2nd Cardiac Ablation for Afib done yesterday.

I discovered this forum after my first ablation in 2017. In May 2017 I had a Cryoablation with Dr. Daniel Beyerbach at Christ Hospital in Cincinnati. The journey leading to the ablation was a difficult one. I developed Paroxysmal Atrial Fibrillation while training and doing endurance running races, marathons and 50 k's. The first step was to put me on warfarin and Flecinide. The flecinide only increased the symptoms and I had more flutter along with the afib. The warfarin was a never ending fight to get in therapeutic range. The ablation did not go as I anticipated. I woke up with extreme shortness of breath, chest pain, and groin pain. The Dr admitted he had a hard time. I had catheters in both groins and my left groin developed a large hematoma that may have been pushing on some nerve because I was unable to raise my left leg for two weeks post ablation. That made it hard to go up stairs and get into the passenger side of a car. I had shortness of breath that lasted for about 6 months. I had bruising that was from my umbilicus to my knees. My blood count had dropped dramatically and I had trouble maintaining my blood pressure post op. They then gave me a 20 mg bolus of IV Lasix that further dropped my B/P and I felt at that time I may die. I also had a urinary catheter in for about 24 hours because my groin sites were oozing and I was unable to move or get out of bed. I left the hospital with a critical PT and feeling awful. Several weeks later it was discovered that my kidney function, my GFR was 45% down from pre ablation normal range. They use dye apparently in cryoablation and the multiple CT's that I had to evaluate my shortness of breath had taken a toll on my kidneys. I felt awful physically for several months after my ablation and the sad part was I was having just as many afib episodes. Dr. B then put me on amiodarone and scheduled me for a 2nd ablation. Thank the heavens that I found this site and came to my senses that I should not allow him to repeat the ablation.

The amiodarone did work. But it was something I did not want to be on long term. My shortness of breath and decreased endurance continued to where I quit my job as a nurse because physically going to work was taking a toll on me and with my hospital insurance I could not go to another EP outside of our hospital. After quitting my job I went to several cardiologist and EP's in the surrounding tristate area, OH, KY, IND. I found a big variety in the way they wanted to treat my symptoms, which at that point I was not having afib because I was on Amniodarone at 59 years old. I consulted with Dr. Natale and his nurse. I spoke to Shannon on the phone. I followed all the the recommendations that Shannon sent to me, I totally gave up any alcohol, maintained a healthy weight, exercised but not to extreme. I read research articles. I consulted with Dr. Mandrola. I went off the Amniodarone and when the afib episodes came back I was training for 2 marathons. Bad move on my part, Endurance exercise does cause afib in me and I just had to realize that I'm getting older and with my heart issues endurance exercise is not a good thing for me.

I continued for the past 4 years to have occasional afib. After going to multiple EP and cardiologist's I found a doctor that I was very comfortable with and who seemed to understand me and my goals and when I rattled of research articles I had read and talked to him about different Doctors I had seen, he was respectful and responded in a way that made me confident in him.

I had a Radiofrequency Ablation for Atrial Fibrillation with Dr. Sinno yesterday at St. Elizabeth Hospital in Edgewood Kentucky yesterday. That was a decision that I thought about long and hard. I know that the opinion of this forum is to go with a better known EP. I wanted the option to go home to my own bed after the procedure and for my family to be close. I had the procedure at 9:45 am, I went home at 5 pm. I am able to walk up and down stairs. I have no bruising, no hematoma, and no shortness of breath. My chest does not hurt. I went snowboarding all day on Wednesday on anticipation that my snowboard season would be ending and it has now that I am on blood thinners again. My only complaint is that my legs are really sore ;-) , from snowboarding, nothing to do with the ablation. Time will tell if my ablation has done the intended purpose. At this point I have not had any abnormal beats that I know of. My Kardia says NSR. I feel good! I'm posting only because I think it's important to tell our experience. Good and Bad. I am hoping that this works, but time will tell. May all have happy and blessed holidays.

I'm very happy that your ablation went well, but I think it's a terrible idea to go snowboarding the day after. Your heart needs time to heal and rest from the insult of the ablation on your heart. So with all the time and hard work you put into this ablation, it would be a shame to ruin it by doing too much too soon. Some heal faster than others, but at day two I was in bed and didn't resume pre-ablation exercise levels for a long time. You may feel like you can conquer the world, but really, give your heart a break for awhile.

Jim

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mjamesone
I'm very happy that your ablation went well, but I think it's a terrible idea to go snowboarding the day after. Your heart needs time to heal and rest from the insult of the ablation on your heart. So with all the time and hard work you put into this ablation, it would be a shame to ruin it by doing too much too soon.

A whole lot of people like to say that, and it seems like common sense, but I've seen no evidence whatsoever that it's actually true, and I include anecdotal evidence in that statement. In particular, I don't think it's even possible to ruin an ablation with exercise. Those burns are there and they're going to turn into scar tissue no matter what. I don't know of any way to prevent that from happening. All you need for an ablation to be successful is for those burns to be in the right places and be deep enough to form durable scar tissue. Your heart will do the rest even if you push it to work harder.

Incidentally, I once did a 50-mile bike ride in challenging terrain 3 days after an ablation, and I did it with the full blessings of the EP. I even made sure he understood it was a 4-hour aerobic workout, not some casual cruise down the bike paths. He still completely endorsed it. It took medicine hundreds of years to come to understand that inactivity does not heal, and that patients need to get up and moving ASAP. I completely disagree with people who say you should take off work and rest for a week or two after an ablation. I don't think there's any benefit to doing that and it can even be harmful (DVTs, PEs, physical deconditioning). Just return to your normal activities as soon as you feel able while remaining mindful of the lifting restriction.

Carey: A whole lot of people like to say that, and it seems like common sense, but I've seen no evidence whatsoever that it's actually true, and I include anecdotal evidence in that statement.
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Apparently, there are no evidence based studies, one way or the other. so yes, all we have are anecdotals and opinions. My opinion and experience is similar to what Dr. John Mandrola states here.
Article a little old, but I think it holds up.

"AF ablation is a big deal...
The first thing to say about AF ablation is that it is a big procedure. I tell patients to expect AF ablation to be hard on them. I recommend taking a few weeks off after the procedure. Specifically, I say…read books, watch movies, write a blog, take short walks. but don’t go back to full-gas exercise or work for a couple of weeks."

[www.drjohnm.org]

Jim



Edited 2 time(s). Last edit at 12/23/2023 06:20PM by mjamesone.

I was told to be careful after my last ablation, but it was related to the healing of the catheter insertion point in the groin, not the ablations itself. I felt 100% normal the day after (the ablation was day surgery).

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mjamesone
My opinion and experience is similar to what Dr. John Mandrola states here.

I'm afraid I'm not a fan of Dr. Mandrola. His brand is to write contrarian articles in layman publications criticizing whatever leading EPs are doing lately, quite often without doing the research needed to know what he's talking about. If you'd like to see a good example of that, you might want to take a look at this article. Take note of the author. Since he writes in layman publications, the EPs qualified to rebut him don't usually see them, so they're left for patients to read and be terrified by. I sigh and wait for the panic to set in every time I see he's written a new article.

Although that article you quoted was a good article, the specific section you chose to quote is, IMO, over the top and typical of what I said above.

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Carey

I'm afraid I'm not a fan of Dr. Mandrola...Although that article you quoted was a good article, the specific section you chose to quote is, IMO, over the top and typical of what I said above.

You're entitled to your opinion of Dr. Mandrola, but I'm going to stick to the topic at hand, and the "specific section" I quoted, which you said was "over the top".

In that section, Mandrola says in part "don’t go back to full-gas exercise or work for a couple of weeks (after catheter ablation)".

According to the ep's that did my two ablations, Mandrola's statement is more consistent with their advice than going snowboarding the day after the OP's ablation, or doing a 50 mile bike ride "in challenging terrain" three days after your ablation. It is also more consistent with the numerous posts on this topics I've read in afib forums other than this.

I'd welcome an evidence based study to prove me wrong, but since no apparent studies on this -- one way or the other -- I think we are just left with our opinions and those of our individual ep's. You can have the last word if you want it.

Jim

I don't need the last word and I'm fine with everyone going with their own opinion, and definitely with going with how they feel. I've known a number of people who came out of ablations feeling beat up for days afterwards, and others who feel perfectly fine. Patti and I apparently fall into the latter group. The one thing I take exception to is suggesting that you can "ruin" an ablation with exercise. I don't think that's even physically possible. There's just no mechanism by which scar formation can be hindered by exercise.

Thanks for the responses. Just to be clear, I snowboarded all day the day before my ablation surgery, I am taking it easy post ablation. There are a lot of opinions out there and I believe that you cannot be fully informed unless you consider all options. Yes I realize that Dr Mandrola is an outlier in some of his thinking but I learned a little something from all the various Doctors that I saw and the opinions I received prior to my ablation. One doctor just said stay on amniodarone for the rest of my life which is in my opinion horrible advice. The just of my story was to seek as much information as possible before coming to a conclusion that you are comfortable with. There is no guarantee for any procedure. I hope this RF ablation quiets the aberrant beats that causes symptoms for me. I am anxious to get back to snowboarding. I also downhill mountain bike. How do the boarder’s and biker’s experience with blood thinners? Did you quit the sport or?
Also there is more of a difference between cryoablation and RF ablation than I realized when I had my first cryoablation. Be informed of all the options open to you.


Happy holidays to all.

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Patti Starr
Just to be clear, I snowboarded all day the day before my ablation surgery, I am taking it easy post ablation.
Happy holidays to all.

Apologies for the mistake. I agree with your approach of learning from various sources.

Happy Holidays.

Jim

As I said above, it's concern about the catheter insertion point in the femoral vein(s). Here is something I found at: [pubmed.ncbi.nlm.nih.gov]

Femoral vascular closure devices can be divided into two broad categories. They can be either passive or active. Passive closure devices help with mechanical compression or by increasing thrombosis for effective hemostasis. However, passive devices do not hasten the actual time it takes to reach hemostasis. Active closure devices include suture devices, collagen plugs, and clips.

I don't know what the standard practice is with ablations, but popping the femoral vein open shortly after an ablation would not be a good thing, thus the lifting and activity limitations.

Hemostasis is the process by which your body stops bleeding.

I was told no stairs, no hot tub, for three days and one week respectively.

No stairs? I've never heard of anyone getting that restriction. Was there anything different or unusual about the insertion sites?

I got that wrong...it wasn't a prohibition, but to drag the inserted leg up behind the lifting leg, and to be careful on stairs. They asked me to avoid stairs using both legs naturally. Only for two days, and if no swelling or bleeding near the insertion point, just to commence normal activity.
Sorry for the confusion.