Heart Block After Second Catheter Ablation

[gad]

I am a 49 year old woman who was diagnosed with AVNRT about 5 years ago. My doctor always said catheter ablation was my only solution, so I never tried any medication. I put off the procedure for years, but finally it got so bad that I agreed to do the procedure in March. Unfortunately, the tachycardia returned within 2 weeks. I hoped it was lessened and I could just live with it, but the doctor said this was unlikely. It started getting severe again around the beginning of June and because I am going through a very stressful time (selling my house and moving out of state to start), I agreed to have the procedure done again. Apparently, my good pathway was ablated a little bit in the procedure, but they stopped the procedure within seconds and everything returned to normal. My heart was working normally overnight in the hospital, so I was released the next day. Sometime after I was released, I realized I was not getting better and began to feel so exhausted, I could not take more than a few steps without being winded (I am normally quite fit). It turns out I have heart block and am stuck at about 44 beats per minute. The doctor said he has never seen a case of someone leaving the hospital in good shape and developing heart block later. He thinks there is a chance I have some swelling and it will get better, but it's been about 10 days and he now seems less hopeful. I do not want a pacemaker unless it is absolutely necessary and am trying to get as much information as I can on the likelihood of my heart again functioning normally. Thank you for your help.

[Cleveland Clinic]

gad,

thanks for the post.

Heart block after radiofrequency ablation can occur in the short term after the procedure. This is presumably due to inflammation from the procedure, but the exact cause is somewhat hypothetically. It is however, easy to reason that the procedure itself is pretty darn inflammatory.

The overall risk of permanent block isnt quite clear. I looked through the literature, and there are reports of a small percentage of patients requiring a pacemaker when late block develops. There are also many reports of the block resolving on its own.

I would give the healing process a few weeks as long as you tolerate the block before proceding with any further procedures.

good luck and update us on what happens.

[Lyn2]

I hate to say this, but your story sounds like what happened to me, and I have talked with others with pacemakers that had post ablation heart block.  I did not end up with a pacemaker for three to four weeks post ablation.  I was in the hospital for three days after my ablation and my rate was in the 70s and 80s.  I left and over subsequent days it dropped, until I was getting pauses up to 10seconds.  By the time I got my pacemaker, my rate was in the teens and twenties.  
I never got a clear explanation as to how or why that happened. The only thing said was that the swelling following surgery kept the rate up and as it healed it showed its true rate.  
Good luck.  I do hope that things return to normal.  Just be careful.  My situation became very dangerous.  I must say, I am young and having a pacemaker is not horrible.

[PikaPika88]

I was told the ablation had fixed the palpitations successful for wpw.  Real one is they ablated my HIS bundle.  Left with the anterograded accessory pathway there!  ECG interpreting still showed wpw.

When I was told that I have A-Fib, I went back and asked my cardio is my AV node still active?  He said it was damaged a little bit but still operate, the pulse is a bit low, not nice.  

Now he wrote to my GP and said that I had AV nodal ablated!  What is the real picture or I miss understand what are the dr talking about?

When I came out from the ablation.  My pulse rate dropped to 40 and the BP dropped as well.  IV and an external pacemaker hooked up straight away.  I also got complete heart block if my pacemaker is not working.  Cardio told me the pacemaker is just for an insurance and I'm not the dependant.  

I think after the ablation, the heart has many changes.  Just watch which way it goes.  

Correct me if I'm wrong.

Pika

[WPWGuy]

Hi.  I am sorry to hear of your uncertainty.

I just wanted to mention that my heart ran quite slow (low forties or less) for a while after my procedure for left wall WPW. Although I can not imagine why it would run slow (I had always thought that an ablation on an outer wall would not result in slowness), it did. Nevertheless, several months after my ablation, my heart rate returned to something I would consider a lot more normal for me.

I dont understand it all. But I think there is a thing called remodeling, where the muscles in the heart have to adjust themselves to any electrical changes.  The bigger the changes, the more the adjustment they make.  

I think that I may have been given some Beta blockers during the procedure, which may have added some temporary slowness. In any case,  my heart rate ran a little slow to begin with because I keep myself is reasonable shape.  Also, because I had palpitations after the procedure, I stopped drinking coffee. I was pretty much a hardcore coffee drinker before the procedure, so starting the day without coffee actually made me feel weak.

As a matter of fact, emotionally, the whole thing was exhausting, and I didn't exercise much after the procedure.  I was even easily winded until I got back into my exercise routine and got my strength back.

Regarding the ablation, I know that it was supposed to be a piece of cake, but that isn't how I experienced it.  The simple procedure had a big effect that took a while to recover from. Also, I dont know whether any of this applies to you, or if it is helpful at all.  Maybe some of it applies and some doesn't. I just hope everything works out for you.  Good luck.

[gad]

Thank you for your comments. I am tentatively scheduled to have the pacemaker put in Wednesday, but based on what the doctor says and others' experiences, I think I may try to wait it out a bit longer, but will definitely monitor the situation to make sure my heart rate is not dropping further. The problem is that I am supposed to move to another state a week from Monday, so if I do not get it done here next week, I will need to wait a couple more weeks and have it done in the new place. Has anyone ever gone on a long car trip in this condition? I am a normally pretty active person, but right now can do barely anything. I can no longer climb uphill or walk much at all without getting winded and I'm afraid to drive because I get dizzy. Thanks again to all who replied.

[KAD]

Hi, I also developed a very slow heart rate post ablation.  I was fine right after my 2nd ablation for inappropriate sinus tachycardia, but about one week later all of a sudden I dropped into the 30's with my heart rate.  They hospitalized me right away to monitor me.  I was out of town when this occurred, so my doctors weren't at this hospital.  They had me in the hospital for two days, then released me to go home.  So I flew home on a plane with a heart rate in the 30-40 region.  I did fine and went in to see my doctor and he said I should get a pacemaker and then if my heart rate came up with the pacemaker in then he could remove, but only 6 months after.  If I had the pacer for 6 months or longer it would be in for good, because it becomes to risky to rip it out at that point.  I would be very careful to drive in your situation.  It is just very unpredictable about how low your heart rate will drop.  Once it starts beating so slow you really don't get adequate perfusion to your brain.  I obviously kept the pacemaker in because I did end up needing it.  When they do checks on my pacer and turn it off for a second I am still with a heart rate in the 40's and it doesn't feel good. I think I did make the right decision to keep the pacer in even though it does have its own risks and I am a very young pacemaker patient at the age of 28.  Good luck and take care of yourself!

[WPWGuy]

After the ablation, I discovered I had aquired some VT. I gave it some time, saw a couple of local doctors, and did an angiogram (that came back favorable).  I didn't travel much for a while, but several months later, I did a few trips halfway across the country to see a couple of specialists. On one trip, I drove 5 hours to Cleveland for a second opinion. Since the VT was new thing for me, the trip was a little nerve wracking at times. I did enjoy the drive. And the visit helped put my mind at ease.

I dont think anyone ever suggested to me that my VT warranted a pacer though.  To help me understand the safety part of it, I asked my doctor how serious my condition was on a scale of 1 to 10.

My ten beat runs of monomorphic VT apparently didn't amount to much:  I received a 2. This really doesn't say much about my fitness for travel right after the ablation though.  My pulse was slow, I was dizzy at times, easily winded, and had a lot of uncertainty and apprehension about my condition; I would not have wanted to be driving alot, or to be traveling alone.

I have recovered and have no problems with travel at all now.

[mir123]

HI I AM NEW TO THE SIGHT. I HAD A CATHETER ABLATION DONE ON MARCH 31 IN CLEVELAND FOR SVT AV NODE RE-ENTRY PROB. I STILL FEEL THE PVC'S PAC'S BUT I WAS TOLD I WAS FIXED AND NOW I AM HAVING EPISODES OF 140- 160 HR. ALL DR'S SAID GO OFF THE ATENOLOL 25 ONCE DAILY, BUT I FEEL LIKE I NEED A HIGHER DOSE. THE CRYOTHERAPY WAS CHOSEN FOR MY ABLATION DUE TO IT'S SAFENESS. THIS RULES MY LIFE. MY ONE GLIMMER OF HOPE THAT I WAS GOING TO BE NORMAL AGAIN IS GONE. MY SVT DIDN'T SHOW UP UNTIL I WAS 23. I AM A NURSE SO I KNOW ALL OF THE "BAD THINGS" THAT COULD HAPPEN WHICH MAKES THINGS WORSE. THIS WHOLE THING IS VERY UPSETTING! ANY THOUGHTS?

[mdee88]

Hi Mir123, I can relate. My situation sounds just like yours (In feb I had ablation for SVNRT SVT). It helped, but I still have bursts of SVT, which has been very frustrating to deal with (probably more mentally than physically) because I was so hopeful that all my anxiety regarding this would be over. My doctor seems to think it will clear up, but I have this frequent fear that it's going to happen again, worse than before. It affects a lot of areas of my life. I take 25mg of Toprol, but I obviously would need a higher dose to prevent these episodes. Right now I'm really trying to assess how to handle it. It may just be something I need to get over mentally. I will write again after I see my doctor in a few weeks. I feel like I need a better answer than what I've been given.

[RHYTHMRN]

HELLO,
I AM A 39 YEAR OLD FEMALE WHO WAS DIAGNOSED WITH MVP AND AVNRT AT AGE 13. I HAD MANY EPISODES OF SVT OVER THE YEARS AND MY CARDIOLOGIST FINALLY TALKED ME INTO HAVING RF ABLATION. ( I AM ALSO AN RN AND SOMETIMES THE MORE YOU KNOW, THE WORSE IT IS).  i HAD MY FIRST ABLATION 4/19/06 - CRYOABLATION.  I GOT SO SICK 5 HOURS INTO THE PROCEDURE IT HAD TO BE STOPPED.  THEY HAD ABLATED 5 AREAS AND I ENDED UP IN A JUNCTIONAL RHYTHM.  THER WAS TALK OF DOING ANOTHER ABLATION IN 2 DAYS OR GOING BACK ON BETA BLOCKERS AND HOPE THE NEW RHYTHM WAS FROM THE IRRITATION OF THE HEART TISSUE.  I NEVER FELT RIGHT AFTER TH 1ST ABLATION - FATIGUED ,SHORT OF BREATH WITH MINIMAL EXERTION.  AFTER 4 WEEKS I STARTED HAVING SVT AGAIN - CONSTANTLY.  I WAS PUT ON A MONITOR AND IT WAS FINALLY CAUGHT.  I HAD MY SECOND ABLATION 6/22/06 - THERMAL ABLATION THIS TIME.  WAS TAKEN OFF THE BETA BLOCKERS AND SENT HOME ON THE THIRD DAY.  I COMPLAINED WHILE STILL IN THE HOSP. - 1ST DAY POST ABLATION OF INC. HEART RATE FROM JUST TAKING A FEW STEPS.(NURSE CAME RUNNING INTO ROOM DUE TO HR IN 150S - I WAS BRUSHING MY TEETH.  DR.S TOLD ME NOT TO WORRY - WILL GO AWAY. I ASKED TO BE PUT BACK ON BETA BLOCKER AND WAS TOLD IT WASN'T NECESSARY.  I FELT LIKE I WAS PUMPED UP WITH ADRENALINE - VERY ANXIOUS.  I HAD BEEN ON BETA BLOCKERS FOR 25 YEARS. I SUFFERED FOR THE N EXT MONTH WITH TACHYCARDIA, SHORTNESS OF BREATH , ANXIETY AND PANIC ATTACKS AND OCC. SKIPPED BEATS - ALL STARTED DAY AFTER ABLATION.  FINALLY WENT TO ER (CARDIOLOGIST AND EP COULDN'T SEE ME FOR 2 MORE WEEKS AND I COULDN'T STAND IT ANYMORE.  ER DOC HAD ME TAKE A WALK AROUND NURSES STATION - GOT ABOUT 1/2 WAY - SOB,DIZZY HR 150'S - TALKED TO EP AND ADMITTED TO HOSP WHERE I HAD PROCEDURE DONE.  WAS IN 3 DAYS - TOLD IT WAS INAPPROPRIATE SINUS TACH, PUT BACK ON BETA BLOCKERS AND WAS TOLD IT WOULD PROB. GO AWAY.  WELL TACHY. SUBSIDED, NOW I AM HAVING SKIPPED BEATS CONSTANTLY.  HAD MONITOR AND SAW EP DOC  - HAVING PREMATURE JUNCTIONAL CONTRACTIONS, PACS AND OCC PVCS.  I HAVE NEVER HAD SO MANY PALP. IN MY LIFE. I TOLD DOC I AM NOT EVEN ABLE TO RETURN TO WORK. I HAVE NEVER FELT THIS BAD IN MY LIFE - I FEEL LIKE I AM SLOWLY DYING.  THE SOB AND PALPS ARE SO FREQUENT THEY CAUSE ANXIETY. EP SAID SOMETIMES PACS  ARE COMMON FIRST MONTH OR SO AFTER ABLATION - THIS IS 8 WEEKS FOR ME.  IT PUZZLES ME WHY THE PALPS. GOT WARSE AFTER RESTARTING BETA BLOCKERS.  ANYONE HAVE SIMILAR PROBLEMS POST ABLATION?? LIKE YOU I THOUGHT THAT THIS WAS THE ANSWER - NEVER HAVE TO WARRY ABOUT SVT AND GET OFF OF MEDICATION - NO LUCK SO FAR, I WOULD APPRECIATE ANY COMMENTS.......................

[Spottedowl]

A related discussion, Solution for heart attach with pacemaker was started.