atrial tachycardia after ANVRT ablation

[annie1724]

In April I had my first episode of atrial fibrillation lasting 12 hours.  I was put on an IV of cardizem, then digoxin .  I have a history of svt and took verapamil for 15 years.  My EP urged me to have an ablation for the svt hopingthat the svt could have been a trigger for the a-fib.

I had the ablation 8 weeks ago, and my AVNRT was successfully ablated.  However, in the weeks since the procedure I have had very brief runs (2-17 beats) of tachycardia once or twice a week.  I also experience occassional skipped beats and also extremely brief feelings (2-3 seconds) of a fluttering in my heart.  My EP had me wear a 48 hour monitor, which showed PACs (1/10 of 1% of total beats) and also two "3 beat runs of atrial tachycardia.  Unfortunately I did not have any of the fluttery feelings while on the monitor.

My EP said that the atrial tachycardia was not a dangerous arrhythmia, but was a precursor for atrial fibrillation and prescribed .25 mg atenolol.  I was so shocked by the diagnosis that I really did not ask good questions, so I'm hoping you can help me!

1. How likely is it that the atrial tachycardia is still a result of my heart being irritated from the ablation?  I asked my doctor if it was possibly that and he said yes, possibly, but I didn't ask him how likely.  Occurences seem to be lessening somewhat

2.  Do you think I have had this atrial tachycardia all along and it was just masked by the AVNRT?  If so, shouldn't it have shown up in the ep study that I had ?

3.  Could this be a new arrhythmia?  But if so, doesn't it seem strange that it would have started one week to the day after my ablation?

4.  If atrial tachycardia is considered a precursor to a-fib, does that mean I am definitely going to develop a-fib?  That it is just a matter of time?

5. What do you think the fluttery feeling is? I know it's impossible for you to know, but I am concerned about atrial flutter.  Does atrial flutter generally last 2-3 seconds?

Thank you so much!

[annie1724]

Thank you for your answer, Doctor!  If you happen to come back to this post, I just would like something clarified,if you don't mind.

You said you didn't think there was any evidence so far that I have atrial tachycardia.  My EP said that the monitor showed a "three beat run of atrial tachycardia."  Is that the same as a run of PAC's?  And the 5 or 10 beats in a row that I feel could also be a run of PAC's then??

Thank you so much!

Especially relieved to hear that atach doesn't automatically lead to a-fib!

[Cleveland Clinic]

1.  That would be unusual 8 weeks out of from the procedure, but certainly possible.  First of all, I don't think there is any evidence so far that you have atrial tachycardia, instead, just some PAC's.  It's highly likely that they have always been there and that's why you were found to have AVNRT.  PAC's usually start AVNRT.
2.  They probably saw some PAC's which is very typical during EP studies.  A lot of them come from the catheters that are in the heart.
3.  I don't think so.
4.  Atach is not always a precursor to AF.  I don't think you should be concerned about that at this time.  
5.  Fluttering just means fast heart rate.  Atrial flutter is a technical term which can cause fluttering in the chest, but so can any other from of fast arrhythmia.  So, it is a very nonspecific finding.