Post-Ablation Progress and Regression

[Robb S]

I am a few days short of the 3 month mark since my ablation that was performed to treat atrial fibrillation.  My EP told me not to make any judgement on the success of the ablation for at least 3 months afterward.  Up until a week ago the time that I spent in afib was steadily trending downward.  I was at about 30% in afib after the first few weeks and had progressed down to about 2% as of Dec. 20th.  The progress was not smooth, with 2 big jumps from being under 10% back up to near 20%.  I keep a 7-day moving average of the time that I am in afib.  In the last week I have regressed from the 2% level  back to 20% and there is no sign of reversal yet.  This has me a little puzzled and concerned.  I am due to see my EP in about 3 weeks.  Has anyone else experienced such wild swings in the AF burden, especially at the 3 month mark?  I read that some EP's say that total healing can take 6 months so I am still holding out hope that my procedure will be a success.  My episodes are definitely different than before the ablation- they are just a few hours in duration whereas before they averaged about 36 hours, but there were 4 or 5 days between episodes.  Also, I have a 'spiked' vagus nerve, referred to as high vagal tone.  I have done a lot of shoveling of snow in the last 2 weeks and that crunches the vagus nerve in my abdominal area.  I may have irritated it, making it even more active in disrupting normal heart rhythm.  Now I often go into afib after drinking or eating something cold, apparently exciting the vagus nerve.  In my thinking, the ablation should prevent afib no matter how active my vagus nerve is.  I would be interested in hearing where others were at after 3 months and if they now consider their ablation successful.

[Robb S]

Thanks for the input.  I am not very familiar with SVT but I imagine that the 3 to 6 month rule still applies.  I had cryo ablation on the pulmonary veins and RF ablation on the other areas on the heart walls.  You are correct in that AF ablation is a tricky procedure.  My EP did the work and then could not induce any more Afib, but at my first follow-up visit he said that I might need another ablation.  I think that he based that on the length of time that I was in afib in the first few weeks afterward.  You noticed the periodic nature of time at low AF burden in my log.  I am wondering about that too.  If my EP can't explain it then it may have to do with the swings in my vagal tone. There are anticolinergic drugs that suppress the parasympathetic nervous system but my doctor hasn't suggested them yet.  

I wish you success as well.

[Bromley]

Hi. I  had an ablation, for accessory pathway/SVT and after three months was still on pins and needles about it. The ablation eliminated my original tachycardia. There were no major complications detected during my self-initiated medical follow up; however, I continue to experience short runs of some type of unknown tachycardia, probably VT, and have not authorized an additional ep study yet to determine what it is. This raises questions / conflicts with diagnosis if a problem can be attributed to long run VT (i.e. near syncope caused by an allergic reaction could be an example).

Afib ablation is a very complicated topic, as are they all in this area.  It is certainly nice to see an improvement, and I like the fact that you have been diligent about keeping track of your experiences.  I thoroughly believe that this is the right thing to do, and would be inclined to do the same. I do wonder what type of ablation you received. If PVI,  I would wonder myself (I am not a doctor or medical professional or even a medical student, nothing medical in fact) if isolation of the pulmonary vein(s) was complete. Ask your doc.

Also, during the trend downward, it is curious that the raw data show some periodicity with a cycle  length of several weeks.  I am really rather interested to hear what you ep has to say about all of this.

Anyway, best of luck. Others here have been affected by afib, so I imagine we may hear some input from them....