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Heart Disease (Expert Forum)
Increase in skipped beats post ablation concerns
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Increase in skipped beats post ablation concerns
by glassheart46, Nov 23, 2003 12:00AM
I am now 3weeks and 3 days post ablation for AV node reentry, atrial tachycardia and atrial extrasystoles. The slow pathway was ablated as was the atrial extrasystoles and the atrial tachycardia. For the first 2 weeks or so after ablation the only symptoms I experienced were an occasionl skipped beat(maybe 12 to 24 per day very well spaced) and daily gradual increase in heart rhythm (not abrupt and would only get up to 100bpm or so.) The last 3 days things have changed. I now have skipped beats much more frequent. They will come in runs that lasted an hour or so the first day and an hour or so the second day and yesterday it started at 4pm and did not let up at all untill I finally went to sleep around midnight. This am they are gone but for a few now and then. I was very hopeful that my ablation had worked and now some doubts are starting to creep in. My common sense tells me that the skipped beats should be decreasing, not increasing. I am wearing a loop monitor and was told that these beats are from the atrium and they called them early beats or skipped beats. My question: Is it possible that I am getting the old problem back: the old problem being bigeminys and trigeminys daily, 7 days a week and of course tachycardia; or is this just post ablation irritation. They get so bothersome that I have a difficult time getting to sleep. I take Alprazolam which does not help for the above. I was never bothered much with skipped beats prior to ablation. Should I be calling my EP at this point? Thanks for this great forum.
Doctor's Answer
by CCF-M.D.-RCJ, Nov 23, 2003 12:00AM
Glassheart,
Thanks for the post, and follow-up.
It is very common for patients to experience a transient increase in palpitations for the first 3 months (and sometimes up to 6 months) after an ablation. We think that this is due to increased inflammation from the burning (or freezing) used to perform the ablation.
It certainly could also be that the sites that were ablated are now recovering, which also sometimes happens. Only time will tell which of the 2 mechanisms is in effect.
The best thing that I can advise is to wait and see, which I realize is difficult. Further therapy at this point, however, may be too hasty.
It certainly would be fine to contact the EP.
Good luck.
Thanks for the post, and follow-up.
It is very common for patients to experience a transient increase in palpitations for the first 3 months (and sometimes up to 6 months) after an ablation. We think that this is due to increased inflammation from the burning (or freezing) used to perform the ablation.
It certainly could also be that the sites that were ablated are now recovering, which also sometimes happens. Only time will tell which of the 2 mechanisms is in effect.
The best thing that I can advise is to wait and see, which I realize is difficult. Further therapy at this point, however, may be too hasty.
It certainly would be fine to contact the EP.
Good luck.
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The part I hate so much about all of this is the calling the doctor part. They make one feel like a big baby and that you should suck it up and not worry. The shoe needs to be on their foot and then they would understand the anquish one goes through. Thanks again for the post. I appreciate hearing from others who are going through this.
You wrote:
>>>>My EP doc never once mentioned post ablation symptoms or the possibility that it could come back or cause yet another problem. <<<
ditto for me
Funny thing is, after the first ablation I had more "post ablation" activity. After this one, practically nothing. Of course, that could be because they got the dang culprit!! hahahaha....Interesting theory on the anti-imflammatory aspects of taking an aspirin.
I won't be talking to my EP for a week now as they are on vacation so I would like to ask if you or anyone reading this post has been perscribed medication post-ablation to get one by until the healing process is over or is that contridictory? Would that hinder the healing process or would it in someway keep one from knowing if the ablation worked. Also, I am confused on this issue; maybe someone can answer:
I had AV node reentry which produced tachycardia for a year and a half. However, the month prior to my ablation my heart went into trigeminy's and bigeminy's which lasted the entire month and was terminated upon ablation. My question: Did the tri's and bi's have anything to do with the AV node reentry or was that a seperate thing. I got three burns and the report stated they were for AV node reentry, atrial tachycardia and atrial extrsystoles. I'm sitting on pins and needles worried that I will get the trigeminy and bigeminy back as the Verapamil I was on for AV node reentry did not help that at all but did help the tachycardia. If I got the tri's and bi's back, what kind of medicine would I be put on? Sorry for all of the questions. Hope you just might have some insight into all of this as I sure cannot get much out of my EP. Thanks so much for your help.
But enough about me. I'll bet you are truly elated. Man, after going through the first ablation and having all of those PVC's afterward, this must be pure heaven. I can only imagine it!
And it's so great to hear of all the energy that you have. Now you can really enjoy life a little better as that is the way things are meant to be. I was on Verapamil before the ablation and it did not help the tri's and bi's, but I don't have them yet, or the tachycardia which it did help, just the pacs which are very bothersome as you know. I won't be able to talk to the EP doc until next week as they are all on vacation. Maybe by then things will have calmed down anyway. I hope so. I don't dare take a verapamil without checking first.
You take care and have a great day!
I hope your extra beats begin to fade soon. I don't want you to miss out on chocolate!! It does seem as though a lot of people need more than one ablation. In my case, the doctor told me that up front...She said they were going to be very conservative and she has since said, they will "chip away at it". I'm thinking that we're done chipping!!! YEAH!! Even though I had the 2nd procedure, I know my first ablation was successful. So try to keep thinking positive thoughts and maybe the extra activity will subside. Has your doctor ever mentioned a possibility of a 2nd ablation? As Dr. RJ said, try to give it time.
You are right, I am elated to be pvc-free after all these years! It feels so strange....I was in bigeminy, trigeminy, etc. so much that I just chalked it up to my unique beat. I do keep wondering if the improvement is helping the heart muscle...time will tell. Maybe you can ask your doctor about taking a beta blocker to help calm down the pacs? Yep, they can be a pain!! Talk to you soon...Have a GREAT Thanksgiving!!
I went to a great EP doc but he told me nothing, NOTHING about what to expect.. only mentioning when I finally got him on the phone briefly after the ablation that I could expect "transient" skipped beats. I've tried to call him since but was told " he can't answer questions. He's too busy." It is very annoying.
The Cleveland Clinic doc is the only medical source I've heard or read saying this is possibly normal for, possibly, many months so that gives us all a ray of hope.
Again, I'm glad I had the ablation because at least i can feel that my heart was finally checked for malignant arrhythmias as best as it can be checked; and I feel , finally, validated that the atrial tachycardia reentry focus was documented and "zapped" after being treated like someone who was making up the rapid heartbeat for the better part of the past 20 years; and, truly, I have less palps. but I sooooo want to be one of those people who can live life without worrying about the next feeling that my heart is momentarily " stopping" or skipping and beating wildly or suddenly speeding up into double or triple time, even if it is only for a few seconds.
Happy Thanksgiving, all.
I am totally crushed. Anybody help me here with some informative answers. Input greatly appreciated! Also, does this mean that I can expect to get back the trigeminys and bigeminies? I don't know how the tri's and bi's fit into the picture. I only had two episodes of them before the ablation. The first episode lasted 6 weeks and the second episode happen one month prior to ablation. I have not had any tri's and bi's since. I was looking forward to a least drinking a cup of coffee per day but was told that was totally out. Also, no alcohol, but that wasn't a problem. Hope someone can provide some insight.
Thanks!
I understand that he is telling you that you have 3 options, but what is his recommendation? When my doctor asked if I was up for a 2nd ablation, I asked what she actually recommended. She said she would recommend the ablation, but she could also prescribe beta blocker (or another RX) if I did not feel ready or whatever. I have never taken Toprol, so I don't know much about it. I've taken Inderal (with some success), Tenormin (awful side effects after one dose) and sectral (don't recall much about that one). For me, the Inderal was best, but everyone is different.
AND, you are right...WHAT THE HECK HAPPEN TO THE 2-3 MONTHS HEALING PROCESS?? Does this mean that the ablation was not a success, or that you have new "stuff" originating from a different foci? I really think you may want a second opinion at some point...How woudl you feel about that? Not that your doctor isn't qualified and very good, it's just that the 2nd opinion might clarify some things for you. I'm thinking that trying the RX might be worth it...But, is the doctor saying without an ablation you will have to stay on RX??
When you say trigeminy and bigeminy, do you mean the pacs? I'm a little confused...You said you only had 2 episodes of them before the ablation. Do you mean persistent trig's and big's?
Did your doctor say you could not drink any coffee? Did that aggravate your arrythmia in the past?
Hang in there Glass.....we are all here for you.
Now it's been about three years since the ablation, and I can say things appear pretty normal. I choose to ignore my pulse in order to avoid the anxiety loop, however, once in a while, there are some bumps and even a few minutes of chaos which are not possible to ignore...but nothing persistent, and these are relatively rare occurences.
Focally originating arrhythmias require a pathway between the focus and the pacemaker system(s). As I understand it, ablations are designed to electrically isolate those foci (originally I thought the ablation toasted the focus itself). So, after isolation, chances are they persist in producing electrical noise, but it doesn't go anywhere. Eventually, these isolated foci are thought to slow down their signalling. However, if there was a gap somewhere in the isolation procedure, or there are other foci in the neighborhood, some new signalling may get through and cause a new arrhythmia...I also understand this to be relatively rare.
So, the general picture is that most of the time an ablation will isolate the focus responsible for the arrhythmia. In the process, tissue is scorched and the local nervous system is irritated. The irritation can last for a very long time (like for me)...it lasts longer than the healing process for the scorched tissue. One of the things foci depend upon to send through their abberant signals is the state of the nervous system surrounding the heart. The more irritated it is, the easier it is for the foci to send the signals through the cardiac tissue. (This is why fear often causes the heart to skip...it's simply the nerves affecting the cardiac tissue which in turn allows focal signalling to jump through).
So, bottom line...I would wait a while longer to see if your original arrhythmia is gone. It does sound like irritation and some simple skips to me. The Toprol is not a bad idea, since it would help ease you through this period of recovery. I used it along with Tambocor to help control my skips. BTW, Tambocor is a rather unique med since it works by affecting the ease with which electrical signalling travels through cardiac tissue (essentially counter-acting the scenario I described above). Above all, discuss those three options with your EP and point to the obvious prematurity of making a decision to have a second ablation. (the EP may be thinking that although your original arrhythmia is gone, there are leftover foci that it would be nice to toast).
Take care, I am sure things will work out well for you.
-Arthur
I agree.
If it is any consolation, my ablation was for atrial SV note reentry node tachycardia and I've had some runs of fast beats that I bet are atrial tach..but they are few and far between.
I do not agree that ablations are being done willy nilly. In fact, it took YEARS for my docs to agree to an ablation ( and, no, i wasn't pushing it) because they wanted the "hard evidence" which is , in fact, hard to get from an event monitor which only has 2 leads. Sometimes atrial tach can look like sinus tach and vice versa, the EP doc told me. And without very rapid, sustained rates of either, no one wanted to do anything invasive, no matter how relatively safe. The advantage to having an ablation to atrial tach is not only to make you feel better -- a quality of life issue -- but because it can increase your risk of developing a-fib. Also remember that while most cases of WPW can be noted via clinical signs and symptoms and an EKG - that's not always true. And it's a good idea, I think, to make sure with an EP study that WPW isn't going on.
So all in all, I hope you can look on the proverbial bright side and I hope things calm down for you palp-wise -- and me , too!
I'm having fewer episodes of those dreaded sensations although I've had days where I was absolutely sure nothing was "fixed". My EP doc, in our one brief phone conversation 2 days after my ablation, said the a tach COULD come back but it would be " very, very rare .. one in many, may hundreds of people".
Remember also the words of another EP doc to me -- he said there are very, very few things that can be "cured" in cardiology. But an ablation IS a cure for many people. So when people talk about about 70% over time versus 98% or whatever, you have to stop and think about it. SEVENTY PERCENT is still a whopping fantastic stat! ( I actually think the cure rate for atrial tach is much higher.)
About the drugs -- certainly ask your doc about beta blockers, etc. But, for me and lots of peopel, the side effects are horrendous and although I wanted it to work SOOOOOOOOOO much, they actually made my palps worse.. so much so that I ended up back on the event monitor that caught my atrial tachy "officially".
My Ep did not speak to me personally. He never does over the phone. I only got this info second hand from his nurse. She stated that he had looked at my strips from the loop monitor and seen one isolated incident of atrial tachy that lasted for 16 beats..and said he seen a number of sinus tachy episodes with beats up to 120. Also many early beats or pac's. I think he feels the original ablation worked but that this is new arrythmias. I am so depressed. I think the doctor should at least speak to his patient. The choices he gave me are not too good. I have low blood pressure already, Toprol would make it lower and I have never handled beta blockers very well in the past; lots of pac's. And another ablation; don't think my insurance company would go for that. My best option right now based on what I feel is best for me would be to wait and see how it goes. I will work my way through it without meds as best as I can. Thanks again you guys! I really appreciate the support!
I hope the EP is wrong and it is just irritation from the ablation. I am going to bank on that at least for another two months.
The weird thing is they are so varied.. a thumping on the left side of my rib cage.. what seems like very brief quick beats. One time, I felt my heart beat hard and fast ( but not as fast as pre-ablation) for maybe 20 beats. Other times, I can move my head, brush my hair and do other arm movements and feel a "blip" -- some irregular beats. Sometimes that's all I feel. Other times, I'll have that momentary " i'm dying" weak feeling that passes in a second or two.
I have only felt what seemed to be a flurry of very fast beats once since the ablation.
In general, I have fewer palps. I know I am very adrenaline sensitive. My cardiologist ( not ep doc) whom I saw 5 weeks post ablation said i'm probably de-conditioned if i improve my vagal tone the palps should get better.. but I'm still so worried and depressed that I"m not "fixed" by the ablation, on the days I have what feels like waaay too many palps, I just can't get going, you know? I'm also very fatigued and worry that's my heart but it is probably just sleep deprivation for lots of reasons, including my stinker puppy.
Lynn
I have a question for you and Glassheart. Often my heart beats feel a little strange. The rhythm seems normal, but there's this strange sensation, almost a sensitivity. It's dependent on what I'm doing and what position I'm in and is a constant reminder of my situation. Do you experience this at all?
BTW, sorry Glassheart to digress on your thread. I do hope that this conversation helps all of us to feel that there are others who relate to some degree. I hope you are improving.
Last night, just as I was drifting off the sleep, I awoke with my heart beating rapidly with some irregular beats thrown in and I thought , OH NO..the ablation didn't work.. the fast irregular stuff kept up for 20 to 30 seconds... then it stopped and I felt a few irregular beats as I finally went to sleep. This a.m. I had a few irregular beats here and there.
The thing with me is I had a month long holter in June that showed nothing dangerous ( mostly PACs, rare PVCs and "inappropriate sinus tach" and one brief run of SVT that the EP doc wasn't sure was really SVT) and then I had another month long holter in August to right before the ablation -- that's the one that caught the runs of atrial tach and that's why I got the ablation. However, with all the tests I've had over the years and with the EP study and ablation, I think my docs are so sure , so convinced there's nothing serious going on with my heart that they just aren't interested in my palps. but they are driving me NUTs. I was reading about SVT and apparantly you can get it ectopic SVT without a reentry site ( which is what i had ablated) so I'm thinking maybe these rapid beats are ectopic and not the return of the problem that was ablated. I don't know. i stay so confused and worried. and , yeah, i feel my heart feeling " weird"... I think it may be blood pressure ups and downs. my cardiologist, at the ablation follow up visit, suggested that that could be causing some of my palps -- and i needed to get in better condition to improve my vagal tone and to lessen any dysautomia.
That part I was fine with, as it didn't happen very often, and while I was on active duty it never happened. What is concerning me now, is for the past 6 months my heart has started to "skip" beats. Sometimes it happens 4 or 5 times in a row before returning to a normal heartrate. At the worst times, it happens near 20 times per minute. It is causing my entire life to degrade and all my cardiologist tells me is that i'am fine and won't even give me an appointment. I have a wife and kids and my own father died when I was 3 years old, I can't allow myself to do the same to my kids. The town I live in only has one cardiologist, and at the present time I can't go get a second opinion. He didn't give me any details aside from I have SVT. These "skipped" beats are destroying my life and I'am taking it upon myself to discover as much as possible about them.
I don't know exactly what type I have, because as I said the cardiologist didn't tell me much of anything. It feels like its in the lower part of my heart so I guess its ventricle. Which according to what i've read is the most dangerious and life threatening. My wife tries to understand but she has no idea, and although I don't get tired playing or running around, when it happens, as it does all the time now, I just can't function because of the fear my heart is going to stop. Sometimes I have chest pains toward the middle of my chest, but I just tell myself its not my heart its my lungs or something else.
If anyone has learned something that I haven't found on my own, or has gone through similiar expierances any information would be great.
Not having answers can drive you mad sometimes. Best of luck.
Although I'm still struggling with this, I have to say that seeing a doctor that really seemed to care was a wonderful experience. She sat down with me, asked a lot of detailed questions and reponded to all of mine(I had typed up a list of symptoms and concerns)without making me feel foolish. She confirmed that I'm not crazy or paranoid and am reacting very naturally to what I've been through. When we were wrapping up she said warmly,"I hope I was able to answer all of your questions sufficiently. It seems that, more than anything, that's why you're here." I thought, "Wow, she's absolutely right, and she really seems to want to help me." It really lifted my spirits. I guess I'm writing this to support what I mentioned earlier in the thread about finding a doctor that you can trust, and can help relieve the tension.
A bit of history, when I was 20 I experienced my first catheter ablation for an attypical arrythmia, I guess within my right atrium I had two circuits that were sending energy the wrong way and were opposing eachother, in any case, this was fixed. And following the procedure everything was fine for about a year - when the new arrythmia started.
However, with this last catherization I know I could have expected an increase in the number of arrythmias for a few months, however, I seem to have arrythmias that are coinciding with fits of coughing.
I was a little sniffly before the procedure, but not that bad. After the procedure, when on my pain meds (hydrocodone), I had a lot of green mucus coming up. Having stopped the meds, yesterday, I now am just coughing intensly, and it feels like the phlegm is stuck in my chest it won't come out.
I don't have a fever, but I feel sick, I feel like I am working with one lung.
Should I see the doc again, because my arrythmias are causing me to get lightheaded.