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Ablations and Arrhythmias
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Ablations and Arrhythmias

About three weeks ago, I had surgical ablations in the left atrium for atrial fib and two linear ablations in the right atrium for atrial flutter. In the left atrium, this was the second time.  But this time the pulmonary veins were isolated.  Previously, a modified maze procedure was suppose to have been done (about 11 months ago) but I continued to have atrial fib and flutter.  Since surgery, I have done well from a surgical perspective.  However, I have very rapid, irregular heart rates with any kind of activity.  Sometimes, it is so fast I cannot even count the rate and I have chest pain with it.  Laying down for 20-30 minutes will help it to stop.  I am on Toprol and and verapamil now.  My electrophysiologist says that he does not want to do anything for 3-4 months or even longer.  My pacemaker is set for 45..ventricular lead only.  The atrial lead was damaged in surgery somehow so it is not capturing.  I am now on my own intrinsic rhythm which hasn't shown any organized rhythm etc. since surgery.  I am wondering how long does it take for the inflammation and healing to occur from the ablations and for the rhythm to stabilize. Are there any long term studies available that evaluates the effects of ablations etc.  I did look but haven't found anything.
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Dotty,

Unfortunately there is no clear consensus on how long it takes to stabilize the rhythm after these procedures, especially since the field is actively evolving and the procedures continue to change.  Certainly, it is recognized that immediately post procedure an increase of arrhythmias can occur, most likely secondary to inflammation.  3-4 months seems reasonable to see an improvement in rhythm control.

good luck
16 Comments
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Dotty,
I wanted to relate my experience, which sounds a bit similar.  I have a pacemaker also, and suffer from a-fib.  Very rapid rates, and up until recently not controlled well with antiarrythmic meds. etc.  I went in for an ablation about a year ago.  The exact same thing happened with my atrial lead.  It was no longer capturing, and I was only pacing at 40bpm with the ventricular lead.  My intrinsic rate like yours is extremely irregular.  So not long after that the EP doc. went back in to replace the atrial lead, only to discover the very next day that it was not working again.  It turns out that due to all the ablations the lead was not able to conduct an impulse.  We finally got it right.
Now, the second part of this is the way my pacemaker is now programed.  It is entirely different than it used to be.  I used to be paced in both atrium in ventricular.  Now, I am only paced in the atrium.  My rate is set at 80bpm. so that my intrinsic rate can not come through.  It is my own rate that seems to trigger my a-fib.  Because I am set at 80bpm 24/7, I now hardly ever have a-fib.  It is truly a miracle.  I don't know if it will remain.  I still have to take multiple meds. but just the same it is progress.  
I do hope your doc. opts to get in there and fix that lead.  I think that may remedy some of this problem.  Good luck!  I'm sure the doc. here has some good advice.
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Avatar_n_tn
Thank you for sharing your information.  I am happy to hear that your atrial fib is under control. I am not sure if my situation is a bit different in that the ablations were done in surgery.  For some reason, my electrophysiologist believes that my own intrinsic rate and rhythm will settle down as the healing and inflammation resolve.  My goal really is to have an intrinsic rate and rhythm with no medications and pacemaker solely as backup.  I had the pacemaker placed for sinus node dysfunction so have wondered if I wouldn't need the pacemaker for the long term.  My intrinsic rate is so fast sometimes I cannot even count the rate and I get chest pain as a result. I have clean coronaries so am not too concerned about the discomfort. It does settle down with rest.  I do not tolerate Toprol very well..very fatiguing and depressing...
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Avatar_n_tn
Does anyone have problems with pvc's or pac's that are induced by postural changes (sitting down, standing up, rolling over)?
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Avatar_n_tn
I have had positional PVC's and PAC's for 18 years.
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Avatar_n_tn
I'm not sure if this will help but I had an ablation for atrial flutter (over a year in heart failure as a result and 1 month off the transplant list before they agreed it was tachy induced) but for a good 2 months after the ablation.. major success (mabe 3 months) I was still having palpitations which concerned me greatly as I thought the ablation was supposed to sort this out. My cardo said that that this had become almost habit and so the elec impulse would continue to try and simulate behaviour for some time.

He was probably talking **** and trying to settle me down but it worked because by about month 3 they stopped altogether.  I only get them now if I induce them with stimulants such as alcohol etc...

RELAX... give it a couple of months and then re-assess.  Best of luck xx
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Had ablation 2/20/2004 for afib.  The afib is gone and so are most irregular heart beats.  I still had periods of afib for a few weeks after ablation.  This is normal.  I also had irregular beats, and my heart rate was elevated.  Also normal.

The afib pretty much ended after one month, the irregular beats really came down significantly 2.5 months after the ablation, and the faster than normal heart rate is starting to come down to normal.

I just had my 3 month check up, and the cardiologist basically says it takes time for things to heal completely.  I have read anywhere from 2 to 6 months.  I don't know how long ago you had ablation, but if it has been just a few weeks it may not be enough time to determine success.

Inflamation (inflammation) of the heart muscle is part of the reason for irregular beats.  They wanted to put me on anti-arrythmic, but I said just give me an extra 25mg of atenolol.  They agreed, and I believe that blunted some of the hyperactivity of the heart muscle.

I also decided to take an anti-inflammatory med (advil) twice a day.  I don't know if it was in my head or in my heart, but it appeared that this helped reduce the irregular beats.  If advil works to reduce inflammation elsewhere I reasoned why not in the heart.  I did this for two months until things basically leveled off.  Take it for what it's worth, your situation is entirely different.
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This is my first time writing,  so forgive me if this doesn't go the the right forum.  
I had cardiac ablation twice about 10 years ago for Re-entry AV node SVT's.  It worked, but in the last few years I see my heart is starting to just beat high (130-170) for no reason.  I'm so unhappy,  I thought this would never come back.  I'm 45, and have other health issues,  and just didn't want to worry about this anymore.  I also have PVC's everyday,  sometimes up to 1000 a day, although my cardiologist says I have to live with them.  But the rapid beat that comes on anywhere is just not going to work for me.  Has anyone dealt with this.  I have been very stressed lately, and I'm wondering if this is just bad tachycardia,  although I think I'm just trying to make excuses for the obvious.

Thanks for any input I receive.

Cindy
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Avatar_n_tn
I've have positional pvc's/pac's for nine years, only when I bend over.  No doctor has really explained why, just that they are harmless.  If anybody knows why this happens, please let me know.
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My understanding is that PACs that occur due to foci can be induced by fluctuations in the nervous system surrounding the heart.  The transit of electrical signals through the heart muscle is often governed by the state of this nervous system...thus, signals from a focus travel more easily when the nervous system is turned up (increase in tone).  Postural/positional changes cause an abrupt change in your autonomic tone, and thus can lead to a transient increase in PACs.  Lots of other things change the autonomic tone, and if you look carefully at the postings herein, you'll find that most, if not all, PAC increases can be traced back to such changes.  

-Arthur
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Avatar_n_tn
Thanks for the information.  I am now four weeks post operative..so four weeks post ablations.  Yes, I understand it will take time for the inflammation to subside and the healing to occur.  It can take up to six months but it doesn't making coping with all of this much easier.  My problem is that I can't cope with any kind of activity which makes rehab difficult.  I am now on verapamil so will see how that works.  NSAIDS (like advil) are contraindicated for me (I am on coumadin).  I am interested in hearing from other people who may have had ablations (particularly surgical) to see how they progressed after the procedure.  It would also be interesting to learn what happens down the road...does it really work for the long term??  Also, are drugs necessary for the long term?  I know this is all very new and the research data is just now being collected..so we won't know for a while.  Perhaps in five years, there will be a completely different approach to treating these problems.  There is so much research going on in the world of electrophysiology.
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Avatar_n_tn
I also have pac's, pvc's every day for five years. Sometimes things like reaching over my head, bending over, trying to sleep on my left side, eating, and lieing down will bring them on.  Also have paraxosymal tach, and sinus tach, as well as junctional arrhythmias. Also taking a deep breath at times will cause them. I have low blood prsuure at times due to atenenol which keeps my heart from racing for long periods of time, but doesn't totally control it. Hopefully this helps the people asking if others have the same experience.
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My PVC's can be positional and also come on after or during eating.  Interestingly they disappear altogether when I'm asleep, my holter monitor shows completely normal rhythm during the night and as soon as I wake and start moving around back they come, some days have been up to 10,000 on a bad day.  Also,(I think I have commented to someone before) during the last 20weeks of my pregnancy they disappeared altogether only to come back after delivery.  Somehow my stomach getting larger must have pushed or moved something so my heart wasn't irritated? similar situation to positional PVC's I would think. I wonder why this happens.
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HELLO ALL GREAT FORUM,I AM SO GLAD TO SEE THAT THERE ARE SO MANY LIKE ME OUT THERE.CANT EVER GET ON TO ASK MY QUESTION SO I AM HOPING SOMEONE WILL BE ABLE TO ADD SOME INSIGHT.37yo FM STARTED WITH PVCS 6 MONTHS AGO,5'4' 120 LBS.NO ALCOHOL NO TOBACCO PLAYED SOCCER FOR 15 YEARS,AND NO CAFFEINE.HOLTER SHOWED 5600 PVCS IN 24 HOUR PERIOD ECHO WAS NORMAL STRESS TEST NORMAL.TAKING ATENALOL 75mg PER DAY AND 30 OF CELEXA FOR WHAT THEY SAY IS ANXIETY.MY QUESTION IS HAS ANY ONE EVER EXPERIENCED BURNING IN THE CHEST AND STOMACH FROM THEIR MEDS OR IS THIS A FEELING FROM THE PVCS.I AM MISERABLE AND NOT COPING WELL WITH THESE.I HAVE READ THAT ABLATION IS OFFERING SOME RELIEF TO SOME BUT MAYBE NOT AN OPTION FOR ME,MY CARDIOLOGIST SAYS THAT THERE WAS AN EPISODE ON MY RECENT EVENT MONITER THAT COULD BE VTACH BUT I DONT KNOW IF THAT IS FIXABLE OR NOT.PLEASE HELP ANY INFO WOULD BE GREATLY APPRECIATED.I DONT KNOW WHAT IS WORSE THE BURNING IN MY CHEST AND STOMACH OR THE PALPS THEMSELVES.

SIGNED MISERABLE CANADIAN GAL
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Avatar_n_tn
I have never heard anyone complain of a burning sensation due to PVCs.  It's much more likely that sensation is due to an irritation in your GI system (esophagus/stomach). There appears to be an association between GERD symptoms and an increase in ectopics (PACs or PVCs), probably because of an effect on the nervous system surrounding/behind the heart.  If I were you, I'd have my esophagus/stomach checked out ASAP (in fact I did just that when my PAC/PAF symptoms first showed up).  An endoscopic exam is simple and painless, and worth it.

-Arthur
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Avatar_n_tn
thanks for the info I will mention that to my doctor the next time I see her,she is away for a month but maybe I will go to the ER.I do have the peace of mind that I work at the hospiital,I bellieve that this gives some relief when I am at work because I know that if something should happen I dont have far to go.haha.Again thanks for the info and I hope that all is well with everyone here on the forum.
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