AF shortly after ablation

[AQPHD]

I know I should be asking my doctor these questions, but he is on vacation. Two weeks I had a cryoablation with the artic front baloon catheter. Doc had me taper off Flecainide and cut Toprol to 50mg. In two days I went into full blown AF. Nurses and doc say it's normal to have events weeks after an ablation. I accept this, but I'd like to understand why. He put me back on the Flecainide and now I have no symptoms. Can I get some clinical type info about why events occur right after ablation, and how will the heart adjust over the next few weeks to being symptom free (I hope)?   Thanks.

[Forum-M.D.-MJM]

hello,

for some reason, af ablation appears to decrease the symptoms of atrial fibrillation.  it is not uncommon to have people with symptomatic AF to have asymptomatic AF after ablation.  Some outcome studies suggest inappropriately high cure rates because they don't randomly check heart rhythm post ablation and find asymptomatic patients.

There is a saying that AF begets AF.  When you have atrial fibrillation, the recovery properties of your atrial change.  If we say the time it takes the atrium to contract and be ready to contract again is 250 msec in a non AF heart.  After months of AF, the recovery time is shorter say 200 msec (numbers are only examples).  We know that AF occurs more easily with shorter atrial recovery time (recovery time is also called ERP or effect refractory period). In the period after ablation, the atrium has often remodeled to have a shorter recovery and it is easy to have recurrent AF.  Over time, as you stay out of AF, the atrium remodels closer to its original state, but probably never fully recovers to its pre AF state.

It is also possible that there is imflammation around the ablation lesions that are causing PACs and making it easier to go back into af.

Many centers continue medications like flecainide for up to 2 months post ablation while the atrium recovers.

I hope this helps.  Thanks for posting.

[frs87]

That was really elucidating.

Once again, I am not sure if I will obtain any answer since I am asking this in another person's thread, but I was wondering if that premise of shorter ERP also happens in Atrial Flutter? And the inflammation after ablation you wrote about, does it go away after some months and the heart's muscle go back to normal shape? Because I will discuss the possibility of a second ablation with my doctor but I want to be sure that the procedure does not make any 'permanent' damage.

Thanks.

[AQPHD]

Thanks for both responses to my post. It helped normalize my feelings. Atrial fibrillation drives me crazy. I guess I expected an instant cure from all symptoms immediately; but I understand this doesn't happen. I'd welcome anyone elses comments on their post ablation experience.

[dquenzer]

I had an ablation for AFIB almost 3 1/2 years ago.  I had a signficant number of episodes the first week after the ablation.  They generally did not last long.  I also had a higher resting heart rate.  That has since come back down.  It took about 3 to 4 weeks and I was pretty much episode free.  I had a few runs of tachy that's about it.  

So you can expect episodes of flutter and fib after an ablation.  They should dissipate in time if the ablation did its job.

[AQPHD]

Thanks for your comment. Can I ask, did you come off medications quickly or did you step them down, or are you still taking them?  3.5 years of afib free is a pretty good result from ablation. Congratualtions. May we all stay in synch. Anthony.

[dquenzer]

Just got your post.  I stayed on the Atenolol.  I suppose I could go off of it, but it really doesn't hurt anything.  The doctors don't seem to think it's necessary to come off of. Also it keeps my blood pressure lower which helps in general.  I say why mess with success.

This might be different if I was on something stronger.  I think I would try to come off of it.  The thing about many of the drugs is that they keep the irritation level down.

The only thing about atenolol is that it does reduce exercise capacity because it keeps the heart from pumping as hard.   Since I like to run I know it did affect that.  But I'm 52.  My goal is not some record or to run a marathon.  I just want to stay in reasonably decent condtion.  I feel good over all.

[khatri]

I HAD SVT SINCE LAST 2 YEARS. I TOOK AMIODRONE REGULARLY FOR ONE YEAR. AND THEN I CHANGED AND STARTED CALAPTIN 40 MG /3 TIMES / DAY. THEN I GOT VERY LOW BP..WENT HOSPITAL...ADMITED ONE NIGHT AND BACK..........STOPPED CALAPTIN..AND AGAIN STARTED AMIODRON..........DURING THESE DAYS I GOT SOME LICKAGES IN MY AR VALVE BY 3 GRADE.......DOC. GAVE ME ZAART 25 MG/DAY...MY HR WAS 173 MAXIMUM...142 IN MOST OF TEH PEACK TIME...72 IS IN AVERAVE AS PER HOLTER..LATER RECENTLY I DID EPS+FRA..IT WAS SUCCESSFULL....TODAY( 16TH JUL 2007) IT IS 6TH DAY...BUT I AM WORRIED ..IF IT OCCURE AGAIN?????
ANYONE WITH THIS SIMILAR ???

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