5 weeks post ablation and occasional a fib

Five weeks ago I had my 2nd ablation. The fist one was done 9 years ago and cryo balloon ablation was done. The recent RF ablation was done and I'm having slow a fib (75 to 85 bpm) about every 3 days. I take 300 MG of flecanide and it converts back to normal sinus rhythm in two hours. I've started hiking and my cardio feels like it getting stronger everyday. Has anyone had occasional a fib which eventually goes away?

Recent means different time-frames dependent on context. You've had a recent second ablation (you did WELL!! to get nine years out of the first...good for you!). If we're talking 4-5 weeks, then it's not so bad because you're still in the blanking period. If we're already nine weeks out, and you're truly getting detectable/measurable AF, then it's not very good news I'm afraid. Blanking runs about 8 weeks, typically, and the literature says that if you have AF early, but that it subsides and ends near the middle of the blanking period, you're gonna be okay. It was a success. The same study I saw said that if it seems fine in the first weeks, but then AF begins to return, even in short runs, it usually is a poor prognosis and we can assume that there is still a defined path for the spurious signals.

You should be assigned a Holter monitor by about Week 10-15 to see what's happening. If/when that reveals PACs (quite common), then you'll be given a salute and told to enjoy your life. A heavy PAC burden, though, will have to be figured out and fixed, or at least controlled. But, if you have brief periods of AF, then the EP will know that he/she must have you back, with your agreement, and at least consult with you if not offer to try another mechanical tune-up (ablation).

I wonder what "A heavy PAC burden" means? How many PACs is that?

[www.nature.com]

It depends on the person evaluating you (there might be other factors we aren't aware of), but generally around 8% burden consistently you will be asked if you'd like an intervention other than what has been in place to date. Even so, that's a pretty stiff burden by the time you're given that level of PAC occurrence.



Edited 1 time(s). Last edit at 04/20/2023 04:35PM by gloaming.

Thanks for the information. Currently, my afib is only between maybe 75 to 85 bpm and always starts when im sitting or laying down. I'm doing fast 2 mile walks in the mountains at 5600 feet and feel fine. I had a lot of issues with my stomach after the ablation and they gave me omeprazol which seems to help.

Recent research indicates that even a few hundred a day of PAC/PVC is a concern particularly in those of us who have AFIB. Increases risk of more AFIB episodes. Several articles have circulated on this web site that you can research. A recent article for example, co written by Dr. Sunny Po out of University of Oklahoma outlines the research they recently done on this topic.

And just to let you know, when I had my first ablation, and the blanking period had passed, my Holter report showed a lot of PACs. The outreach nurse who asked me to call to discuss the results raised her voice and emphasized the word 'lot' over the phone, and gave that little pause for extra effect after uttering it. By my own count, using my smart watch, I was getting three or four PACs each minute!!! And this went on for months until I was granted a second kick at the can. The point is, you can live with PACs, even a great many of them. It's not to say they are innocuous,...they are NOT, especially when their frequency is large. But just as with AF, you can get by for a long time. I'm still here, and my poor heart must have produced 50K PACs between the time the Holter results were fed to me and when I had the second ablation.

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gloaming
And just to let you know, when I had my first ablation, and the blanking period had passed, my Holter report showed a lot of PACs. The outreach nurse who asked me to call to discuss the results raised her voice and emphasized the word 'lot' over the phone, and gave that little pause for extra effect after uttering it. By my own count, using my smart watch, I was getting three or four PACs each minute!!! And this went on for months until I was granted a second kick at the can. The point is, you can live with PACs, even a great many of them. It's not to say they are innocuous,...they are NOT, especially when their frequency is large. But just as with AF, you can get by for a long time. I'm still here, and my poor heart must have produced 50K PACs between the time the Holter results were fed to me and when I had the second ablation.

Were you offered mediation for the PACs.? Did the 2nd ablation cure the PACs.
I have just finished the blanking period and getting 1 PAC 2nd or 3rd beat (about 30 PACs per minute) and that's not much fun.

I am sorry to hear this. All I can do is relate my own story, and I don't live in your body. But, here goes: A week after my first ablation, I had to go to the ER for an emergency ECG per my GP's urging. I had gone to see him per my EP's instructions a week after my procedure. I was in AF, according to him, and he said get to the hospital for an ECG right away. It showed full blown AF. I was admitted, and to spare you a lot of the story, I ended up on Amiodarone (the anti-arrhythmic of 'last resort') for eight weeks. Happily, that drug tamed my AF, although I had a relapse four weeks after commencing the Amiodarone. At Week 8, I stopped everything. I even went metoprolol-free for almost six weeks. Then, while visiting my daughter and her newborn a day's drive away, and walking their first, a toddler, I developed AF once again. Keeping it short, I finally had a second ablation, same EP, mid-February. It has worked...so far.

To address your question: Those numerous PACs were present from the get-go, as far as I can tell. The Holter monitor came at Week 10, but I had been to the ER twice and on Amiodarone between the ablation and the Holter. I was off Amiodarone almost three weeks by the time I wore the monitor. That report showed 'a LOT of PACs.' I was told to cease metoprolol when I started the Amiodarone. This means I had been off all meds for the heart at least four weeks, maybe five, by the time I returned from Calgary and called for my Holter results.

IF you have a lot of PACs, and you are more than six weeks out of an ablation, I would say you're probably not fixed, and you may find AF creeping in before long. That was my route, it may not be yours. You'll have to ride this one horse yourself.

Agreed, seeing the PACs on a readout, or feeling them, or being told you're having them, is a disappointment and dismaying. Happened to me. What was almost worse, though, was when I read about PACs and when Carey told me that PACs are almost going to be ignored by the medical community. I only learned of my PACs when I slunk back from Calgary to get myself back to my 'team' in case things went bad in a hurry for me. While in line at the ferry to get back to Vancouver Island, I called the outreach nurse who told me of the results of the Holter I had worn two weeks earlier. No AF at all, but lots of PACs. Over the next 12 weeks it was a miserable existence with frequent AF. I was cardioverted three times three days running during New Years, and told that now it was atrial flutter, 4/1 block. All cardioversions failed within hours to minutes. I soon and worked my way up to 150 mg of metoprolol a day. For me, the second ablation couldn't come soon enough, and it only happened mid-February due to a cancellation. I hadn't even been called yet to schedule me for May or June...if I was lucky. In fact, now that I recall, my own family doctor wrote and referred me back to the EP under whose care I was already! I guess that letter reminded that office that I wasn't doing particularly well.

You will be called to wear a Holter in a few weeks. Meanwhile, and I hate to actually have to advocate this way, there might be no better currency in your pocket with your EP than having an ER ECG showing how your heart is behaving. Do this if you're in a really bad way, can't sleep, deeply anxious, and feeling generally unwell. If you can tough it out, the Holter will tell the story. Wouldn't hurt to verify that the Holter is coming, though.