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]

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..

[dquenzer]

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.

[dquenzer]

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.

[axg9504]

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...

[dquenzer]

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?

[dquenzer]

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.