Ablation-related elevated pulse after exercise? Or LBBB-related?

[LBBBguy]

Where to begin...

41 years old, discovered WPW earlier this year, had the RF ablation done about a month ago.

However, here's the catch. Originally, based on my EKG, my EP thought the WPW was on the right side of my heart. When he went in and did the EP study, he discovered I also have Left Bundle Branch Block (complete), and that it was producing a misleading EKG. My WPW was actually on the left side. He ablated it and it seems to be gone, leaving me with the LBBB. In my follow up a couple of weeks back, he said I should be fine, my prognosis is excellent, I should go out and live a long, active life and the plan is to be monitoring this situation annually.

OK, so that sounds good. So I started going back to the gym last week, and I've noticed that my HR takes a long time to get back down to a normal resting rate. Hours, actually. When I went in for my appointment, my pulse was 56. My BP was a little bit high 120-somthing over 90-something, which was a bit odd since my BP has always been close to perfect. Anyway, to give an example, I finished my workout today at 1pm. At 2pm my HR was still about 90. At 2:30, it had gone down to about 80. Now it's a little after 4pm and my HR is now down to about 70.

I've read a few topics where people have described various symptoms sorta-similar after an ablation, but I haven't come across anyone quite like this one where it seems to be exercise-related and it takes a long time to recover like this. I guess I'm trying to figure out if the more likely culprit is the ablation or if perhaps my "special" case with the LBBB (which may indicate yet some other heart issue--more on that in a bit) is behind it, or if maybe I'm just out of shape, although even if that's the case it doesn't seem like it should take THIS long to recover, right? I was in pretty good shape prior to the procedure. 6 feet, 170 lbs, got plenty of regular exercise, etc. and I was only inactive for four weeks. My workouts have been sort of vigorous, but I haven't felt dizzy or anything during.

Backing up a bit, when the WPW was first discovered back in April, I had a fairly thorough workup done because I originally showed up in the doctor's office with feelings of a "tightness" in my chest. So I got the Holter and the Stress Echo in addition to the EKG. That was back in May. Everything looked good.

I've got a call into my EP, but I thought I'd post here to see if anyone who's had an ablation or has LBBB has experienced anything similar since shared experience with these things seems to be helpful. Any insight is appreciated!

[LBBBguy]

Thanks again, very helpful from both of you. My EP seems unconcerned about my elevated pulse. I'm not so sure, so I'm backing off a bit on my exertion level and am looking into getting a second opinion as well.

Happy HEALTHY holidays to you!

[cindy707]

Gee thanks so much it makes me feel good knowing that while i get something out of this site that i can give something back too........we can only draw from the heart (not literally of course) and mind and share everything w. each other and yep i know i feel great knowing there are other people out there from God knows where going thru the same things as i do.....this is the epidomy of a great support group and everyone is so knowledge-able and apparently stable people...this is wonderful......

[ptadvoc8]

Just wanted to let you know I found both your posts really interesting, helpful and reassuring - since you are now now 3 years out from your procedure, it is helpful to hear your perspective and experiences in re recovery and healing, exercise symptoms and your use of BBs. Thanks for sharing that info!

[ptadvoc8]

Yes, going "easy" seemed to work best for me during the first 3 months -- both physically and mentally -- once I finally accepted the fact that I just seemed to need the extra time to heal!

I just had my 3 month "anniversary" and my 3 month post ablation check and asked specifically about exercise levels. However, prior to that appointment (based on your post here and our "conversations") as an experiment I tried really pushing the cardio a few days ago and noticed the next morning my pulse was still slightly elevated beyond what I think it would have been had I done that pre-ablation, but it's much better than it was even a few weeks ago.

Interestingly, after my 3 month post ablation check, I have still not been cleared for full out exercise -- they are recommending an echo stress test to see how the electrical circuits and heart rate are post-ablation when I push to my limit, so I am still just going easy until I complete that test. I don't think they do this with everyone, but since I still have some short runs of SVT followed by a few minutes of bradycardia and they are not sure where these are coming from in the heart, they are doing yet more testing...

I have expressed my wish to get OFF the beta blockers, but they are recommending I stay on them for now. My marvelous Mayo EP said he expects it will take me a year or more to get off the BBs given that I have been on them for so long. It has been my experience that most cardios really like BBs and I have to say that much of the research I read certainly supports some of the positive and heart protective nature of these meds, but they do often have side effects to varying degrees and I just want to be as med free at this age as possible.

Hope that info helps and that you are doing well... Happy Holidays!

[cindy707]

I only wish my pulse were as low as a pro athlete but no such luck.  Yep i've been on BB since the ablation but not specifically for what you think.  When my cardiac doc says that in the future they will prob. be a maintenance drug for all humans and he takes them w. no cardiac probs. its like sign me up.  I agree w. him 100% why would we not take something that has virtually no side effects that helps our hearts relax and not work as hard.  He did a simple explanation....a hummingbirds heart is small beats crazy fast and they live a fairly short life because their hearts over tac itself where say an elephant who's heart beats slower with less stress on it lives a VERY long time...simple but makes sense to me so thats the theory that makes the most sense to me and everything i've read on the BB's and yep my pulse rate gets up there but i am rest assured that w. the BB i am safe with no irregularities and its smooth sailing.  I do get those moments tho where i sort of feel like a fib may start up even after the ablation but the BB's do their job so i'm good to go...most of the time i think i just scare myself with the "what if's" no matter how my doc tries to reassure me i have to quit thinking that i know more than he does LOL!!!!!  Its tough being a girl sometimes........................

[LBBBguy]

I read your other posts to fill in some of the blanks, and it sounds like you've been on beta blockers since your ablation 3 years ago. Is that right? Even after things eventually settled down?

So during the 4-5 months where you "sat on the edge of the cliff and pushed" were you aware of your HR being frequently kind of high? Sometimes for no apparent reason? Not in tachy, but I'm assuming that if you're a gym rat your resting pulse is probably pretty low normally.

Thanks for your comments!

[LBBBguy]

Thanks for sharing that experience and comments. Yes, I have read on various threads here that some people have experienced an elevated pulse for some time afterwards, and that has been comforting to some degree for me. I'm pretty much a newbie here, and I have to say that since these things are somewhat rare, it's incredibly helpful to talk about this stuff with others going through similar stuff. I've felt even more "special" when I discovered that it wasn't just WPW that I had going on, but I guess that's just part of what makes all of us unique.

The "it just takes time to heal" theory does make sense to me. I also play hockey and get the occasional strain or sprain, and I've discovered that sometime around when I got into my upper 30's the injuries just seemed to take pretty much a year to get to where they didn't bother me anymore. It used to be much faster, right? And that seems to make sense since most pro athletes--the ones who end their careers by choice--hang it up typically as they approach 40. So we'll see how it goes.

So has backing off in the gym helped? How about the beta-blocker? Is the plan to get off of them entirely in a few months? I'm definitely going to stay in touch to see how it's going with you.

Thanks again!

[cindy707]

Hi i'm a gym rat too and i had my ablation 3 years ago and got lucky and the cardiac surgeon that did mine was the protege of Drs. Natale and Sheinmann who developed the ablation procedure.  I remember he told me specifically that it sometimes takes up to a year for all of the passageways to completely heal when they re-direct everything during the procedure and that we may notice diffs in our B/P and H/R until we "settle" back down into a pattern our body adjusts to.  He also said we may get random ghost symtoms during that time frame but the best advise he said he gives to his patients is to put it out of our minds and "Sit on the edge of the cliff and just push" and to go back to the gym and do all of the things we want to because its a new lease on life after the procedure.  I took it to heart in regards to the gym and it took about 4 or 5 months and everything regulated itself.......

[ptadvoc8]

I have WPW and had cryo ablation for a left sided accessory pathway in September. I was also diagnosed with LBBB, probably "transient or episodic" during the EP study. When I asked about this because it concerned me, my cardio said it is "no big deal" -- however, I am not sure how a transient or episodic LBBB would compare to a complete one.

After my ablation, I had elevated pulse rates with ANY exercise -- from simply moving from a sitting to a standing position, walking, or climbing stairs. It would start beating fast almost immediately and would last for some time -- up to several hours afterward, depending on how much physical effort I had expended. Over time, this has improved to the point that my pulse rate now seems pretty normal, although I still feel a bit out of shape since I have not been pushing as hard during healing. Although my doc was very clear that it could take me 3 - 6 months to heal and know whether or not the procedure was successful, I was still STUNNED at how slow my recovery has been -- but then I am more than a decade older than you.

If you have read the other postings, then you will know that while this is not often discussed with patients, it does seem to be fairly common. While I have never heard a definitive explanation, I have read studies that suggest it may be related to the heart "healing" itself or the temporary disruption of parasympathetic nerve pathways in the heart, or simply to the body adjusting after the procedure. Despite the "minimally invasive" nature of ablation, it is still a MAJOR procedure and it took me the entire last 3 months to really start to feel back to myself again, which was a surprise since my procedure supposedly went well and I am in relatively good health. I was instructed to continue taking 25 mg of Metoprolol (a beta blocker) for 3 - 6 months post procedure to help regulate and moderate my heart beat. Since I have taken them for over 10 years, I don't know if this affected my heart rate any differently than it would for someone who had never been on beta blockers. But, some patients seem to be prescribed some sort of anti-arrhythmic drugs post ablation while others are not.

You mention you had ablation by RF, and some studies suggest that RF lesions can sometimes take longer to "settle" and heal, so give yourself that extra time to heal if you need it. And I am always in favor of calling your medical team ANY TIME you have any questions or concerns! I would be curious to know what your EP says in re this situation, so please do post after you hear back from him if you feel comfortable doing so. Best wishes!