Just dealt a major setback following my recovery from ablaltion....

Early Saturday morning, I was awakened with severe arrhythmia from out of the blue.  I had to get back on the Metoprolol which coincidentally I had stopped completely taking only one day earlier. I took a scheduled stress test today that was suppose to see how I was doing off the Metoprolol, but it became a test to see what was going on rather than to see how I’ve progressed since the procedure.  This was nothing like I had before.  I was/am experiencing PAC's with non-sustained runs of SVT thrown in.  Cardiologist wants me back on  my original dose of 100mg per day that I was taking before the procedure back in Nov. and may fool around with other meds before sending me back to the doctor who did the procedure.  He thinks there might be  filament of conductive muscle that he missed during the procedure.  So ultimately, I may have to get another ablation done.  We’ll have to see.  I still managed to get 10 minutes on the treadmill which doesn’t sound like much, but at the end is running 4.2mph up a steep incline.  Doc says at some points, my heart was throwing salvos of SVT between 250 up to 300 beats per minute.  I could have gone more, but he punched me out having gotten enough data.  I'm currently OK, but I feel PACs at least once a minute at rest, and walking about the large building here at work results in SVT and lots of PAC's.  This is not good…….  

[cindy707]

Tom do not panic here or even think its a fail until its been confirmed.  I went thru just about the same thing i think a total of 3 times after the ablation was done almost five years ago and one of the worst was the last one which was a little over a year ago where i ended up back in the E,R,  and had to get converted.  My heart surgeon is the one who played around with the meds and we tried probably four of them before we hit on it with antenolol which was perfect for me anyway.  As i always post i take a low dose every morning when i brush my teeth (.25 mgs.) and so far so good.  If the ablator feels they may have missed something or something else reared its ugly head and popped up then i would def. get it taken care of.  I now take the antenolol and have a pocket pill called Multaq that if i go into a sequence of events and can't convert myself then i hit the Multaq and so far i have only had to take a half of one and it def. did the job.  So my docs criteria was this:  If i wake up out of a sleep or feel anything off in my pulse rate regardless of the source and its the pounding and irregular beats i am to take an antenolol..i wait 45 min. and if it doesn't convert i take a secondary antenolol give it another 45 minutes and if it didn't convert to go to big gun Multaq and if i didn't convert after 30 minutes i was to head to the E,R,...so far its worked for me on the rare occasions that it has happened over the last few years.  You may want to toss it past your heart doc and see what they say...the other funny thing Tom is that this may happen...convert and never ever happen to you again....i know it so ***** what you are going thru and i know the disbelief that you feel right now but you are still less than a year out and it may be more common than you think.....Just let us know..we all care about you so much and whenever i see you responding to others posts i don't even bother going into it because i know they are in good hands with you my friend...my fingers are crossed that you will wake up in the morning and it has suddenly stopped..if it happened to me it can happen to you <3

[beema36]

Oh Tom I am so sorry to hear this. You were just doing so well. Let's hope its just a small set back. It's amazing you could go ten minutes with your heart doing that. I am impressed.
Keep us posted. You are in my thoughts and prayers.
Beema

[merileegal]

You've helped so many people here on this site. Now we're all here hoping and praying for a quick fix for you. I've read that sometimes the heart finds a new extra pathway after an ablation so maybe that's what this is and they can zap it and you can continue on with your path to recovery. Wishing you the best.

[achillea]

Rats, Tom!  What a lousy break, huh?  I hope it all gets fixed with the minimum of trouble.

[itdood]

I think you went about 7 months?  That's promissing I think.  Even if you do need a follow up, it sounds like it's receptive to treatment.  Like your doc said, part of the surace must have come back online.

Do you know the approxiamte location of the rentry circuit?

[tom_h]

Thanks everyone.  I'm going on 8 months. I believe the location is in the left atrium near the valve.  I racall the electrophysiologist telling me that the conductive path was extremely wide and required connecting the burn "dot" with another one to literally form a line of dots.  He needed 17 burns to bridge the width of the path.  I'll go again in a second.  If he said be there tomorrow, I would.   In the mean time, if I do anything, I get clusters of PAC's, interspersed with 5 or 6 beats of tachycardia.  As I rest, it eventually settles down.  I seriously doubt that uping my doseage of Metoprolol is going to do anything except make me slowwwww....  This literally came out of the blue.  I ran 2 miles last Thursday afternoon after work and felt like an ox afterwards.  There was no arrhythmia at all.  I can feel every single one of these.  I have been getting little runs of tachycardia every now and then, but have chalked it up to the procedure and really never even considered it.  These PAC"s though are worse than the PVC's.  They don't hit as hard, but I don't like the effect it leaves you with.  I've wracked my brain search for an outside stimulus, diet, food, illness, but I can't come up with anything.  I was actually looking to see if blackberry seeds could cause arrhythmia as I've been enjoying sev eral pint of them.  I though I might be getting ill.  Prior to my ablation, I would swear that I'd get PVC clusers prior to getting sick, but I feel fine.  So we'll see what the next week brings, and move on from there.

[littlegreenman1]

Icky (harshest words allowed by the auto-moderator here)

Hope you're able to go back in and get fixed up.

[Jannie411]

Oh no!  I can't believe this happened to you.  You were doing so well.  I hope they can fix the problem soon.  Hang in there, we're all rooting for you!!

[kbug1013]

Hey Tom, I will be fine. I know how PAC & PVC are anoying. But I am sure if anyone can get through this it is you. I am so grateful for all the advice and support that you have given me. I will be praying for you daily.


Kelly

[kbug1013]

It will be fine! sorry

[cindy707]

Tom do not panic here or even think its a fail until its been confirmed.  I went thru just about the same thing i think a total of 3 times after the ablation was done almost five years ago and one of the worst was the last one which was a little over a year ago where i ended up back in the E,R,  and had to get converted.  My heart surgeon is the one who played around with the meds and we tried probably four of them before we hit on it with antenolol which was perfect for me anyway.  As i always post i take a low dose every morning when i brush my teeth (.25 mgs.) and so far so good.  If the ablator feels they may have missed something or something else reared its ugly head and popped up then i would def. get it taken care of.  I now take the antenolol and have a pocket pill called Multaq that if i go into a sequence of events and can't convert myself then i hit the Multaq and so far i have only had to take a half of one and it def. did the job.  So my docs criteria was this:  If i wake up out of a sleep or feel anything off in my pulse rate regardless of the source and its the pounding and irregular beats i am to take an antenolol..i wait 45 min. and if it doesn't convert i take a secondary antenolol give it another 45 minutes and if it didn't convert to go to big gun Multaq and if i didn't convert after 30 minutes i was to head to the E,R,...so far its worked for me on the rare occasions that it has happened over the last few years.  You may want to toss it past your heart doc and see what they say...the other funny thing Tom is that this may happen...convert and never ever happen to you again....i know it so ***** what you are going thru and i know the disbelief that you feel right now but you are still less than a year out and it may be more common than you think.....Just let us know..we all care about you so much and whenever i see you responding to others posts i don't even bother going into it because i know they are in good hands with you my friend...my fingers are crossed that you will wake up in the morning and it has suddenly stopped..if it happened to me it can happen to you <3

[colby12]

Yes there is a difference because mg citrate works in the citrate exchange portion of the krebs cycle and is not involved in muscle cell pathways to the extent malate exchange portion is. Mg malate is invovled with supplying energy for muscle cell function including heart muscle cell pathways which can misfire if not functioning properly causing heart arrhythmias such as PACs and PVCs. There are many studies to verify the clinical value of mg as related to arrhythmia especially after open heart surgery. I take 425 mg of magnesium malate per day but I take a formula that includes malic acid. This is extremely important because the malic acid is synthesized in the body through the citric acid (Krebs) cycle (in the mitocondria) and it may be at a deficit in the mitocondria of the cell. Malic acid provides the cells with energy and carbon skeletons for the formation of amino acids. Synthesis of proteins, fats and carbohydrates necessary for cellular integrity, normal activity and function are dependent on ATP availability which supplies the energy for their synthesis and actions and malic acid/malate pathway is the pathway magnesium needs to facilitate for proper muscle cell function. Magnesium deficiency causes swelling and disruption of cristae in the mitochondria, with a decreased number of mitochondria per cell so mg and malic acid work together to provide proper functioning of muscle cells. Additionally, only tissue malate is depleted following exhaustive physical activity, even though other key metabolites from the citric acid cycle necessary for ATP production remain unchanged further demonstrating the use of malate in the muscle cell pathways including the heart muscle tissues. I use Source Naturals formula because it includes malic acid with magnesium but if you prefer you could take any form of magnesium and eat a granny smith or green apple and hope for the best. You would probably have to eat ten green apples though to get enough malic acid to make up for the loss. Let me know how you do. I believe that the reason people are confused with the different types of magnesium that are availble is because you have to understand microbiological cellular respiration/function to see how all this works. I have had 2 years just to understand this much. Thanks

This commentary is for informational purposes only and is not meant to diagnose or cure any disease or condition. Please check with your doctor for all of your personal care needs.

[dmacd74]

Misery loves company I guess.  As you know Tom, I've on my 7th day of feeling like crap. In fact, I'm on a monitor right now!  Hang in there, this may be something that just requires minor med tweaking.  Keep us posted....

Debbie

[DeltaDawn23]

Keeping you in my thoughts and prayers . . . Hang in there.

[tom_h]

Thanks for your concern and encouragement.  The 100mg/'day of Metoprolol help to surpress the arrhythmia, but walking more that a hundred yards, or climbing a flight of steps causes a huge reaction.  Ba-beat beat beat ba-ba-ba beat beat beat ba-beat.  That kind of pulse.  It's terrible.  I don't know how I'm going to function when I need to exert myself.  Running, something I've been doing again is impossible at the moment.  Cindy, thanks for your advice. I'm going on vacation next week to the south Jersey shore.  If it's no better when I return, I will contact my cardiologist and see what's next.  About 4 months ago, I drastically altered my diet (not dieting), reducing carbohydrates to about 1/10 of the daily recommendation for adult males.  This has resulted in rapid weight loss, as well as steep decline in my blood glucose.  But I can't help wondering if I screwed something up with my electrolytes?  I started taking no-carb electrolyte replenishment fluids, but that hasn't helped at all.  Meanwhile, my chest has begun to ache again like when I use to have SVT of a lot of PVC's.  Advil seems to help for that.  I'll keep you posted.  Thanks agan.

[is_something_wrong]

From what I know (and that's unfortunatly not much), an ablation really upsets the atria and it takes a long time for this to completely heal. That's why medications are continued for a long time after ablation in some cases.

The runs you had (and the PACs) aren't necessarily caused by a reentry mechanism? Some spots may just get really upset and start trigger PACs. The annoying thing is that just a few atrial cells may cause trouble, because they have the "domino" effect on the heart (one cell depolarize, all will).

I hope this didn't set you back too much, if you do like your cardiologist told you and start taking the meds again I would think you would be fine?

[LindaTX]

So sorry, Tom....I know how disappointed you must be but I don't think this is so unusual.  I do want to tell you that going off metoprolol can be difficult.  I'm assuming you weaned off it gradually, very gradually.  The fact that you had just gone off it the day before may be more than coincidental.  There could be enough of a connection to throw you into tachycardia to say the least.  It's just a possibility.  It actually happened to me when I went off ToprolXL a little too suddenly.  Wish you the best....I think you'll be fine!

[tom_h]

I tappered off the Metoprolol very gradually, halving the dose on a weekly basis.  So I went from 25mg twice a day to once a day, then halved the dose to 12mg once a day per myt cardilolgist's instructions.

I guess I shouldn't say anything because it usually blows up in my face afterwards, but....  I'm happy to report that the arrhythmia has subsided to almost nothing.  I'm back on a daily dose of 100mg Metoprolol, and seem to tolerate this pretty well as it was my former level before my ablation.. Friday, I'm going on vacation for a week at the South Jersey shore and it will involve some walking around, so I'll have to see how that goes.

Thanks everyone for your concern.  I really do appreciate it!

[merileegal]

Glad to hear you're feeling better and hope that all goes well for your vacation.

[bonzia]

So sorry to hear about your arrhythmia problem.  I can't imagine what you are feeling.  I'll keep you in my prayers and
have fun on that vacation and live for the moment.  Every day is a blessing.
Each day is different and there will be better days ahead.
Please keep me posted on how you are doing.

[LindaTX]

Hey, Tom.....I just wanted to add, fortunately I haven't been bothered by a-fib since Dec.  But after I went off my meds, I started having SVT episodes for about 24-hrs about once every 3-4 weeks.  Had to go to the ER a couple of times, once was given adenosine which caused a momentary 3rd degree block. The other times I reverted back to NSR on my own.  My EP in Austin offered me this....it's worked twice.  Take one ToprolXL (100mg), wait 20 min and take 3 100mg Flecainide.  That's a big dose but it did the trick in about an hour. Perfect NSR of 65bpm. Of course I'm not suggesting you do this but this "pills in a pocket" method worked really well for me.  My Dr. is saying I'll probably need a "touch-up" ablation so he's got me on the books for Sept.  Haven't decided yet if I'll take him up on it.

[tom_h]

Update
I just got back from a week vacation which took me out well away from home.  During the week the PAC's, PVC's, and brief bursts of SVT continued after starting literally out of the blue.  At first it appeared to be cyclic in nature, but now it's almost continuous, worsening due any type of physical activity.  I do experience periods of quietness, but they are now few and far between.  I've never considered myself mush of an optimist, so with these symptoms, I'm going to have to call my ablation a failure.

My cardiologist was reluctant to prescribe an antiarrhythymic as he wants to monitor me when I start one.  I agreed, so it was basically a pretty quiet vacation so as not to aggravate the symptoms further.

The depressing thing about the whole thing is before my ablation, I knew what to expect.  I had 3-5 SVT episodes per month.  I converted them, and continued on with my life.  These are completely new symptoms and are debilitating.  I cannot do anything approaching strenuous without my heart skipping and racing.

I've increased my Metoprolol dose to125mg/ day, and plans are to add an anti-arrhythmic, and speak to my EP to see what my options might be.

[beema36]

Tom,
I don't have any good advice or words of wisdom. Just wanted to let you know I will be praying for you and that your drs find the proper treatment for you soon.
Beema

[rcslone]

I am so sorry to hear this Tom. I hope your EP can get this fixed and you can get your life back to normal.

I had my ablation back in Dec. and have been off all meds since Jan. A couple of days ago I had what may have been a run of SVT while sitting at home watching TV. I say may have as I have been under a lot of stress the past week, as my wife's mother died last Friday and I have had alot of other issues bothering me. I almost think this may have been a panic attack, as it felt somewhat different. My heart was beating fast, but not the hard thumps as in the past. It also felt as if I was having trouble catching my breath. It did not last long and I have not had anything happen since. I see my family doctor in Oct. and will mention it to him them, provided nothing else happens before then.

[tom_h]

My condolences to you and your wife on your loss.

These bursts of SVT that I'm experiencing are as you describe; almost pitter-patter by comparison, and around 180, not in the 200's as before.

[cindy707]

OMG sometimes i get so mad when it comes to this situation with all of us because we can't pinpoint the trigger of why this happens to any of us and its so damn frustrating.  Its like there is no  rhyme or reason as to why it happens whether we are sitting quietly by a lake or jogging or even sleeping.  My heartfelt feelings Tom is that don't give up yet altho i now its depressing right now...you have to look at the statistics...you are eight months out and until we hit the one year mark we get some really crazy things that happen to our hearts.  I was not without those issues either...since my ablation almost five years ago i have had to be converted a couple of times and it did the trick but do i feel like i can relax?  Oh heck no...even tho i am moving into the one year mark since the last chemical conversion i still somewhere in the back of my mind am just waiting for me to wake up out of my sleep with the same thing. The great news is that the doc gave me Multaq as my pocket pill and granted i have only had to take a half of one once and let me tell you that stuff works like a charm i am always still somewhat fearful as i think all of us are with any type of heart issues.  It colors out life for the duration i think.  Have you spoken to the ablation doc to get their take?  As anyone said anything about the possiblity of a chemical conversion or the possiblity of using a big gun like the Multaq to knock this out?  That after ALOT of trial and error for me was the combo that worked.  In this day and age of medicine no one has to suffer thru this and i firmly believe that sometimes our hearts just need a kick start by re setting the electrical of the heart so it goes back into a normal sinus rhythm.......i wouild seriously think this over...i know that my symptoms as well were definately different than the original issues i went in for....i wouldn't call it a fail yet....i would just get super proactive.....demand a fix for this now and not let the docs give you a wait and see attitude because you are the one who has to live with this....i'm not qualifying your situ i just know that something can be done and once you knock it out the odds are very much on your side....i never let mine go as long as you are because i have a pretty big mouth (obviously lol) and hammered the doc with everything i could to get it fixed.  In the end it wasn't my heart doc that took care of it it was Dr. Hao my ablator/surgeon which makes a whole lotta sense since he was the one in my heart and doing his thing...he knew immediately each time what the issue was because of the mapping and told me it was expected and that the incidents would become less and less and this is after the one year mark so he hit it on the nose.....so Tom....as off the wall as it sounds this is one of those times where you have to put on the big girl pants and put a stop to this and please don't think its a fail.....yet......give yourself the best chance possible of correcting this thru meds or conversion to give yourself a fresh start......we are all here for you my friend altho wouldn't it be nice to not even know one another meaning that if only we didn't have these issues our paths would probably not cross in life.....keep the faith and never give up....just fight for the answers and solutions and i would do it as aggresively as possible becaue this is no way to live................................<3