PACs (while exercising) after ablation for Atrial Flutter

[frs87]

Last year when I was 19 I started suffering from PACs while making exercises. Later it developed into a Supraventricular Tachycardia. In December I had an ablation, in which they surprisingly discovered that I actually had an Atrial Flutter. The procedure was a success: they clearly found the localization of the Atrial Flutter, ablationed it and everything went back to normal. Since then I kept feeling these terrible PACs. I understand they don’t offer any risk; I also recognize I’m a very anxious person, which probably doesn’t help. However, most of these PACs I feel while making vigorous exercises. This worries me a lot because I can’t help thinking that the arrhythmia is coming back. I had an ergo metric test couple of weeks ago, and I was lucky: I had several PACs. So I showed the result to my doctor and he said it was normal. He said I should avoid being so anxious and - if I wanted to - he even could sign something authorizing me to participate on a marathon (I’m a runner). Yes, he seemed this confident. He says I have a perfectly structured and strong heart. So, who am I to disagree? Still, I can’t help the feeling that something is not right. I keep having those terrible terrible PACs almost every time I exercise. I noticed it is somehow related to my emotional state at the moment: if I start to run already worried, the PACs tend to occur more frequently. This makes sense. But even so, sometimes I’m OK but I still have them. So my question is: 1) Is there any chance of a recurrence of Atrial Flutter almost 6 months or more after ablation? Should I be worried about this? 2) The presence of PACs during exercises is a bad sign or it can be normal if you are a anxious man? Notice that I have PACs occasionally during the day, but it’s while I’m exercise that they show up with intensity. 3) The fact that I insist to make exercises since a few days after ablation until now even having several PACs can make any ‘damage’ to my heart in terms of modifying the electrical system? Or am I being too paranoid?
(I’m sorry my English, it’s not very good)

[Forum-M.D.-MJM]

Hello,

I agree with your doctor completely.  At this point, your problem isn't your heart, it is you worrying about your heart.  This is a common problem, but one that we as physicians can't fix.  

1) Is there any chance of a recurrence of Atrial Flutter almost 6 months or more after ablation? Should I be worried about this?

Yes there is a chance.  This is not a life threatening problem and it is fixable.  Your quality of life is probably more compromised by the worrying than the arrhythmia.


2) The presence of PACs during exercises is a bad sign or it can be normal if you are a anxious man?

The PACs do not affect your physical health, they have a bigger impact on your emotional health.  Emotional health is very important but difficult to fix.  I will through this question back at you -- what would make you feel better?  Your doctor has told you that you are fine and your health is not at risk, but your worrying appears to be what gets to you.  There are some problems that are very difficult to fix -- PACs and PVCs are often in this category.


3) The fact that I insist to make exercises since a few days after ablation until now even having several PACs can make any ‘damage’ to my heart in terms of modifying the electrical system? Or am I being too paranoid?

There is not known risk to PACs.  I would continue exercising and try to move on.  If the atrial flutter comes back, address it then.  If you can do this, you will have a more peaceful work outs and days.

Thanks for posting.

[axg9504]

This is an interesting question to me. Can an ablation cause other arrhythmias that were not present before? I had an ablation during an EP study for an atrial flutter that showed up during pacing. Should an ablation be done for an arrhythmia that was not documented before the EP?

[axg9504]

This is an interesting question to me. Can an ablation cause other arrhythmias that were not present before? I had an ablation during an EP study for an atrial flutter that showed up during pacing. Should an ablation be done for an arrhythmia that was not documented before the EP?

[frs87]

I didn't developed an Atrial Flutter after the ablation. During the ablation, they incited my heart to trigger the arrhythmia, but what they saw was an Atrial Flutter, not a simple SVT. It doesn't seem the ablation "created" the AF, I already had that, but never had a serious crises before (though I had already felt some strange symptoms some times).

[NurseKagome]

There are some problems that are very difficult to fix -- PACs and PVCs are often in this category.


I am just wondering what you meant by this comment since I found it unclear. I understood the rest you said before it. Thanks!!

[Forum-M.D.-MJM]

There are many arrhythmias that we can ablation and they are gone for life -- AVNRT, AVRT (WPW), atrial flutter and fibrillation in most people.  PAC/PVCs are often difficult to treat with medical therapy like beta blockers, flecainide, etc.  When it comes to ablating PACs/PVCs, they sometimes are not present on the day of ablations, they can come from different areas of the heart making it difficult to map them. It is also important to mention that ablation procedures do carry risks.

It some people they cause significant, life altering symptoms despite not being life threatening.

Hope this clears it up.

[anacyde]

First, thank you for posting the question because the answers reassured me immensely.  I also suffer from exercise-induced PACs and supraventricular tachycardia.  I do totally understand the frustration, the fears AND the anxiety.  I am also an anxious person.

On the bright side, it appears your ablation is successful thus far and that should be incredibly reassuring.  I'm very happy for you!  Reading the forum here has helped calm my fears and it's kept me exercising regularly.  I do notice anxious days yield more PACs, but even with a monitor that showed it my cardiologist told me he was extremely happy with what he saw and considered me healthy.

Try not to let the anxiety take over.  Worry can drag you down both mentally and physically.  Sounds like you have a real healthy heart!  Try to take comfort in the experiences of others here, and in the wise words of the doctors who offer their time and expertise to all of us.  Focus on tackling the anxiety so you can enjoy your good health :)

[frs87]

Thanks everybody for posting.

Today I was running and I felt MANY PACs, which frustrated me a lot. Although my doctor says the ablation was successful and until now I haven't had a crisis, the idea that the arrhythmia may come back leaves me extremely unhappy.

When I got home I was like "I can't do this anymore". I didn't even know what "this" was, it's just that I felt very depressed. Yeah, I know this is dramatic and ridiculous, but I'm only 20 and thoughts of a limited life keep running in my head. What if a second ablation doesn't work? Will I have to take medicines for how long? Etc.

I think the best solution is to exercise in other ways for a while. The worrying and anxiousness is getting over me, but I can't let this happen. I'm aware that AF isn't a life-threatening problem, but the fear is controlling my life.

I'll try to fallow the recommendations, though it's very difficult. Thanks anyway for the answers, they keep me calmer.

[dquenzer]

Don't stop running!

I would suggest that you go to a biofeedback person to help you control your anxiety reactions.  When I first started getting PAC's a great deal I also felt like I couldn't do anything.  I finally realized that I was doing the WRONG thing by changing my lifestyle.  So I started running again and simply said I was going to tough it out.  It worked.  

One of the ways to deal with anxiety is called flooding. If a person is afraid of dogs you simply put them in a room of dogs until they adapt.  I ran anyway and just learned to adapt, and when I felt anxious I would do the biofeedback relaxation techniques.  It helped. And I am still quite alive.

Here is another suggestion.  If you are running alot are you over doing it?  Your body may be saying to "slow down."  So run moderately. Stay hydrated.  No caffiene.  No stimulants period.  But don't stop running if you enjoy it.

[anxietymike]

For about 2 years now I have experienced severe panic attacks while working out. I have had  extensive heart test and the docs  say there is nothing wrong. I seem to get winded and light headed very easy, but the ending conclusion is a panic attack. Could this be  my breathing???   I dont know but  I am fustrated   can anyone help??