In Recovery- Successful Ablation

I couldn't be more pleased. My heart sufficiently misbehaved today to allow for a really successful mapping of the PACs and SVT. My Pre-Ablation EKG caught the SVT and ectopics and also showed a new prolonged QtC, right axis deviation, and some other changes from the high burden of ectopics over time.
He ablated the area at the right pulmonary vein. He felt super happy and feels confident that there will be success. Interestingly, he also said that my heart looked super healthy and that the strength of my heart/health of my heart is probably the only thing that prevented the ectopics from kicking me into Afib. He said most of the time, the ectopics in that area would cause paroxysmal afib.
I'll be discharged on Ivabradine to help my heart rate stay low while it heals and help if I get IST. But for now, it seems like a win!! Thanks so much for the prayers and support. Will continue to update!

Spectacular news!!! I've been thinking of you all day and wondering how it went. Glad they were able to see so much!!!!!

Wonderful! I am so happy for you.

Yay!! Thanks for taking the time to reach out, Megan, and I wish for you wonderful days, weeks, months, and years ahead. Go easy for a day or three, but you will know when you feel well enough to go for walks and to see people.

Great news!

Awesome news! Take the time to let things heal and then put this chapter behind you.

Fantastic news! So happy for you!

Who did your ablation?

So happy for you!!!

WOO-HOO!

Congratulation on your results!

As a side question to the group - have any of you been shown a picture of your heart after ablation? One was given to me, and I was surprised to see the number of times I was "zapped". I almost went back into A-fib after seeing it. If I remember correctly, there must have been over 20 zaps. Doc, what'd you use, a shotgun? I accept that my surprise was my fault; I didn't ask how many times I'd be hit during pre-ablation Q&A.
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I was told that sometimes it takes two ablations to be effective but after seeing that I'm hesitant. I've got to believe those scars on the wall of the heart must render it less pliable and effective. I totally understand its better than having A-fib and possible stroke. However, isn't it possible for one of those scars to break off, causing problems later in life?

Anyone else wonder about this? Is my hesitation on ablation #2 ill-warranted?

Scars on your heart from electrical cardio conversion? I never knew an ECV leaves scaring . Mine must be polka dots after 54 ECCs

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susan.d
Scars on your heart from electrical cardio conversion?

I thought it was about ablation.

Cardioversions do not scar the heart.

Megan had an ablation, so the scarring would have been internal to the LA, on the endothelium.

I had my ablation at Abbott Northwestern in Minneapolis with Dr Melby.

As for the scarring, I, too, have had an extensive amount of ablating, and I, too, wonder about long term pliancy of my heart. I do think that later in life it can increase risk for an MI or heart failure, but I was at high risk of ending up with heart failure anyway if I didn't ablate, so it made my choice easier.

I think your concerns are valid and depending on your age and other risk factors, it would be worth exploring all the options. Ablation still seems to be the gold standard, but I definitely think there can be risks later..

Just my thoughts..

Meg

Anyone get weird migraine weirdness after sedation?

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MeganMN
Anyone get weird migraine weirdness after sedation?

A number of us had migraine auras after ablations but that is thought to come from piercing the atrial wall rather than sedation.

That is really odd. They did pierce my atrial wall. Why in the world does it do that?

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MeganMN
That is really odd. They did pierce my atrial wall. Why in the world does it do that?

Here is what Chat GPT4 has to say:

**Post-ablation migraine** is a recognized phenomenon that can occur after **atrial fibrillation (AF) ablation**, especially when the procedure involves **transseptal puncture** (piercing of the atrial septum) to access the left atrium. Migraine-like symptoms, such as headache, visual aura, and other neurological signs, have been reported post-ablation in some patients, with various hypotheses around the cause. Here’s a summary of how post-ablation migraines may arise, particularly after atrial wall puncture, with supporting references:

### 1. **Mechanism of Migraine Development after Atrial Wall Puncture**:
- **Microemboli Formation**: During transseptal puncture and catheter manipulation, small air or thrombotic microemboli can inadvertently enter the left atrium and subsequently the systemic circulation. These microemboli may reach the brain and trigger migraines by activating the trigeminal vascular system.
- **Evidence**: A study found that patients undergoing AF ablation had a higher incidence of post-procedure migraine-like symptoms, and transcranial Doppler monitoring detected cerebral microemboli in some patients, suggesting a potential link between microemboli and migraines (*Circulation*, 2010).

### 2. **Air Embolism and Neurological Symptoms**:
- **Air Embolism Risks**: Even minimal air emboli introduced during catheter exchanges or transseptal puncture can cause transient ischemic events. These ischemic events might lead to neurological symptoms similar to those seen in migraines, such as visual aura or sensory disturbances.
- **Supporting Research**: Case studies have documented instances of migraine with aura after AF ablation procedures, suggesting that inadvertent air or thrombotic emboli may play a role in triggering these symptoms (*Journal of the American College of Cardiology*, 2012).

### 3. **Endothelial Activation and Inflammatory Response**:
- **Endothelial Damage**: Piercing the atrial septum and ablating cardiac tissue can lead to localized endothelial injury and inflammation. This triggers the release of inflammatory cytokines and endothelial factors that may contribute to migraine mechanisms, as migraines are known to be associated with vascular and inflammatory changes.
- **Inflammation and Migraine**: Inflammatory cytokines, such as interleukins and tumor necrosis factor-alpha (TNF-α), released due to atrial wall injury can activate trigeminal nerve pathways, potentially leading to migraines. Elevated inflammatory markers post-ablation have been associated with neurological symptoms in some studies (*Heart Rhythm*, 2016).

### 4. **Association with Patent Foramen Ovale (PFO)**:
- **PFO and Migraine**: Some patients with AF have a patent foramen ovale (PFO), an incomplete closure of the atrial septum that can act as a conduit for paradoxical emboli (emboli crossing from the right to the left side of the heart). During or after ablation, the altered flow dynamics or the presence of microbubbles may increase the risk of paradoxical emboli reaching the brain and triggering migraines.
- **Research Findings**: A study indicated that patients with a PFO who undergo AF ablation may have a higher risk of developing post-ablation migraines, likely due to increased microembolic load (*Neurology*, 2013).

### 5. **Autonomic Nervous System (ANS) Disturbances**:
- **Autonomic Changes**: AF ablation can impact the autonomic nervous system, particularly if ganglionic plexi in the atrial walls are affected. These plexi are involved in the regulation of heart rate and can also influence the trigeminal system, which is implicated in migraine pathophysiology.
- **Link to Migraines**: Ablation-induced changes in autonomic tone, including alterations in parasympathetic and sympathetic balance, may trigger migraines by impacting cerebrovascular reactivity and trigeminal activation.
- **Study Data**: An investigation showed that patients with migraines following AF ablation had measurable autonomic disturbances, which correlated with the onset of post-procedural migraine symptoms (*Journal of Interventional Cardiac Electrophysiology*, 2014).

### 6. **Oxygenation and Cerebral Hypoperfusion**:
- **Transient Cerebral Hypoperfusion**: Reduced cerebral blood flow can occur after AF ablation, especially if microemboli temporarily obstruct smaller cerebral vessels. This transient hypoperfusion can mimic migraine aura and contribute to post-ablation migraines.
- **Research Support**: A study examining cerebral blood flow changes post-ablation found that some patients experienced transient reductions in blood flow, which correlated with migraine-like symptoms post-procedure (*European Heart Journal*, 2015).

### Summary:
- **Microemboli and Air Embolism**: The formation of microemboli or air emboli during atrial wall puncture and catheter manipulation can lead to migraine-like neurological symptoms.
- **Endothelial and Inflammatory Response**: Atrial septum piercing and tissue ablation can trigger endothelial injury and inflammatory cytokine release, which are associated with migraine mechanisms.
- **PFO and Paradoxical Emboli**: Patients with PFO undergoing transseptal puncture may be at higher risk for migraines due to the potential for paradoxical emboli to reach the brain.
- **Autonomic Disturbances**: AF ablation can disturb the autonomic nervous system, potentially triggering migraines via alterations in cerebrovascular tone.
- **Cerebral Hypoperfusion**: Temporary decreases in cerebral blood flow due to microemboli or other factors may lead to migraine-like symptoms post-ablation.

### References:
1. Lellouche N, et al. *Incidence and mechanism of post-procedural migraine following catheter ablation for atrial fibrillation*. Circulation. 2010.
2. Hildick-Smith DJ, et al. *Inadvertent microemboli and post-ablation migraines in AF patients: case reports and implications for catheter safety*. Journal of the American College of Cardiology. 2012.
3. Waldmann V, et al. *Prevalence of migraine with aura after atrial fibrillation ablation and the role of paradoxical emboli*. Neurology. 2013.
4. Pokushalov E, et al. *Inflammation and autonomic disturbance as triggers of post-ablation migraine in AF patients*. Heart Rhythm. 2016.
5. Mainigi SK, et al. *Autonomic nervous system disturbance and migraine following atrial fibrillation ablation*. Journal of Interventional Cardiac Electrophysiology. 2014.
6. Takase B, et al. *Cerebral blood flow changes and post-ablation migraine symptoms in atrial fibrillation patients*. European Heart Journal. 2015.

Thanks George. I also asked Chat and got a similar answer. The doctor did say that I have a PFO. Fascinating. I'm assuming that it isn't usually persistent. The things they don't tell you when you go in for surgery.....



That's why I have you all, right!!

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MeganMN
Thanks George. I also asked Chat and got a similar answer. The doctor did say that I have a PFO. Fascinating. I'm assuming that it isn't usually persistent. The things they don't tell you when you go in for surgery.....

That's why I have you all, right!!

I also had ocular migraines after the placement of a MitraClip which also required a transceptal puncture. The frequency went down as the puncture healed. Once I knew what it was, it didn’t bother me much.

I experienced ocular migraines after 2 ablations and a Watchman placement. They have significantly decreased in the past 3 years. Now I get maybe one or 2 a year.

Thank you MeganMN ! Though I was going crazy for a min.

"Scaring" may have been the wrong word; I'm not a Dr. However, I believe that going up one's groin to their and ablating, burning, cauterizing, zapping, or whatever the proper term is, cannot leave a heart without some sort of an unnatural state. It cannot be compared to an unablated ticker with regards to performance or efficiency. And I wonder if its remotely possible for a little piece of all those "zaps" to break off. I will ask my Dr at my next consultation for a 2nd ablation.

I do believe ablation is a good option when all else fails; but I'd like to know of the risks.



Edited 1 time(s). Last edit at 11/01/2024 02:46PM by Myticker.

The septal puncture and the burns can create micro clots. That's why you're loaded up with heparin during the procedure.

For those of you that experienced post procedure migraines, how long did they persist? Short term or long term?

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MeganMN
For those of you that experienced post procedure migraines, how long did they persist? Short term or long term?

At first I had one every couple of days and then they thinned out and were gone after about 2 months. Hope they don't hang around long for you.

What, if anything, helped the migraines? I've been knocked down for two of the last three days. Not sure what might help.

I would talk to your doctor and see if they can prescribe something to help. Most of the OTC remedies have NSAIDs and/or a stiff dose of caffeine. The small upside is that it should only last a week or two, the downside is you have to get through it. You could inquire about a low dose beta blocker (catch 22) as most of them do help with migraines or something more targeted for them.

Thanks for the suggestion. I am taking Ivabradine for the post procedure tachycardia and will chat with my EP office tomorrow. It sounds like, after researching, that I may need to back off on activity and continue to lay low. That is an extremely tough order with three school age kids and a busy farm,.but will try to back off and rest more. I also researched the Theanine/GABA that I was taking prey procedure and it sounds like they may also help to dampen the autonomic nervous system. Will run that by my EP Nurse tomorrow and see what shakes out. All in all though, SO GLAD TO HAVE A NORMAL RHYTHM!!!

Taking it easy is probably the best thing right now. Just try to accomplish the most important stuff and pick up on the rest later. Hopefully the migraines will start to dissipate soon. And NSR is awesome, may it be that way forever!

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MeganMN
For those of you that experienced post procedure migraines, how long did they persist? Short term or long term?

My headaches lasted about 2 months. I didn't get them every day and when I did I took paracetamol.
It's quite rare, only about 2% get them, although this number could be much higher as not many people report them. I didn't.

I keep getting these weird random 6-10 second 'head rushes' where I feel super dizzy, like my head is hollow. Then it passes. Not sure what to make of it. Still getting very mild headaches, but not the ocular stuff. Any thoughts?

Anesthesia hangover?

I doubt it. I just had a titch of Propofol and Fentanyl. Not sure if it could be related to the migraine?

Megan, if you can remember to do it when the head rushes happen, it would be great to get a concurrent HR. It may be momentary bradycardia.

I have something similar that happens and just can't get it pinpointed to a specific cause. I do believe it is related to HR or possibly BP. At the stage you are at, it might be related to the procedure. I would let the Doc team know about and ask them if they have seen it before.

Thanks, I will discuss it with them and also pay attention to my heart rate. I also talked with my Integrative Medicine doc yesterday and she added some supplements to support my autonomic nervous system (GABA, Theanine, 5-HTP). Another migraine yesterday. They are no fun!

I have only sympathy and prayers to offer.