high pulse rates after all ablations?

Hi,

I actually have a few questions.

One, I usually tend to have a higher than comfortable for me pulse rate (80s to high 80s & even to 90+sometimes). Maybe partly due to having a total thyroidectomy 17 yrs ago & hard to regulate.

I am also wondering if one will go through that long period again of higher than normal pulse rates after a 2nd ablation, which was 3 yr after first because of untreated flutter after 1st one but not wanting to travel yet when pandemic began. So 2nd ablation with partial LAA closure was this past August & I am about to go back to Austin for TEE to see where I am.

Is there any way to gauge if you might be having problems that will warrant Watchman - like easily getting breathless, fatigued, or having a pulse oximeter but getting good 02 levels in 90s, feeling uncomfortable with high pulses. No arrhythmias of concern though, weekly Kardia readings NSR.

I took a 45 min walk this AM (do that a lot), then have been in kitchen cooking with one break to pay some bills. I am so tired & breathless & pulse is 93.

One other health issue is an intracochlear schwannoma ("benign" vestibular tumor) that eventually caused deafness in one ear & about 3 yr ago had an episode of vertigo on waking that has left me with dizziness or at least bouncy feelings all the time. Especially when taking my walks in forest (dappled light, tree roots, winding paths, up/down) & esp in kitchen bec there seem to be so many stops/starts, turns, constant motion & work & on my feet. I have brain MRIs with and without contrast to monitor the tumor & it slightly increased last Feb. I do very well in that I keep up with exercise & activity & even balance though not what I used to be at all, but I feel a lot more tired.

I never know if my fatigue, breathlessness, racy pulse are due to my heart problems, thyroid problems though my stats are fine, or my vestibular problems. Right now for example, I don't feel right - very uncomfortable bec of my pulse.

What does this high pulse or uncomfortable feeling point to? Will it settle down ages from now bec of Aug ablation making it stay up a yr or 2 & what on earth will happen to my pulse if they decide to finish off the LAA after TEE results indicating that need in a couple of weeks from now?

Also I have to taper and stop my carvedilol 6.25 mg before the Watchman with possible ablation later. The carvedilol calms my pulse some, so it is uncomfortable thinking of stopping it bec of the way I feel now. I stopped it the last 2 procedures & was fine. It is just while I am feeling the way I do now, I hope I won't get into any problems when stopping it next week.

Thanks. I know - so many variables, hard to say, but the racy heart feeling might be something the afib group would have a comment on.

Yes, most ablations cause an elevated heart rate for a prolonged period, often upwards of a year. But there are exceptions. A few people here have reported no elevation following ablation (though I'm not sure how many of those were taking rate limiting drugs).

None of the symptoms you report have anything to do with a Watchman. They won't exclude you nor will they justify one. What will justify a Watchman is the TEE. If your TEE shows adequate flow velocity in the LAA, an appropriate E:A ratio, and no "smoke" in the left atrium then you won't need a Watchman, but the odds of that are only about 40%.

A heart rate in the 80s and 90s that's normal rhythm doesn't cause the symptoms you describe. But what can cause them is the carvedilol. Beta blockers cause pronounced fatigue in many people, including me. Carvedilol isn't as bad as metoprolol, but I still feel it. I suspect the vestibular problems are the source of at least some of this. What makes you think you feel "off" because of the heart rate? After all, the 80s aren't very high. That's perfectly normal for some people, and most people will go that high just from standing up and walking across the room. Count me as skeptical that the heart rate is the source of your symptoms.

Another ablation isn't going to raise your heart rate even higher; it will just extend the time it's elevated.

Since my 1st ablation was in 2019, I am well aware of reading here about elevated ht rate after ablation for possibly a yr or longer or none. Thing is, I never took my pulse before, so I had no idea if mine was elevated after the first ablation. I do know one thing - you & I are different with re to pulse - pulses in high 80s definitely make me feel bad, racy, can feel the rapid ht beat, anxious, fatigued or lightheaded from all the heart raciness coming on that is not there all the time from a beta blocker. It just comes at certain times & is not always there.

I like carvedilol & I take a relatively low dose I believe - the only dose lower is one step down. It calms me. I don't need to be kept up bec that is my natural state - too excitable, fast metabolism, anxious. The carvedilol also calms my benign essential tremor of hand. I feel that extra fatigue when the pulse gets racy. I used to feel the very same thing when years ago I took Anacin which had caffeine in it, but that got rid of my non-classic migraines, but then I would feel lightheaded, anxious, racy & unstable. It was a Catch-22-got rid of the headache somewhat, but gave me awful other feelings. I did not even know it had caffeine in it when I was younger. I am extremely sensitive to caffeine. Until Imitrex came into being, when I was younger I had no choice re my chronic headaches.

Otherwise, it is quite likely related to thyroid. The vestibular stuff makes me tired in general, but this particular racy feeling that gets me short of breath when I have been working hard & I can feel my heart beating does not seem due to my ear tumor. The ear tumor gives a level of fatigue in general, but I am talking about episodes that come on at times, not all the time. Before the ear tumor affecting me, the beta blocker I had already been on did not do that.

You ask why I feel my racy feeling in the heart has something to do with my heart - bec that is where I feel it & when I check my pulse during those times, it is always higher than usual.

At least now I know another ablation won't make ht rate go higher, just prolong that rate possibly.

Also, what is an E:A ratio & what is smoke in the left atrium?

Thanks.

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Carey
Yes, most ablations cause an elevated heart rate for a prolonged period, often upwards of a year. But there are exceptions. A few people here have reported no elevation following ablation (though I'm not sure how many of those were taking rate limiting drugs).

None of the symptoms you report have anything to do with a Watchman. They won't exclude you nor will they justify one. What will justify a Watchman is the TEE. If your TEE shows adequate flow velocity in the LAA, an appropriate E:A ratio, and no "smoke" in the left atrium then you won't need a Watchman, but the odds of that are only about 40%.

A heart rate in the 80s and 90s that's normal rhythm doesn't cause the symptoms you describe. But what can cause them is the carvedilol. Beta blockers cause pronounced fatigue in many people, including me. Carvedilol isn't as bad as metoprolol, but I still feel it. I suspect the vestibular problems are the source of at least some of this. What makes you think you feel "off" because of the heart rate? After all, the 80s aren't very high. That's perfectly normal for some people, and most people will go that high just from standing up and walking across the room. Count me as skeptical that the heart rate is the source of your symptoms.

Another ablation isn't going to raise your heart rate even higher; it will just extend the time it's elevated.

Well, you're rather unusual if a normal heart rate in the 80s is something you feel and it really bothers you. I don't know why that might be. If you do normal exertion that raises your heart rate that high, does that bother you too?

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Madeline
Also, what is an E:A ratio & what is smoke in the left atrium?

The E:A ratio is a boring number you don't actually need to understand, but it's important in the decision whether you qualify for a Watchman. You can read about it here.

"Smoke" in a TEE indicates low blood flow velocity, which is an indicator you need a Watchman. You can read about it here.

It's all about blood moving in and out of the LAA. If your LAA is pumping and moving blood adequately, you don't need a Watchman. That's what this TEE is all about.

Thanks Carey, another question I just thought of is about anesthesia. Since I will have the TEE earlier in the day and then they told me if the results indicate, later the same day I would get the watchmen. I am told one can have a sore throat after the TEE. That has never happened to me after the anesthesia for the ablations, even the last time that I was in the hospital when I got pericardial effusion and had to be taken back and put under again, I did not experience sore throat. but I don’t know if they intubate both times or what. So I am wondering what to expect this time: would I be intubated both times for anesthesia causing even more throat soreness at the end of the day?

You aren't intubated for a TEE but they do pass a scope down your esophagus so that's why the possible sore throat. I've had half a dozen TEEs and never a sore throat. If you do experience a sore throat, it will be a minor annoyance at most. It's no big deal.

I don’t even know if we’re intubated for the ablations. Is it general anesthesia and is there a tube passing down the throat or is it just do an IV?

And for the watchman procedure - the anesthesia and style there?

Thanks!

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Carey
You aren't intubated for a TEE but they do pass a scope down your esophagus so that's why the possible sore throat. I've had half a dozen TEEs and never a sore throat. If you do experience a sore throat, it will be a minor annoyance at most. It's no big deal.

They use general anesthesia for ablations and Watchman implants, so therefore you'll be intubated. Again, if you have a sore throat at all, it will be a minor annoyance that lasts maybe a day or so. I think out of 6 ablations and 1 Watchman, I had a very mild sore throat once or twice. Definitely nothing to be concerned about.

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Carey
You aren't intubated for a TEE but they do pass a scope down your esophagus so that's why the possible sore throat. I've had half a dozen TEEs and never a sore throat. If you do experience a sore throat, it will be a minor annoyance at most. It's no big deal.

So what anesthesia is used for the TEE. Possibly having watchman with general anesthesia later in day.

My TEE lasted 7 minutes and all I got was an iv of propofol-same as an ecv.

A TEE at St. David's will use only propofol, but with longer procedures like an ablation, the anesthesiologist will probably induce you with propofol but then switch to longer-lasting agents during the procedure. That's pretty standard.

Propofol twice in one day is no problem.

Note that some hospitals will only give you a numbing agent to gargle. You'll be wide awake for the whole thing as they stick a garden hose halfway down your esophagus. I wouldn't agree to such a procedure.

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Carey
Note that some hospitals will only give you a numbing agent to gargle. You'll be wide awake for the whole thing as they stick a garden hose halfway down your esophagus. I wouldn't agree to such a procedure.

Ha! Me neither!!!

Thanks, should be all questions fully answered by now, sure you hope so :-) heh heh