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Post ablation atrial fibrillation
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Post ablation atrial fibrillation

Dear Dr.,

I just had an ablation one week ago.  The day I was released from the hospital, I had an episode of atrial fibrillation.
After speaking with the doctor's office, I went to the ER.  They recorded a-fib with V-tach (but my EP said the EKG he got from them only showed AF).  They gave me cardizem in my IV and a cardizem drip and more cardizem afterwards.  I never converted to NSR but they said I could go home after 6 hrs. with a pulse rate of about 130 (and still with very irregular beats).  I finally converted later that night during my sleep.

The meds I was put on post ablation were:
Norpace 150 mg X 2
Topral XL l00 mg daily
Warfarin (now 3 mg daily... more to begin with)
Aspirin 325 mg
And the dr. said I could take Magnesium too (I'm taking 400 mg)

Since that day, I have had 2 or 3 other long attacks of a-fib with very irregular beats lasting 2 or more hours.  My EP told me to take additional Norpace + Toprol and if I don't convert in a reasonable amount of time, call the dr. and/or go to ER.

My question is this:
Is it normal to have bouts of a-fib like this post ablation? Is a-fib also part of the healing process? Or might we say right now that the ablation was a failure?

I have been experiencing PAC's and PVC's occasionally, but the literature I have states that I wouldn't have any more a-fib.  I'm having it now just as often as I had it before.

BTW, I'm not sure what kind of ablation I had...my EP spoke of the PV ablation before the procedure, so I assume that's what he performed.

Thanks

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239757_tn?1213813182
Swanee,

It is very common, in fact some people have increased episodes after ablation.  It probably is due somewhat to the inflamation (inflammation) remaining after the procedure.  It is not uncommon for this to last a few months. It should tail off over time and I would give yourself a good 6 months before really deeming failure.

good luck
25 Comments
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Avatar_n_tn
I had the same thing after an ablation for AFIB.  I had more irregular heart beats for about 5 days after the ablation, and had a number of afib bouts.    Mine settled down after a few weeks, and then I had just real short bouts, and now I'm afib free. It's been 18 months now since ablation, and it seems to have worked.  I'm still on a beta blocker.  Doctor figured it was just good to keep the heart from irritation.  But I'm running etc. and feeling good.  Hope yours is successful as mine.  But it will take some months to know for sure.
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Avatar_n_tn
I've discussed my situation before here and you've been kind enough to describe yours. I've been pursuing the cause of exercise intolerance for 3 years now, meaning having difficulty running after doing a mile in 12 mins or so. I can get dizzy if I push myself after this point and have to revert to a fast walk. I've had a heart catheter and an EP with an ablation for an atrial flutter in my right atrium and nothing has changed. I've had two event monitor studies. The first one was judged by one EP as showing small runs of Afib and the second set, which consisted of many more events showed only an irregular heartbeat in sinus rhythm. The EP who did my ablation wasn't convinced of my first EP's diagnosis of Afib. During the EP study they couldn't get my heart to do much of anything except for that atrial flutter which they successfully ablated. I've tried beta blockers and they made things worse. I have no problems during normal activities and after my exercise routine, limited as it is, at least from my perspective, I feel great! You say you are able to run now, can you tell me what your level of tolerance for running was before and after? If there's anyone else here with a similar problem please chip in.
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Avatar_n_tn
I was actually running about 3 miles 3 to 4 times a week at about an 8 minute clip when I had afib.  My Afib was not constant, but sporadic. I was on anti-arrythmics and a beta blocker.  Actually I was in pretty decent shape for being in the late 40's.  But pretty soon if I would run outside in the cold weather I would have atrial flutter that would turn into AFIB.  When I stopped and walked awhile, I would be OK and start running again, but I never felt tired etc.  But that's when I decided to get the ablation.

Right now I am on atenolol 25mg twice a day.  

I didn't start running again until 3 months after ablation.  I had bought a really good treadmill, and then I started very slowly.  I never exercised too the point I was really tired.  I just tried to increase length and intensity at very small increments  

Right now I run about two miles at about a 9:30 to 10 minute pace.  I don't push too hard, and then I try to ride bike for another half hour, this is mostly to get calorie burn with some aerobics.  At this point I really don't have any exercise intolerance other than just being 50.  At 50 I don't get in shape as quickly, but in the past few weeks, I've noticed I'm starting to see some results.  But I have taken it very slowly.

My suggestion to you is the following:
1.  Warm up by walking a few minutes at a fast pace.
2.  Then start walking and running.  I found it very helpful to walk a minute, run a minute, walk a minute, run...etc the first half mile or so.  This really helped me to build up to where I could run farther.
Then run your next mile slowly.  Or if you can't go back to intermittent running and walking.
4.  If you feel a bit tired, but good at the end of it that should be good enough.
5.  Then after about 3 weeks of that start increasing the time you run from one minute to a minute 30 seconds.

This is how I got back into shape, and it really worked well for me.  I never felt as though I was pushing too hard.

Hope this might help.
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88793_tn?1290230777
Hi Everyone on this post,
Could I ask which country are you all in?  I'm from Melbourne, Australia.  I recently find out have A Fib as well but my Dr told me have to take medication for the rest of my life.  I'd an ablation done in 1985 for WPW 10% case.  Permanent pacemaker implanted.  Dr said I have a lot of episode recorded in my pacemaker.  Something.. ventricle increase the rate.  Take atenolol, Dixogin or Flecainide by itself not worked.  Now take the combination of Flecainide and Verapamil.  I hope you all can tell me a little bit more about the relation with A Fib and Ablation.  Thanks.  Pika.
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Avatar_n_tn
Dquenzer: thanks for the history. I am trying to determine if I really have some arrythmia or if it's perhaps lack of fitness after all. My EP has suggested flecainide two times a day, but I haven't started yet. I have not responded to any of the BB's I took . My quandary is that if flecainide does work, I am not sure I want to take it the rest of my life just to be able to run. I don't like taking drugs. In my late thirties I ran a lot and could do 7:30 pace for 6-8 miles. Then I cut back on running. At 50 I was still in fairly good shape and could run 3-4 miles with some walking. Then I really slacked off. Trying to come back at 55 I noticed that I was not improving. Then at 58 I started getting dizzy spells. That's were I am now at nearly 61. I start running at a 9:40 pace and usually stop at .5 mi. After that I walk for a couple of minutes and try to resume at 9:40 for a minute. After a couple of these sequences I will start getting dizzy at the 9:40 pace. If I slow to a fast walk I'm OK. When I stop after I feel a dizzy spell coming on I'm breathing very hard.  I am going to get a pulmonary evaluation to see if perhaps I have some breathing problems. At this point I have no confidence that I can improve and based on my past history of achievements I find that embarassing. Thanks for your input, it helps to know what others are experiencing.
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Avatar_n_tn
I would think that your medication would include Coumadin to thin your blood if you have Afib. I was told to take the same when my first EP saw (I think subsequent evidence showed he may have been incorrect) "bursts of Afib" on my heart monitor during running. I have never had any heart palpitations or recorded high heart rates at any time, or even widely fluctuating heart rates. My reasoning in rejecting Coumadin was that I did not think that I was in Afib, if ever,  very long at all to justify it. Sounds like you might need another EP study to determine the source of your arrythmia.
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Avatar_n_tn
It just occurred to me: You have Afib when running, and you are able to continue after a while, no dizziness, no tiredness. However my EP's think that my dizziness etc. are due to an arrythmia of some sort!! I assume you had very irregular heart rates when you had your Afib. My heart rate, as per my Timex heart monitor shows it goes up smoothly during my initial run, levels off at 130, thereafter as I run and walk it goes down and does not seem to go up to 130 again. when I step off the treadmill it goes down, sometimes as low as 50. It stays fairly steady at this low rate for a while and then it ramps up to 90-104 which is what it should be, since I work out with weights after the treadmill.
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88793_tn?1290230777
Hi, Dr did not give me blood thinner.  I've a history of ITP (low platelets). I'm taking some herbs (in tablets form) that my mum posted to me.  It dissolved the blood clots and it helps to stop the bleeding as well.  (It is very good for gun shot wound and after operation.) I didn't tell this to my cardiology.  Two weeks ago, morning at 1:00am I went to ER because my back chest pain and I can't sleep.  My oxygen intake is 100%!!!  I knew that because my TCM practitioners are very strict.  They want me to do 2 kind of exercises to increase the oxygen intake.  I think all these exercises (slow motion) are came from part of the Martial Arts.  Hey, you all haven't told me which country are you in?  I just wander their ablation for A Fib is so advance than Australia.  Thank for your post. Hope you all get well and healthy. Pika
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Avatar_n_tn
Strangely enough I never felt dizzy when I got AFIB while running.  I felt a bit nervous and anxious, but never dizzy.

I have heard others say the same thing.  In fact some people in constant AFIB run and don't feel dizzy.  I find that hard to believe, but it's true.

At age 61 I don't think taking an anti-arrythmic is a bad thing.  If you were in your 40's maybe.  I had no side-effects when on anti-arrythmic.  It is better to stay in rythmn.  The risk of AFIB is worse than the risk of taking a drug that has found to be quite safe.



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Avatar_n_tn
I missed something significant in your last post.  You said that your heart rate doesn't really get above 130, and also that it slows very quickly.  That's a bit strange.  My normal heart rate during exercise is 130 to 140.  And when I start walking it takes about 3 to 5 minutes to get back down to 100 or lower.  This could be why you are getting dizzy during exercise.  Your heart rate doesn't get high enough to compensate the exercise.  However I will have to say that your target heart rate at age 61 really shouldn't be higher than 130.  

220 minus 60 is 160 (your max rate.)  80% of 160 is 124.  That should be about what your rate should be.  Anything more than that may be too strenuous.  Therefore it might be a conditioning factor.

I'm not a cardiologist, but I think there is a condition where the heart actually goes too slow. People in this condition need a pacemaker to speed their heart rates up.  I'm not saying you have this.

Have you described this condition to a cardio.  And what did he/she say?
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Avatar_n_tn
Both my interventional cardio and the EP he recommended are aware of my research with my Timex monitor but they have not set much store by it. Now the confusing thing is I have become dizzy when my rate was in the 90's. Every exercise period is consistent: It ramps up smoothly as I start my initial run on the treadmill. I wish I could run at that pace for a longer time than 5 mts to see if it will go down at some point. But I have to stop and walk. It does come down to the 100's when I walk, and will go up subsequently as I pick up pace. Since I can't do many more fast runs after that I can't tell whether it does not pick up because I'm not on a higher load long enough or whether its because of something else, but I do know that when I get off the treadmill it goes down to 60 sometimes 40 even. I can be in this stage for 10-30 minutes sometimes till the rate suddenly ramps back to 100. As I said I'm working out with weights during this time. There is no firm correlation between how I feel and my low rate. I don't get dizzy, I need to run to do that. My BP gets low too sometimes (90/60) at the end of my exercise. BTW I notice that a day or so after aerobic exercise my BP is 105-110/60-70 whereas its normally around 120/80. Thanks for your input, your info on bpm was useful. If you are typical, your bpm should not go down as you exercise. I was wondering if there is some conditioning factor that kicks in and slows things down...
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Avatar_n_tn
Actually heart rate should increase as intensity increases no matter how good of condition their in.

If a person exercises at maximum heart rate too long they fatigue out.  It's too strenous.

As a track coach I check heart rates for interval work.  Typically a high school student will have to work out at about 150 bpm to 160 bpm or even higher.  But the rate should drop to about 120 bpm after three minutes.  Otherwise the interval workout was too hard.

My heart rate generally drops to to 90 to 100 about 4 minutes after I run.  That's what should happen.  I'm on atenolol, so my heart rate probably is a bit slow.  

But I really think that the uneven aspect of your heart rate should be determined.
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Avatar_n_tn
If your students run at a constant pace, does their bpm fall after a few minutes? To recap my situation, my bpm does not fall below 90 when I'm on the treadmill, but it doesn't seem to go readily to 120-130 after a few minutes of running-walking when I pick up the pace. The steep fall starts after I stop running. My interventional cardio who recommended an EP did think my bpm slowdown was significant, he thought maybe I should get a pacemaker that would bump up the rate if it goes below x, but what would x be if my dizziness doesn't seem to be correlated to low bpm all the time? I wasted a year with my first EP who diagnosed me with AFIB and did not want to do an EP study. My second EP, the one I'm seeing now has been much more helpful. I'm going to a pulmonary specialist to see if perhaps I could have exercise induced asthma or some other pulmonary problem. BTW, do any of your students suffer from this or do you know of anyone who does? What are the symptioms of EIA? Thanks again for your insights..
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Avatar_n_tn
No.  Actually if they run at a constant pace their heart may actually go up if they run long enough.  For example when I ran a 16 mile road race in my 30's, my initial heart rate over the first 10 miles was pretty even, but the last 6 miles I had to labor even while keeping the same pace.  My heart rate didn't go down, but up.  When fatigue sets in the heart rate goes up.

It has been my experience (I ran track in college, and coach high school track) that heart rates will go down slowly but steadily after you stop IF the exercise is not too strenuous. My track athletes do not experience quick drops in heart rates, and nor do I when I'm done with my workout.  On the otherhand I've had athletes whose heart rates did not go down appropriately, but stayed up too long.  I told them they over did it, and so I had them rest longer, slow down the interval pace, and take more time between intervals until their conditioning improves.  

I do have some athletes that get exercised induced asthma.  They not only get dizzy, but they start gasping for breath.  One girl was pretty bad as a freshman.  However as her conditioning improved her episodes decreased and she had pretty good tolerance.

It could be that your dizziness is related to your heart not being efficient after a certain point during exercise.  Do you ever feel chest discomfort? Have you been checked out for a blockage?  

I really don't think your problem is exercise induced asthma.   If I were you I would have a real thorough examination by an EP who is really going to get to the bottom of the cause of the symptoms, which it sounds like you are.
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Avatar_n_tn
I had an ablation a year ago.  I am 47.  I have had an irregular heartbeat all my life but suffered not ill effects until three years ago when suddenly I could not exercise without quickly topping 200 bpm.  I would walk on the beach and hit the sofa afterwards.  Prior to that I was exercising regularly.  I would run for ten minutes and slowly get myself in the 150 range and then either leave it their or kick it over 160 towards 170.

Since the ablation (I am also taking beta blockers) I am regular but my exercise capacity has fallen off.  I assume part of this is the two years I could not run, and age.  I have been walking and running as you described but have a hard time getting up over 130 bpm, although if I road run I can get into the 140's.  Is this consistent with your experience?  The limited capacity has started to concern me.  Also, am I getting the same relative benefits at the 130 range that I was getting from the 150 range?  Thanks.
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Avatar_n_tn
"I had an ablation a year ago. I am 47. I have had an irregular heartbeat all my life but suffered not ill effects until three years ago when suddenly I could not exercise without quickly topping 200 bpm. I would walk on the beach and hit the sofa afterwards. Prior to that I was exercising regularly. I would run for ten minutes and slowly get myself in the 150 range and then either leave it their or kick it over 160 towards 170."

I assume you had SVT.  Actually having a heart rate this high (160 to 170) for being in the mid 40's would really be a sign of over exertion.  It could be that your high heart rate may have been a precursor to your problem.  When I was really in shape in my 30's (running half marathons etc), my heart rate seldom got above 150 during exercise.


"Since the ablation (I am also taking beta blockers) I am regular but my exercise capacity has fallen off. I assume part of this is the two years I could not run, and age. I have been walking and running as you described but have a hard time getting up over 130 bpm, although if I road run I can get into the 140's. Is this consistent with your experience? The limited capacity has started to concern me. Also, am I getting the same relative benefits at the 130 range that I was getting from the 150 range? Thanks."

Many people have complained that beta-blockers decrease their exercise capacity.  I'm not sure because I've been on them so long (10 years).  Age, deconditioning, and beta blockers may all contribute.  

As to your bmp at 130, actually that should be your target heart rate for moderately strenous exercise.  Going over 130 isn't necessary.  My suggestion is that you not be concerned about your bpm, but try to increase the duration and  intensity.  The key is NOT to work so hard you can't talk while exercising.  STRATEGY: Increase intensity and/or length in 10% intervals.  For example if you are running and walking 2 miles.  Then increase the amount you are running by 10%. So if you are running for say 1 mile, then run 1.1 mile.   If you are going to run/walk the same amount of time then increase the length by 10% ie. go 2.2 miles.

Do the extra 10% for about one month, then increase it another 10%.  I think you might find that your exercise capacity increases.  The problem is that we try to go too fast.  The result is injury and/or not enjoying it.
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Avatar_n_tn
Dear Dr.

Had a afib ablation done 24 days ago.  Was in NSR for the first two weeks. Then noticed that when I went on bike ride that my resting hr was sitting at 88 - 95 and not in NSR.  Prior resting HR between 45-55.  During exercise heart rate did not jump higher than 140. Prior to ablation the meds converted me into NSR after 24 hours.  

Meds that i am currently taking:
rythmol 325 mg twice a day
cardizem 180mg once a day
coumadin 4mg once a day

Have not been NSR for approximately one week.
Question is if I do not convert in next few days should I should I go for conversion?  

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Avatar_n_tn
Well, it's a little over 3 weeks now since my ablation, and my EP switched me to flecainide 50 mg X2 (instead of the Norpace), but after I took one pill and had the MOST HORRIBLE CHEST PAIN after several hours, I called the dr. and they told me to switch to 25 mg. X2, which seemed to make me have more PVC's which invariably led to bouts of a-fib lasting several hours.

As of today, I am still taking the flecianide, but have several afib attacks daily as well as about 9 - 10 PVC's per minute (extremely annoying ones, I might add).

I'm wondering if perhaps more people have less afib bouts post-ablation because they are taking the medicines that work for them (i.e. anti-arrhythmatics, BB's, etc). And I just can't seem to find the right combo.

The problem is that my EP is trying hard to get me in NSR for extended periods of time, but I don't think he has the time to work out a schedule with me as a contingency.  For example:

Try 25mg x 2 for 2 days, if that doesn't work,
try 50 mg x 1 or 2 for a couple of days, if that doesn't work,
try 100 mg x 2 etc, etc.

I'd hate to do that on my own, because these are serious medications and I don't have the medical knowledge for this kind of maneuvering!

I get so depressed reading about how many people have such great results and I'm actually worse off than before I had the darn ablation.  I thought as time went by, I'd at least show some improvement!!
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Avatar_n_tn
Not a doc. but I would definitely go in.
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88793_tn?1290230777
Hi Swanee,
Not all but at least I know you and me in the same boat.  I was told like that way as well.  I think it induces my palpitation too. Who's going to believe that?  I choose to start the Verapamil at Friday night so Saturday and Sunday don't have to go to work.  After that, I jump on the bed.  3:30am my chest look like all the food stuck there.  How come one night my chest is put on weight that much??? Open the cupboard, find what ever related to can relief that syndrome.  I know I shouldn't do that but what other options that I can have?  You don't learn that.  That morning when I open my eyes, I can't believe it is my heart.  It was so quiet...... wasn't naughty at all.  As soon as I walk to the kitchen, seem like the palpitations all wake up.  Then I decided what medication are going to take for this morning or not taking any?  May be give it one more try?  May be not toughing this one anymore........ I'm very confuse...... Let me know if you found the right combo. Look after yourself. Pika.
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Avatar_n_tn
Didn't see your reply to my last q till today, thanks for your info on heart rates. Yes I have been checked by catheter for blockages - nothing. I also had an EP study done during which they were able to induce an atrial flutter in my right atrium which they ablated. My carotid arteries are fine, I also had a TEE done and everything did look fine. I do have a Patent Foramen Ovale, which is congenital, an opening between the atria that we are all born with but which did not seal (as is the case with 20-30% of all people). There is a flap there but it is not pernamently closed. The cardio who evaluated this did not recommend doing anything. I understand that is not the cause of my symptoms. (I do have RBBB according to my resting ECG.) I am going to get a pulmonary eval. but as you suggested, I don't think its EIA.
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Avatar_n_tn
Well, it's 2 months post ablation for me and I'm still having severe attacks of A-Fib averaging about every other day, lasting a few hours each.  These attacks seem to be stronger and more painful than before ablation.  I started cutting down on my meds (dosage) because they seemed to make me have more AF and lasted longer.  

Now I'm second guessing my decision.  Perhaps I should take the full dosages recommended, which would be:
100 mg. Toprol XL x 2
300 mg. Disopyramide (Norpace CR) x 2

Right now, I'm only taking:
50 mg. Toprol XL x 1
150 mg. Disopyramide x 1 (I fully realize that this only stays in my system for 12 hrs., but my attacks are sometimes during the 12 hour span and sometimes not).

I'm puzzled by other posters on this board saying they take such small doses of these drugs, i.e. 12.5 mg. Toprol XL.  How is it that my doctor recommends 200 mg. per day?  I've never even tried less than 50 mg. per day!

Is anyone else out there in my situation?  Where they have severe attacks of A-Fib even 2 months post ablation?  My doc did a PVI on me, but now I'm wondering if I'm one of the ones who's PV's aren't the cause of the A-Fib!
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Avatar_n_tn
Hello

My Dad had a Quad Bypass a week ago.  the DR mentioned many time that my dad had a very sick heart.  The bypass is complete.  The Drs are using a Balloon Pump to help the bp.  They have been trying to ween my dad of all meds and balloon pump.  With in the past 2-3 days my dad is getting irregular heart beats, 2-3 times they have used the defibulator on my dad.  They use a low shock and so far 1 shock each time has put my dad's heart back in order.  They are telling my family it is the electrolytes as well as an irritated heart causing the irregular heart beat.  Has anyone ever heard of this?  If so, what can be done?
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A related discussion, post afib ablation was started.
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A related discussion, After ablation was started.
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