pill in pocket) term comes from.

For bneedell, here is the original paper on PIP [www.nejm.org]

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bneedell
Do you take an anticoagulant?

I can virtually guarantee you you're going to be on an anticoagulant for at least 3 months. Your doctor would be irresponsible to take you off it before then unless you have bleeding problems.

After that, it's going to depend on your CHADS-Vasc score and the success of your ablation. Click the link and tell us what your score is. That will help us a lot to understand where you're at.

Sorry for the delay .I've been really struggling...my Chad Score is three and I'm really OK with staying on Eliquis at least for now .since I last wrote I've had a few days of just sinus and then my Kardia and watch say afib for a while again now most days ...my doctor ordered an ECG at a hospital outpatient center and now he is saying it's looking like flutter ..Corey, I think you've gone through this! The nurse told me she thinks it's atypically flutter on the left..so maybe it's a result of the first ablation? My heart ratem is also high so I'm taking some diltiazem that they prescribed but now they're wanting me to take Multaq and see if that helps with the rhythm. Reading about Multaq really scares me.I weigh 95 pounds and before this started was taking absolutely no medication I may have damaged my heart myself 40 years ago using a lot of cocaine for 10 years. I stopped the day I got pregnant with my first son but now it may be coming back to bite me.I did have tachycardia and about 20 years ago had an ablation that fixed that. I eat well,mostly vegetarian a little fish how many low-fat dairy was exercising a lot until the ablation now I can barely do 40 minute flat walk a day but I'm doing that. I am 73. I'm so glad I found this group. I just woke up and I'm writing this from my bed on a tiny Apple mini phone so please pardon any typos punctuation etc. thank you

If you counted the point for being female, you can subtract that, making your CHADS score 2. (The guidelines were changed in 2019 to remove the point for being female.)



Flutter is a common problem following ablations. Yes, it almost certainly is due to the ablation, but it may not continue. I would definitely try the Multaq. Read up on any cardiology drug and they all sound scary, but Multaq is actually one of the mildest antiarrhythmics there is with very few side effects. That also makes it one of the least effective, but there's no harm in starting out with the milder, safer choices. It worked for me following my last ablation, and I only had to take it for a month.

None of this points to any heart damage. It's all pretty standard right now. You should expect bumps in the road during the blanking period. If the flutter continues beyond a month from now, I'll begin to say you're probably going to need a touch-up procedure to stop it.

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Carey
Multaq is actually one of the mildest antiarrhythmics there is with very few side effects. That also makes it one of the least effective, but there's no harm in starting out with the milder, safer choices.

I started Multaq after Flecainide failed and, much to my surprise, it is working very well. It does give me digestive troubles which I am learning to manage with an awkward meal schedule.

Thanks so much Carey. If it is a left side atypical flutter is the ablation difficult ?(if mine does not go away). Also, I am in sinus most of the time but with some flutter. How much flutter did you have after your last ablation?And was your last ablation to fix the flutter caused by a prior ablation?

Typical right-sided flutter is generally very easy to ablate, but atypical left-sided flutter can be difficult. It's not a task for an EP with limited experience.

My last ablation was my 6th (long story). I went into that ablation with afib plus flutter that routinely hit a rate of 250, plus another separate flutter circuit that ran at 120. I came out of the procedure in NSR. During the first month I needed the Multaq to keep ectopics and afib suppressed, but after that all the flutter, afib, and ectopics were gone and remain gone today (it will be 5 years in August).

So I'm not a good example for you to compare yourself to. A large percentage of the people here who've had ablations experienced flutter during the first month of their blanking period, but it will usually go away on its own. Your heart is inflamed and twitchy after the procedure, and it takes a few weeks for that to calm down and for the ablation lines to turn to scar tissue. So you just need the Multaq to keep things calmed down during those few weeks.

Carey...I started taking the Multaq just now, finally got up the nerve..your encouragement helped a lot. Can I ask you (or others who have taken Multaq) what side effects you had and when did the occur after beginning this drug? My EP's NP told me to stop the diltiazem before starting the Multaq,...so now I am just taking Multaq and Eliquis. I have been doing a 2 mile brisk walk with my dog daily (up from 30 minutes a week ago). I have been encouraged to get some moderate exercise...is the Multaq likely to make that more of a challenge? thanks

I experienced no side effects at all. It's really quite a mild drug. Keep up the brisk walks; your dog will appreciate it and the Multaq shouldn't add any problems. :-)

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bneedell
I started taking the Multaq just now, finally got up the nerve..your encouragement helped a lot. Can I ask you (or others who have taken Multaq) what side effects you had and when did the occur after beginning this drug?

I’ve been taking Multaq for a few months. As Carey said, it is considered to be a mild antiarrythmic with few side-effects. For me though, it gives digestive side-effects. It is most effective when taken with a meal that includes fat and protein. Before I started taking it with a full meal, rather than a snack, it was hard to tolerate the digestive troubles. Now, while I still have mild problems, I am tolerating them. I started getting these side-effects shortly after starting Multaq. It is keeping me in rhythm though, for which I am very grateful.

Thanks to both of you for your responses I have had low level nausea and I am making sure I take with meals my ..heart rate has gotten considerably lower and I have not felt any palpitations in the past few days.. just a few PACs . fingers crossed .I know that flutter is hard to pick up without a 12 lead EKG and I just have a Kardia and Watch.. No Afib episodes in the past 10 days so hoping that lasts as well. Step-by-step