Long term effects after ablation: AV Node Block and Long QT Interval

See further down the thread. Edited after getting 12 lead yesterday and seeing a cardiologist today. Right now condition is exercise induced but I was told in no uncertain terms to go to ER if the condition doesn't resolve after exercise.

I had an ablation about 18 months ago. Ever since the procedure, my heart doesn't function as well as it did before the ablation. By before, I mean before I ever had AFIB and even when I was in AFIB. Of course, exercise was harder when I was in AFIB and my heart seemed to top out in the 150s and I could still run and swim with friends at moderate rates.

Initially, after the ablation everything seemed great, heart was working well and no more AFIB. The EP was aggressive and has a good reputation. But over time, I wonder if my heart has remodeled to the ablation burns and is less efficient. I experience angina at heart rates between 110 to 120 now.

Once I sit and rest and get back to the 80s and 90s I feel OK. Takes about 10-15 minutes.

Are any others here noticing long term erosion of heart function after an ablation? I've tried researching an answer to this but wasn't able to find anything. Most of the papers for ejection fraction and ablation are comparing improvement in the near term from ablation when compared with AFIB.

Male 58 yrs, no other issues. Kardia 6L shows me in NSR at 115 BPM and in the 90s or 80s.



Edited 1 time(s). Last edit at 11/07/2023 06:19AM by KingFizzy.

That's not a weakened or damaged heart, that's probably flutter or atrial tach. Go back to your EP and find out what it is and what your options are. A Kardia isn't going to diagnose this for you.

I am already trying to get scheduled to get scheduled with MD and a cardiologist. I also reached out last night to a good friend that works in a heart unit and he said they see this quite often with people that have had an ablation. His brother in law is/was a policeman and had to give it up about 2 years after his ablation as he could no longer run and pass the physical. Best guess is an ablated heart remodels over time and works less well. I have some ejection fraction tests on record and I'll bet mine would be piss poor now. Watching it even closer the last 48 hours, basically anything above 100BPM brings on angina that becomes more pronounced as rate goes up.

Ablations aren't all sunshine and lollipops, they are serious business with serious consequences.

What you're describing isn't a normal consequence of ablation. Angina is never a normal result and it needs to be investigated. The more likely explanation is you have some partial arterial blockages due to atherosclerosis. Really, you need to be seen ASAP.

First you say it's flutter or atrial tach then you say it's atherosclerosis. How does one go from a normal healthy athletic lifestyle with an ejection fraction of 67 and zero agatston to whatever is happening now in less than 2 years? Before the ablation I continued to do half marathons in the 1:42 to 1:48 range. Something is seriously wrong and I only have the ablation as a root cause. We know that an AFIB heart remodels so why wouldn't an ablated heart remodel?

I can't speak to what's happening in the your case, but in my 27 year afib history and 2 ablations, the only impact after the ablations has been that my maximum heart rate has decreased. But that also happens as we age. I am now 78. I work hard to stay in shape, so I know what it takes to stay fit at the highest level as I was in the Olympic swimmer 55 years ago.

Quote
KingFizzy
First you say it's flutter or atrial tach then you say it's atherosclerosis. How does one go from a normal healthy athletic lifestyle with an ejection fraction of 67 and zero agatston to whatever is happening now in less than 2 years? Before the ablation I continued to do half marathons in the 1:42 to 1:48 range. Something is seriously wrong and I only have the ablation as a root cause. We know that an AFIB heart remodels so why wouldn't an ablated heart remodel?

I didn't mean the tachycardia was the cause of the angina. I was only referring to the heart rate. But the two are by no means mutually exclusive. In an older adult, angina is due to atherosclerosis until proven otherwise. Although the tachycardia might bring it on, that's because the tachycardia increases your heart's oxygen demands, and a narrowed artery can prevent sufficient oxygen from reaching the heart. If you have new onset angina and reduced exercise tolerance, why isn't your cardiologist doing a workup? I would have expected at least a stress test, or better yet a stress-echo. Just blaming the ablation may be concealing a much more serious problem.

Being consistently back in NSR is what remodels the heart, and it does so in a positive way. An ablation in and of itself does not cause remodeling.

Quote
KingFizzy
First you say it's flutter or atrial tach then you say it's atherosclerosis. How does one go from a normal healthy athletic lifestyle with an ejection fraction of 67 and zero agatston to whatever is happening now in less than 2 years? Before the ablation I continued to do half marathons in the 1:42 to 1:48 range. Something is seriously wrong and I only have the ablation as a root cause. We know that an AFIB heart remodels so why wouldn't an ablated heart remodel?

Your story is the same as mine. I was a competitive runner, a cyclist, ran snowshoe races, and was in generally very good condition. Even so, once my EP felt he was going to take a serious look at me with a view to ablation, he ordered MIBI test, MRI, chest X-ray, and even an angiogram, the latter of which was one week prior to my initial consult with him. I had been put on statins right from the get-go, three years earlier, by my cardiologist because he feared ischemic heart disease. All test, including a Doppler ultrasound of my carotid arteries, which I requested myself, showed I was as clean as a whistle. So, why am I on statins at 69 years of age, I asked of my EP's understudy. His reply, "Oh no, you DO have heart disease, and you're risk of stroke etc is quite high relative to the general population. You should stay on a statin for life." Fortunately, statins don't have the unwelcome side-effects for me that many report. But, I still think they're a waste of expense on me.

So, you probably are in the same general condition, but unless an angiogram has determined that your various coronary arteries are generally clear, as mine are (the surgeon leaned over and said, 'You're good, minor deposits), you may need some remedial action.

I'm headed to the MD today. Not sure what he plans to do but hopefully I'll get a thorough once over.

I attached a Kardia screenshot.

Thanks Gloaming. I'll be taking your list to the MD and cardiologist.

Got a 12 lead done yesterday and seeing a cardiologist today. My MD is a miracle worker in getting this done so fast, seeing me and the cardiologist referral.

Turns out what's happening is a result of the ablation. First degree AV node block

[www.ncbi.nlm.nih.gov]

I also have this - long QT interval - also due to the ablation

[www.sciencedirect.com]

I know you want the ablation to be the cause but neither of those papers supports that idea, and frankly it just doesn't make medical sense.

First, an AVNRT ablation is very different from an afib ablation; it targets a completely different area of the heart. It involves ablating the area where BBB could be caused but an afib ablation doesn't. But above all, in both cases the effect is apparent immediately following the ablation and is temporary, resolving within one month. There isn't a two-year delay when all of a sudden these things pop out of nowhere. In fact, I can't think of any complication at all that has a delayed onset. Prolonged QT is generally caused by two things: drugs and the genes you were born with. So if you're not taking a drug known to cause prolonged QT, blame your parents.



Edited 1 time(s). Last edit at 11/07/2023 03:46PM by Carey.

I had dozens of EKGS before the ablation and over the last 20 years. Not once did the QT issue come up or was discussed with me by MD, EP, cardiologists. Can't blame my parents or genetics for what has only just been discovered and ONLY since my ablation.

I don't WANT to blame the ablation and certainly way less than you WANT to direct blame away from an ablation. And you didn't even do the ablation. No one is trying to sue anyone here or pin anything on you or this forum. But the fact is cause and effect. A procedure was done and now my heart is different. In some ways good, NSR, in other's bad (numerous)

As far as your other excuse, different people react in different ways. In another thread, you repeatedly say that chocolate, caffeine etc can't and won't bring on heart rhythm issues in spite of others relating their own experience.

I don't know what kind of kool-aid you're drinking or why this forum is basically a tout for ablations and one EP in particular and what kind of remuneration is being received for what appears to be a sales funnel.

Burning the inside of someone's heart is serious business. There are risks, long term affects and for sure it isn't all sunshine and lollipops as you make it out to be.

Really sorry you see it that way but first let me assure you no one's funneling anyone toward anything and absolutely no one's receiving remuneration for anything.

I simply tried to give you the best interpretation I can of what you're experiencing. I honestly believe you need a deeper cardiology workup and that the ablation probably doesn't explain what you're experiencing. If you choose not to believe that, well, that's your choice. I wish you well no matter what the issue is.

"...I don't know what kind of kool-aid you're drinking or why this forum is basically a tout for ablations and one EP in particular and what kind of remuneration is being received for what appears to be a sales funnel..."


The one EP in particular is very highly esteemed by people who don't know about this forum as much as those who frequent this forum. That's an earned right, on both sides of the matter. We let people know, WHEN THEY COME HERE AND MAKE AN INQUIRY, whom we know who is likely to both be available and be amenable to helping. And, we routinely mention others closer to the asker when it makes sense to do so.

What do you do?

Kingfizzy,

One of the things all afibbers want to identify are the triggers that can kick off a bout of afib. Thats natural and instinctive, but reality it that there are very few "triggers" and LOTS of coincidences. I have had over 200 recorded afib episodes, and the only trigger I could identify was having more than one alcoholic drink, and that was not always the case, just occasionally after two drinks. That may have well been a lack of hydration rather than the alcohol. After my ablations, I never gave up anything and went for 13 years afib free after the first and now 3 years afib free after my second.

afib just happens and the best way to fix it is an ablation, and that will only be a temporary fix as it will come back if you live long enough. Of course, there is more one can do to help control afib, but an ablation from a really good EP is the best way to go afib free for some period of time.

I do have to object to “tout for ablations.” If anyone reads this forum with any depth you’ll note a full continuum in approaches. It just often, not always, happens that for most, after trying other approaches that fail, we come to ablations. And since it is stressed by members to seek treatment by the best EP available to you, many of us have had successful ablations. It took me years of trying various other approaches that failed before I had an ablation. But no one is selling anything here—just reporting our experiences.