ablation recovery time

[arthur]

I recently had an ep/ablation procedure conducted to locate and remove the focal source of a paroxysmal atrial fibrillation (lone afib).  The ablation site(s) were located in the left pulmonary vein ostia (openings to the atria).  This procedure is clearly cutting edge, as pulmonary vein foci have only recently (past few years) been identified as potential sources of paf.  

In my case, 9 burns were used to ablate one focus (near the opening to the atrium) which was confirmed to lead to paf.  Three other foci were found to simply generate PACs and were left alone.  It's been nearly four weeks since the procedure and I continue to have regular bouts with PACs (1-6 per min) which come and go, and often appear related to physical exertion.  The frequency of the PACs is elevated compared to pre-procedure, although I have noticed some decline over the past week.  I have read and been told that the recovery time is usually 1-2 weeks (with PACs being a typical symptom).  For a pulmonary vein procedure as described above, what could be expected in terms of symptomology and time, based on experience at your institution?

Your reply will be greatly appreciated, since I am quite worried that I may never get away from these PACs.

[Cleveland Clinic, MD]

Dear Arthur,
In general the heart may be a bit "irritated" following an ablation and there may be an increase in palpitations for 4-6 weeks.  Because afib ablation is so new there is no one right way to perform it, however we tend to ablate more foci here than less.  Of course if you are continuing to have afib they can go back and ablate additional foci. The potential downside of multiple ablations is a narrowing of the pulmonary vein. Where did you have your ablation done?

[Ramman]

I'm considering having the same procedure for PAF. May I ask, how long did your procedure take and how uncomfortable was it? My concerns are, like yours, if a success & the PAF is gone, might I suffer from chronic PAC/PVC's. I'm also concerned about the potential for narrowing of the veins. Best of luck to you. I hope you have a speedy recovery from the PAC's.

[arthur]

The ablation was conducted by Dr. Francis Marchlinski of the Univ of Pennsylvania Hospital in Philadelphia.  Very thorough, very professional. It did take 10 hours on the table and the pv focus responsible for the afib was electronically confirmed no less than 9 times.  I'm not as worried about the afib as I am about the "irritation" causing incessant PACs.  Thanks for your reply.

[arthur]

The ablation I described took 10 hours, most of which passed by unnoticed as I was unconscious.  Typically, such a procedure begins with mild sedation and insertion of catheters (mildly uncomfortable since they go into the groin and neck).  Using local anesthetics you really don't feel much.  This first phase of setting things up takes 1-2 hours, which also includes positioning the "wires" into the various veins/atria (this is more psychologically irritating than physically).  After this, the arrhythmia is induced using whatever protocol was found useful in a separate, earlier session...typically isoproterenol (adrenaline mimic) is infused to pick things up.  The doc and his/her assistants then "map" the potential areas of interest by moving the wires around and seeing where abberant electronic signals emerge and whether they may be responsible for the induced arrhythmia...this takes the longest time...and it is here that you may receive even more sedative (which happened to me) and snooze through the most exciting part.  Once an area (or focus) has been identified as a source of electronic noise leading to your arrhythmia, it is "burned" by low wattage rf energy designed to minimize collateral damage to surrounding tissues and avoid undue clot formation.  With fingers crossed you then hope that they located all the problem foci and you're done with that nagging arrhythmia.  After a few weeks you'll know.

[Ramman]

Arthur, I hope your PAC's are improving dailey. I have an appointment Nov.2 with an EP/A-Fib specialist to discuss having the ablation done. Because, after 25 years of problems, I'm very conscious of every irregular heart beat, one concern, among many, is having frequent PAC/PVC's permanently following the procedure. Please let me know how you are doing and how your doctors have responded to your PAC problems. Are you currently on any medication? Again, I hope the PAC frequency is reducing and the A-Fib stays away. Good luck!!

[arthur]

PAC frequency was terrible during the first 1-2 weeks post ablation (typically 6+/min) and included messy bits like bigeminies.  Weeks 3 and 4 witnessed some relief in that the PACs came in waves instead of constantly, and they even subsided when lying down (although not always).  I'm into week 5 and have been running again (3-5 mi) every other day, with less and less PACS showing up during the run and, especially, after the run.  So, I am optimistic that these skips will subside to a tolerable (pre-ablation) level.  I saw my doctor yesterday and he underscored this clinic's response, namely, that these arrhythmias can occur due to an irritated heart for up to 4-6 weeks (consistent with the normal time it takes for a wound or muscle injury to completely heal).  I was also given the choice to take some medications designed to decrease the PAC frequency just in case they continue to bother me.

So, the prognosis for such a procedure is not so bad.  Just be sure you have all the facts regarding your specific case and a full understanding of the possible complications (thrombus, stroke, pulmonary edema, etc)...and that the ablation may not solve all your problems.

Good Luck !!

[Leslie]

I would like to know if radio frequency ablation could be done for sinus node reentry. My doctor keeps telling me this is not a serious condition when you don't have heart disease. I am taking 180mg of diltiazem per day and I am still having break throughs of SVT. The symptoms that come with this condition are hard to ignor.

Thanks for your reply,
Leslie

[arthur]

Final postscript...
By the 5-6 week period, PACs assumed their pre-procedural frequency, ie, occassional bouts of 1-4/min, particularly a day or two after exercise.  Per doc's suggestion, I am taking flecainide to stop the PACs and it works quite well.  Played a soccer game yesterday and no PACs before, during, or after.  I will wait for the season to end and taper off meds to see what's what.  PACs are a royal PIA, however, things could be worse, so I'm grateful for the Univ of PA Med Center team and happy to be kickin' again.

pps  Leslie, talk to an electrophysiologist (cardiologist specializing in catheter ablation therapy) to get a straight answer to your problem...don't rely on a generalized answer from the internet.

[Ramman]

Arthur, I'm glad to hear the PAC's are reducing and you've resumed your normal activity. I assume you've been free of A-Fib to date so that's encouraging. They apparently removed the problem areas. I wish you continued progress & success with the procedure.

[biasman]

A related discussion, Ablation recovery time was started.

[dhoffa1]

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