Tachycardia after LAA Ablation with Natale

I have a 25 year history with paroxysmal afib. Managed with Pill in the pocket for years but after some further progression, went for ablation #1 in Austin February 2021 with Natale. The afib went but replaced by flutter. So in March 2022, I had the LAA ablated. He said everything was quiet from ablation # 1 still. All was quiet after the LAA ablation for 4 months…..but since then, tachycardia has arrived. I did some research in the literature and there is some data suggesting that this pattern of afib to flutter to tachycardia is not unexpected with LAA ablations. Not sure if that is true or not. I am currently on my 6 month monitor for a week - and it’s just persistent tachycardia of 120-140. I can tolerate it as long as I am not active but as soon as I walk around, I am lightheaded and dizzy. . The nurse navigator told me that being in tachy 24/7 for a week won’t hurt anything, but my gut sure doesn’t feel like that could be true. Anybody else experience this before? I am in line for watchman as soon as we finish up this monitor. Any advice would be appreciated.
Carey,…..I can’t imagine what 230-250 felt like….yikes.
Cindy L

I've heard from a few people who experienced similar tachycardia after an ablation, but not necessarily one involving the LAA. I've never heard that LAA isolation makes this more common. It's true that for one week a rate of 120-140 isn't going to do you any harm.

Has someone done a 12-lead ECG while you're in this tachycardia? How do you know it isn't flutter?

Yes, I had a 12 lead done…..it’s tachycardia per my cardiologist. Had a routine echo done last week and they confirmed it was tachycardia also. But we will see what Natale says after the monitor. His NP told me tachy is a problem more so with the LAA.

Hmmm.... Saying it's tachycardia means only that it's over 100 bpm -- nothing more. Tachycardia isn't a distinct diagnosis and can be caused by many things. Is your cardiologist an EP? If not, I would reserve judgement until you hear from an EP who has seen a 12-lead from you.

Local cardiologist is not an EP. I sent the 12 lead I captured locally to Natale about 2 weeks ago. We will see what his final determination is soon. I will let you know how it turns out. Thanks.

Cindy, I'm experiencing the same after an ablation I had in Dec 2022.

The tachycardia is miserable for me. I can't tolerate exercise or more than minimal activity because, after long periods of high heart rate, I start having chest pain, shortness of breath, fluid retention and now starting to have near-black episodes.

After having another CT angiogram and 2 ER visits with cardiac workups, my local EP has determined that what is likely happening is that the area ablated has affected the autonomic ganglion (which attaches to the heart in that area of the L atrium), and my autonomic system is now not functioning properly causing my heart rate to be unstable.

I'm back on an event monitor for a week. He said once he sees it he is going to try a couple of meds, but will likely need to correct it with another ablation.

Initially, my EP and his staff minimized my symptoms and acted like it was normal..... I had to be very persistent to get them to help me with this.

I'm also waiting to see Natalie who is reviewing my case. He is booked out pretty far so hopefully, I can wait it out.

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The one good thing about the covid pandemic.... it opened up Natale's schedule.

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Amara
my local EP has determined that what is likely happening is that the area ablated has affected the autonomic ganglion (which attaches to the heart in that area of the L atrium), and my autonomic system is now not functioning properly causing my heart rate to be unstable.

I know something about this as I went into my ablation with Dr. Natale with Dysautonomia (Dysfunction of the autonomic nervous system) and was concerned as to how an ablation would affect my already unreliable autonomic nervous system, as they usually ablate not just one area of autonomic ganglia but several. I raised this question with someone who was able to speak to Dr. Natale about this on my behalf and we also spoke about it during my consultation. There are a couple of EPs who are actually treating certain types of autonomic dysfunction through ablating the autonomic ganglia--one of the things that they are trying to treat is syncope. Dr. Natale was very knowledgeable on this topic and explained how an ablation might affect my autonomic nervous system, given my situation.

As I understand it, the reason that most all of us who have ablations have a raised heart rate afterwards is from ablating the autonomic ganglia. There are articles discussing the benefits of doing this--apparently the areas where the ganglia are located are often the sources of arrhythmia. I'll send you a private message so that we can discuss this more if you would like to.

As far as Dr. Natale's schedule, it is somewhat fluid with room for individual consideration according to your medical situation.

Thank you Daisy for your post. They did tell me in advance that any work to the left atrium can cause dysautonomia which I had initially but it passed in a couple of weeks. I had worse dysautonomia before the procedure. Now it's that crazy tachycardia and the symptoms associated.

I'm planning to do more reading on this topic before I talk w Dr. Natale as you suggested. I've done a little research on it and it looks like it takes a very skilled EP to do it.

I feel we are lucky that this field has advanced so much in recent years. 10 years ago some of what we discuss here would not have been possible. I still feel that my last ablation was a partial success and at least the problem was identified and eliminated for a period of time which gives me hope for a total elimination of the problem. The first 2 ablations I had the EPs could not completely identify the source of my issue after mapping and ablating a few areas.

Thank you for you posts and they sound familiar to my situation.
Had my Natale ablation June 2022, rhythm was great for 4 1/2 months afterwards. Then came a flutter episode (regular HR 125-135), resolved with cardioversion.
Next episode 6 weeks later, similar high heart rate for a week, resolved with another ecv. This time the EKG was showing Atrial Tachycardia, not flutter.
Third episode a month later was a sudden onset of a higher HR up to 180. Didn't wait to go to ER with that one, where the HR was fortunately brought down with Diltiazem instead of ecv. That EKG said Supra ventricular Tachycardia.
Whatever the diagnosis on the EKG is each time, it gets very tiring. Hoping Dr. Natale can figure it out.

~ Linda

Linda,

Sounds like you've developed what's generally referred to as SVT. There are two forms of it and it's similar to atrial flutter but not quite the same cause. Fortunately, it's usually easier to deal with. I'm sure Dr. Natale can set you straight.

Thank you, Carey. That is reassuring news. I hope I can keep the SVT from reoccurring in the meantime. Have tried to eliminate any possible triggers, although the last episode happened soon after I had caught a cold. Haven’t had one of those since way before the pandemic.

~ Linda

Sometimes SVT can be terminated with a Valsalva maneuver. Here's an explanation of how to do it. You can also try immersing your face in cold water. It doesn't work for everyone, but it works for many. And since it's a 100% safe*, simple, and free way to terminate SVT, it's worth giving it a try.

* Don't do it if you have retinopathy or you've recently had cataract surgery. But you can still do the face in cold water thing.

I saw a video recently with a modified vagal maneuver to bring down high heart rate if the techniques Carey mentioned don't work or just to have more tools in your toolbox. It's part of a research study and was found to be effective for most people.

You lay on your back with your legs elevated higher than your heart. You use a 10cc syringe with your lips over the end of the syringe, you try to blow the plunger of the syringe backward. You won't actually be able to move the plunger of the syringe with your breath, but trying to do that will help to stimulate your vagus nerve and lower your heart rate.

I just learned about it and haven't tried it yet. It seems like it could work.

There is also that video that someone here posted about six months ago where the person plucks lightly at the traga at the bottom of the ears' openings. It's the small cartilaginous bump closest to the eyes. You pluck them, lightly, upwards using the thumb and forefingers 20 times. Then, inverting the palms, place the thumbs into the opening, not jammed, just enough to make contact with the inner opening, and you lift upwards 20 times. You should hear a swishing sound. This is supposed to increase the tone in the Vagus nerve. It has worked for me a number of times, but not consistently.

I am just finishing up my post 6 month monitor tomorrow but while dealing with all this tachy, I also got a cold. I noticed that I could convert with a good cough now and then. Got several 6-8 hour reprieves while on the monitor, so I am thinking mine is likely SVT as well. I tried The “blowing” technique as well, and it did work once as well. I am lucky that flecanide has previously controlled it until Natale can touch me up (at least it has before I had to come off of it for this monitor).
Cindy