Post ablation atrial fibrillation

[Swanee44]

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

[axg9504]

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.

[Swanee44]

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!!

[dquenzer]

Not a doc. but I would definitely go in.

[DCA]

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?  

[dquenzer]

"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.

[p3]

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.