A fib and flutter beginning 9 days after ablation

It is my understanding that arrhythmia can become worse in the blanking period after an ablation 9 days post ablation I had 2 1/2 days of arrhythmia, which turned to flutter, then had a cardio version to return to sinus rhythm. 3 1/2 half days later I appear to have flutter again, on the weekend of course, and hoping it self corrects. Is this common after ablation? I am taking rate control drugs, 120 mg 24 hour diltiazem, 12.5 mg metoprolol, and added 30 mg diltiazem as needed.

Although it's not unusual to experience arrhythmias following an ablation, you seem to be having more than necessary. Since you've been cardioverted I assume your EP knows about this. Has there been any discussion about adding an antiarrhythmic drug? Rate control drugs aren't going to solve the problem so I'm puzzled why you're on two of them. Talk to your EP about adding an antiarrhythmic and maybe dropping one of the rate control drugs.

I don't know that it is 'common', but I know someone close to me who learned he had atrial flutter only when it was revealed during a checkup. He was ablated within six days, and seemed fine. He wore a Holter Monitor about six weeks later and there it was....back. I haven't seen him since his second attempt about two weeks ago (I should ask).

So, as individuals, we'll all have individual responses to the intrusion and alterations that come with RF catheter ablation. The hand-out given to me as I returned home was that RFCA is a 'big deal', and that one shouldn't expect smooth sailing when one leaves the operatory. Additionally, those who develop a cranky heart in the first month, but that it settles a lot in the ensuing weeks, do better over the long run than those who are initially stable and then go on to develop more crankiness in the next few weeks up to 8 weeks after the procedure. This is empirical, from a study that I might be able to find...again...if I have to.

Said another way, if your first month is bad with some arrhythmia, but then the heart is better thereafter, you'll probably do well. On the other hand, those who seem initially stable, but whose hearts develop some or substantial arrhythmia toward the end of the blanking period, are probably going to need further investigation and mediation.

My own experience is close to what Gloaming says.
I've had four ablations, and the first one has been the hardest on me. It took me weeks to recover, taking some sotalol.
Touch-up ablations were more bearable, but the first months after the procedure were each time the worst.
Let me add it might have been stress related too...



Edited 2 time(s). Last edit at 08/28/2022 02:17PM by Pompon.

EP Knows about the first 2 1/2 day occurrence, and I had a cardioversion. Three days later, it has started up again.
Both times on the weekend. Will call tomorrow about this weekend arrhythmia I’m having again. Thank you for the suggestion on the antiarrhythmic drugs. I’ll ask about that. It has not been mentioned yet.

Interesting. Thank you for sharing.

It's very common for EPs to prescribe an antiarrhythmic for the first month or two following an ablation. Many don't even wait to see if it's needed because it so commonly is. The lesions they create during the procedure haven't become effective yet at blocking electrical signals, so they can't block afib. As they heal over the coming weeks, they turn to scar tissue and scar tissue doesn't conduct electrical signals. That's what makes an ablation successful, but it takes time for the process to complete.

Natale has had me on 100mg Flec x2 and 50mg of Metoprolol since ablation 8/9/22. So far no apparent irregularities. What is interesting is this is the exact dose that didn’t keep me in NSR after my initial cardioversion prior to ablation.

My exper. was between day 3 post RF ablation + day 12 i had 6 countem 6 ARRYTHMIA'S....6 in 9 days yikes the worst ever for me then 1 month of NSR then a final ARRYTHMIA about 40 days out (all 7 lasting about an hour + all KOed by chewing 1x150mg Propafenone PIP within 5-10 min. of starting). After that i have been in NSR for nearly 4 years so don't sweat too much your situation in the early blanking period. As was pointed out here the time to be concerned is if around 2months or so through your blanking period + this keeps happening well most likely you will be going back for a touch up but even then give it that last month before preparing for the next EP table trip.

Thank you

Thank you for this information. This last episode ended up being 54 hours over the weekend. I called the EP office on Monday and they are putting me on an anti-arrhythmic, like you mentioned. Hopefully this will help.

Since I’ve had a couple of long episodes of a fib/flutter, they are putting me on an anti-arrhythmic now. Thank you for bringing that up.

Thank you for this information. I will be adding the rate controlled drug,
Flecinade to a small dose of metoprolol. I’m a little nervous to add a rate control drug to the mix, but I think it’s necessary.

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ZoeySusan3464
Thank you for this information. I will be adding the rate controlled drug,
Flecinade to a small dose of metoprolol. I’m a little nervous to add a rate control drug to the mix, but I think it’s necessary.

Flecainide is the antiarrythmic—perhaps the one moist commonly prescribed,—while metoprolol is the rate control medication. Good luck, hope it works well!

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ZoeySusan3464
I’m a little nervous to add a rate control drug to the mix, but I think it’s necessary.

You should be nervous about not having metoprolol in the mix. The two are almost always prescribed together, the reason being there's a rare but dangerous side effect of flecainide if it's taken without a rate control drug.

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Carey

I’m a little nervous to add a rate control drug to the mix, but I think it’s necessary.

You should be nervous about not having metoprolol in the mix. The two are almost always prescribed together, the reason being there's a rare but dangerous side effect of flecainide if it's taken without a rate control drug.

Carey, could you expand on your last.

Flecainide can lead to a very rare condition referred to as 1-to-1 conduction, often abbreviated as 1:1 conduction. What that means is it can cause your AV node to transmit every beat from your atria down to your ventricles instead of slowing them down as it normally would. If you happen to be in afib or atrial flutter, your atria can be beating at a rate of well over 200, maybe even 300. So if your AV node transmits every one of those beats to your ventricles, that's how fast your heart is going to be beating, and 200-300 obviously isn't a sustainable heart rate. So a rate control drug is usually given with flecainide as protection against this rare side effect.

Update on the ablation that I had on August 10, 2022. On day nine through the end of August, a fib/flutter increased from what it was prior to the procedure. Starting my second month of recovery, a fib and flutter completely stopped. As far as I know, I have not had an episode since. However, it should be noted that three weeks after the procedure my position did add a low-dose of Flecanide to my meds. This is to be a evaluated and discontinued soon, assuming I don’t need it.
My understanding is that it takes time to develop scar tissue after an ablation, which reroutes the electrical impulses of the heart, to prevent the a fib. So far so good, even though it took several weeks to improve.