AVNRT - Post Ablation Symptoms

[JasonW]

I'll keep this question simple...

I had an RF ablation for AVNRT in late September.  For the most part, the healing process has been fine.  There are some days, however, when I have so many PACs that I border on going insane.  The problem is that they are frequent and forceful...not the light ones that we can all ignore, the ones that really thump.  These days of incessant PACs might be tracking with exercise - happening one to two days after a good run.

How long do post-ablation symptoms last?  A lot of us hear 4-6 weeks, but I'm hoping the period is longer because I want these days to fade away eventually.

Any insight is appreciated.

[SamUK6]

Hi everyone, I spent a while reading these responses and thought that I would add my experience. It's been 5 months since I had my second catheter ablation. My first ablation was for left accessory pathway SVT at 11 years old. Having started to suffer from SVT again at the age of 18, I was amazed to find out during my E.P study that the problem was actually AVNRT this time round, so I actually had 2 different mechanisms for SVT! I am 25 years old now.

Anyway, as I said I am now 5 months on from my AVNRT ablation and unfortunately I am also suffering with a high amount of PVCs. These PVCs have been confirmed by my doctor during a 24hr holter monitor which was taken around 4 weeks after my ablation. At around the 4 week post op mark I was only suffering them at night time, and the doctor said at only 0.5% of overall beats they are not at all dangerous. Since then the amount has increased a lot, I would estimate around 10% of overall beats (1 in every 10 beats) on average is a PVC.

I am visiting the doctor for my follow up next month so I'll share the outcome. But in the mean time its comforting to know that we are not alone in suffering this relatively unreported side effect of AVNRT ablation.

[DeepBlueSea]

I had mine done in January. I felt really anxious for weeks afterwards. Had sinus tac and even called myself an ambulance one time I got so scared. However the skipped beats, fast beats and general awareness of beats is disappearing. I don't know why, maybe my heart needed longer to heal than the few days they said and also maybe I think about it less now and trust it to be OK a bit more! I definitely think your symptoms will calm down. Good luck.

[EJhnson]

Yes, I agree, much more time is needed for my heart to recover.  When my Cardiologist said 5 days recovery, I'm not so certain that he realizes how hard I push during my normal exercise.  I only did a very slow jog yesterday.  But, for at least 1-2 months, I will try to keep my HR lower than what it was yesterday.  

Michelle, I'm glad to read that you feel your heart is normal again! Congratulations.

[MichelleP_3811]

My heart rate was elevated for probably a good 3 months after my ablation for avnrt and it took a good year for me to feel my heart was normal again.  I still get the pvcs and probably will always be prone to getting them but I have periods where I feel nothing at all so with time things will improve but your heart has been through a lot and just needs some time to recover.  Good news is you did not experience your previous symptoms and you recovered well so it sounds like the doctor did find the spot but time will tell.  Take care.

[EJhnson]

Tom, thanks for the detailed reply.  In response to your question about me and my experience with this issue and cycling:  First, I'm nearly 60 now and have 40+ years of consistent cycling and running experience, very competitive until I was about 45 years old, even set/have a State time trial record.  I've known since a very young child that I had difficulty getting deep breaths during exercise /playing.  A Cardiologist only diagnosed RBBB back then.  Only recently was AVNRT diagnosed.  During very extreme efforts, until I was 45 about years old, I main symptoms during exercise were 50%  HR drops accompanied by dead legs, followed by an immediate and prolonged difficulty getting deep breaths.  These episodes affected me about 5the times per year until I was about 45.  Since then, they have steadily become much more frequent.  I'm not certain why I waited so long to see a Cardiologist, but other about 50 years ago, I did not see one again until 2013.  Tom, feel free to PM contact me and I can describe more details during my arrythmic events or try to answer your questions , if you're interested.

[tom_h]

AVNRT occurs when a reentry circuit forms within or just adjacent to the AV node. The circuit usually involves two pathways.  There's a fast pathway and the slow pathway, both of which are located in the right atrium. The slow pathway is the one usually targeted for ablation.  These pathways are formed from tissue that behaves very much like the AV node, and some physicians regard them as part of the AV node.  Of course I don't have an understanding of how these two circuits are detected, but perhaps they were able to locate them and ablate one of them.  With just 5 days of healing time, you are going to experience a lot of sensations going forward.  These sensations can last up to a year or more, and it's quite possible that you are going to have to reset your personal norms.  Interesting regarding your experiences while cycling.  In my youth and as a young adult, I was involved in competitive sprint cycling.  The crouch position on the bike along with inadvertent Valsalva breathing often provoked episodes.  I use to hate it, because it meant immediate withdrawal.  By contrast to yours. mine was AVRT, and just touching the catheter to the wall of the atria set it off.

[EJhnson]

Hello.  My ablation for SVT, specifically AVNRT, was 8 days ago.  My Cardiologist said that it was a success, despite his not being able to induce an SVT during the procedure.  He said that he was still able to find a reentry point near the A/V node and ablated it.  My symptoms pre- procedure only occurred during intense exercise (usually running) and a few times cycling.  I was told to only wait 5 days before returning to my regular exercise routine.  I waited a full week and yesterday, ran for the first time since the procedure.  I had a few PVCs during the run, but my heart rate was about 10-15 bpm higher than usual at the same pace as before the procedure.  I'm not certain whether my heart was racing due to the reentry point not being completely ablated.   I'm concerned that my Cardiologist may be over-optimistic about the ablation being a success since he said that he could not induce the SVT (AVNRT) during the procedure.  I thought that was a definite requirement in order to have a successful ablation.  One positive observation from yesterday's run, I didn't have a prolonged high heart rate, once I stopped the run, it decreased normally to lower levels.  Previously, during SVTs my HR would remain elevated for hours.  I would appreciate any opinions or fact about whether an ablation can be successful without being able to induce an SVT during the procedure.  

[NessMul]

Hi, I had an ablation 2 1/2 years ago for AVNRT. I have now been left with inappropriate sinus tachycardia, my heart rate goes from 90bpm to 160bpm for no reason, but I'm in sinus. I also experience a rapid drop then raise after exercise of about 30bpm this repeats continuously for about an hour. I think this was just an irritation left after my ablation, it annoys and sometimes scares me, but all stress tests have come back normal. Nothing more I can do but hope it will resolve itself one day.  

[tom_h]

Please read through this, and you'll see that we were all plagued with jumpiness for months following ours.  Please see my reply to you on your other post.

[Davidstern]

Hello I had an ablation three weeks ago for AVNRT in New york. I am currently feeling really bad with bad palpitations for two days. Please advise to me what I should do?

[tom_h]

I agree with the new cardiologist.  Perhaps a fresh exam and opinion would be helpful.  That said, I was plagued with clusters both before and after my ablation for AVRT.  THey would last for several days, then stop for a week or so with perhaps only a dozen per day.  This went on for about a year and a half when they disappeared for good, and I haven't had them since.  Six weeks is very early in the game.  Forget with the professionals tell yuou on this one.... Your post ablation symptoms may last for a year or more.  I know mine did, and I have seen countless reports of others saying the same thing.  It will be three years for me this November.  I still get occasional brief runs of SVT.  Be patient and see how things develop.... and get a new cardiologist!

[MichelleP_3811]

I felt the same as you for a time but in the whole scheme of things svt usually gets worse with time and your heart could eventually wear out from it so it was a good thing to have it done in my opinion. I will also say my pvcs have almost completely stopped and the ones I do feel aren't strong.  It did take over a year or more to get to that point but with more distance you will notice them calm down.  I am not sure why it takes so long, maybe because I am a bit older in my 40s  but just hang on it will get better and your heart will be calmer than it has ever been. Six weeks isn't long enough.  The going consensus is around 3 months.  You may never fully get rid of the pvcs you had them before as they are the mechanism that triggers avnrt but they will calm down most likely to where they were before the ablation.  Stay strong.

[jacqui500]

I have the same situation as many of you: I had ablation done six weeks ago for svt (AVNRT), and since the ablation I have been having very frequent PVCs. At least I think they are PVCs: they come most frequently in rest and it feels like the heart is skipping a beat and then pounds the next beat harder. I too  experienced some prior to the ablation (maybe a couple of times per day) but nothing close to post ablation (sometimes once a minute, sometimes once in an hour).

They are much more annoying than my original problem of AVNRT that only appeared during or after exercise or other stress, maybe about once a month. If I could go back in time, I would not go through the operation because of this. I don't think I was properly warned about this side effect. I don't have a post-ablation appointment with my cardiologist to talk about this issue and he anyway thinks that people paying attention to their symptoms are just hysterical, so I will start looking for a new doctor if the situation does not solve soon.

I would appreciate to know if any of you have got rid of this problem and how long did it take? I hope you are all doing better by now.

[esjaydee]

I had an ablation done in March for svt (AVNRT).  Since then I have had very frequent PVCs.  I experienced some prior to the ablation but nothing close to post ablation.  Sometimes they are every 3 beats.  It's very disturbing to have them so frequently.  I too am curious about others who have experienced PVCs post ablation, and if they subsided at any point after.  Thanks.  

[MichelleP_3811]

It is the pause after the pvc that allows the secondary pathway signal to make it to the center of the avnode thus giving it the opportunity to get caught in the loop going out the entry and back in the secondary pathway in cases of avnrt.  There may be other triggers for causing one to fall into an avnrt svt but I think mine most likely got trigger by the pvcs.

[MichelleP_3811]

I actually had the pvcs before the ablation.  The ablation didn't cause the pvcs.  I am not sure how I got the pvcs.  If they were caused by the svt initially maybe one of my longer episodes that I didn't do anything about or if something else happened in my past to cause the pvcs to begin in the first place and then having the pvcs gave the svt opportunity to go off.  Essentially when I am having a pvc the heart adds an extra beat from the ventricles and in doing so confuses the SA node causing the heart to pause a beat.  I can feel the pause, it kind of feels like my heart is fizzling out.  If I have a few in a row I have trouble catching my breath.  Pacs are less likely to be felt because you don't have a pause and then hard restart.  I know they are pvcs because they were caught on an ekg in my doctors office.  I may possibly have pacs as well but don't know that for certain.  In any event, more of a concern for me is the statement they don't get worse but mine did.  I never did notice them before up until the last couple of years.  And right before the ablation they were flaring up a lot.  And because they were flaring so much I had at least 7 svt episodes that week.  If I had not had the ablation with the pvcs flaring so much I likely would have started to have daily episodes.  But on the other hand it almost seemed as though the svt would calm the pvcs down once the episode stopped.  But since I didn't know I had pvcs it is hard for me to judge that for certain.  I wasn't consciously trying to understand them at that time.  So I have to go with the notion that the svt stresses the heart enough to allow the pvcs and pacs to get a bit out of hand but after the heart has healed they will settle down.  If not I guess we will just need to figure out how to deal with them.  I only had a couple of weeks were I felt really really sick with them.  Now they come and go and are more of a nuisance than anything else.  

[JasonW]

I don't second guess  having the ablation.  I hate SVT and became really sick of holding my breath and waiting for it to happen.

Are you sure that you are having PVCs and not PACs?  From what I read, they feel similar.  Did you catch them on a holter, EKG, or event monitor?  I ask because usually ablation for AVNRT consists of work and burns in the atrium.  Hard for me to see how that would irritate the ventricle.  But...I'm no EP so it's entirely possible that I don't know what I'm talking about.

It's concerning me somewhat that no one else is jumping in here to say 'Oh yeah!  I had to deal with daylong episodes of premature beats, too!'

If you're out there speak up.  It helps people like Michelle and I to know that the specific symptoms that we're dealing with are common.  It gives us hope that we're not special cases and that we can look forward to the symptoms going away.

[MichelleP_3811]

I struggle a little with wondering if I made the right choice doing the ablation.  The pvcs didn't bug me that much prior to the ablation.  But in the long run I kind of think having the two problems isn't healthy for us.  Though I did not know what they were and that they weren't related to the avnrt I was starting to get quite a few flutters prior to the ablation.  I guess it kind of seemed as though they calmed down after a run of svt but to be honest I can't say that for certain.  I know I felt the flutters quite a bit so I can't say for certain that correcting the svt created a bigger problem with the pvcs.  It may have but then again the pvcs getting a bad as they were may have put me in more danger of falling into VT.  The medical community doesn't consider either condition life threatening in a healthy heart but if I am going to be honest I rather think not doing the ablation sooner has left me with the pvc problem.  The two problems obviously feed into each other but I kind of wonder if I had been a little more on top of the svt problem I wouldn't have developed the pvc problem.  But it is kind of the chicken and the egg riddle.  Which came first.  I guess in the whole scheme of things we can't go back.  I am down to little bouts of pvcs a day, some days almost none and they aren't that troubling.  I have faith that you will reach that day as well.  

[JasonW]

I think we're on to something here...

The heart block thing was just a result of the burn site being so close to the AV Node...once the swelling went down I was okay.  The doctor had me on Carvedilol before the procedure but took me off of them afterward.

I'm not having any issues with tachycardia.  I just get these three day stints with PACs.  Day one is the ramp up, day two is all day misery, and day three is the ramp down.  So far, there's no rhyme or reason to the bouts...the correlation to exercise is my best theory.  Maybe be a little lazy for a couple of weeks and see if they stay away?

Something you wrote, Michelle, really struck me.  The idea that the premature beats are much worse than dealing with the SVT really hits home.  The tachycardia might hit me twice a month and ONLY when I was exercising so I seemed to have some control over it.  The PACs defy reason and are miserably 'in your face' when they are at their worst.

I appreciate your story.

[tom_h]

Most of us report months for the post ablation symptoms to fade. Did you continue a beta blocker following the procedure?  This often helps lessen the bumps and short runs of SVT.

[MichelleP_3811]

I had an ablation for avnrt in early september.  I had flutters that I did not know were pvcs prior to and after the ablation.  They would come and go and mostly feel like popping corn in my chest.  About 6 weeks after the ablation I got a case of the flutters that did not stop.  I became aware at that point that I had pvcs.  Like you they were inncessant lasting all day and having upwards of 20 a minute.  I couldn't eat, sleep and I was short of breath and my chest hurt.  I felt worse than I ever had with the avnrt.  It all kind of took me by surprise because for the first 6 weeks I felt pretty good, just an occasional thump or pang.  The incessant pvcs only lasted a week.  The second week they started to lighten up.  Now 3 weeks later I am mostly free of them during the day or if I get them I only get little bouts of them but only 1 a minute or so.  I talked to my doctor about it and he told me that the pvcs will not go away but they should get to a point where I don't notice them once my heart has had a chance to heal.  He wanted me to give it a good 3 months before we did anything more.  But I can say that though they come back they did stop going off like crazy.  I did not have any sort of block and don't know that my heart was enlarged or not so it is possible your heart has a little more healing to do than mine but hang in there.  Once your heart calms down into a more normal rhythm I am sure the pacs will fade away for you as well.  If not, you can go on beta blockers to help regulate your beat.  I kind of think a flucturating beat has a lot to do with letting in the extra beats.  My heart rate is jumping around like crazy when the pvcs are flaring but when my heart is pretty steady the pvcs don't flare as much.  So try to give yourself some time before you worry too much.  And if exercise is making them worse then slow it down a bit so your heart isn't working so hard.  Your heart has been through a lot and needs a bit of a rest.  Best of luck and keep us posted on how you are doing.

[JasonW]

I think the two week episode that you experienced is what I'm talking about.  They're incessant and pounding...one can't  hardly concentrate on anything else.


Can you tell me more about your experience during that two weeks and what your doctor might have said about it?  Was there anything that you did to improve them?  Did you get a little down worrying what life would be like if they didn't stop?

Thanks

[tom_h]

Feeling "better" took about 2 weeks.  By one month was back to normal.  However, the little blips, PVC's and little runs of SVT continue even today, and it will be one year in  couple of weeks.  I really don't know if this is a result of the healing process or if this is just how its going to be.  I had a terrible episode of PVC's and PAC's about 8 months post ablation that lasted for 2 weeks.  They suddenly disappeared and I've been fine for the most part ever since.

[JasonW]

I appreciate the link.  What I see there is more about how one feels immediately after the procedure.

I too had swelling and 2nd Degree heart block two days after the procedure.  It cleared up within the next day or so (remained in the hospital the whole time) and the doctor sent me home.  After wearing a holter monitor for a day about a week later.  The doctor told me the danger of needing a pacemaker had passed.  Thank God.

But to my original question...on Tuesday I was officially six weeks post ablation.  4-6 weeks was the period that the doctor gave me to heal.  I am still having days where I have a ton of hard PACs.  I guess I'm looking for someone to say that it actually takes longer than 4-6 weeks for all symptoms to subside.

Is there anyone who had post-ablation symptoms persist for more than six weeks?  Esp PACs.

Thanks.