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Very frequent extrasystoles, including bigeminy, 9 weeks after ablation

I had an ablation in 2012, but it needed to be repaired -- I was told that due to my relatively young age, the scar healed at some place(s) so the signal was 'leaking' through it.

During the second ablation 9 weeks ago they decided to again isolate two veins in the left atrium, but also the superior vena cava in the right atrium.

Left me home without antiarrhythmics, but the next week after an episode with alternating AF and atrial flutter they put me on amiodarone, which I stopped taking a week ago (but due to its very long half-life should be still active in my body?).

In the meantime, I have begun having more and more skipped or premature beats (my doctor says of supraventricular origin). And the situation recently worsened, and now I have them almost constantly (10-30 per minute, with episodes of bigeminy, after sleep it is mixed with skipped beats -- looks like bradycardia) and have problems sleeping. They tend to diminish in number or go away after some moderate physical activity.

Do you have any clues about that? Could they somehow irritated or damaged the synoatrial node?
2 Responses
1807132 tn?1318743597
What did you have ablated, afib or a reentry svt?  If it wasn't afib I am not sure why you have it now.  It is a different issue all together but it is possible the svt irritated the heart and triggered that afib that would hopefully subside once your heart has had time to heal.  I had an ablation for avnrt which was a reentry circuit near my avnode.  I had premature beats very similar to you for a full year and the second year I still had thousands and day but now a few years out it is more in the 100s and some days I don't have any but I don't expect to ever get rid of them fully.   I honestly don't know if we would ever get a definitive answer to whether or not the ablation itself damaged nerve endings.  I know for me I was having daily symptoms with my heart.  I was not aware of the differing issues and thought it was all svt related.  It was only after my ablation and I stopped getting the tachycardia episodes that I realized that the skipping, thumping and jumping of my heart was something else.  So I do know that I was having a lot of ectopic beats prior to the ablation but I can't say for certain whether or not they were worse afterwards or the same.  I don't think I ever had afib though.  But hopefully yours will calm down like mine have with time.  

If you exercise try to not overly push.  do a proper warm up and cool down and see if that helps.  Avoid caffeine, sugars and carbohydrates.  Foods that irritate the stomach and cause acid reflux.  And stay well hydrated.  As well manage stress.  Those are big triggers and though you likely have a more physical reason for the extra beats anything we can do to avoid adding to them firing off may help.  I would also discuss with your doctor what is happening and see what they say.  But do give it at least 3-6 months for things to settle down.   It is possible this will resolve on its own.  Take care and feel better soon.
12492606 tn?1459874033
RE your 2012 AF ablation.  Your pulmonary veins were isolated and they reconnected requiring a second procedure to re-isolate.  Your EP also found triggers at your SVC and that was also ablated.  Your flutter could have a CTI origin or you could have atypical atrial flutter (left sided).  AF ablation often require CTI ablation (usually done in one procedure as the EP should have tested for that after the PV isolation).  Anyway, don't freak out as right sided flutter ablations are relatively easy, left sided requires skill but still easy for an experienced high volume operator.  This has nothing to do with your young age being a contributing factor to recurrence so I don't know why your EP told you that.  It is just that the initial job in 2012 didn't hold and the recent redo didn't get the job done either.  The most important thing for AF ablation is to do it at a high volume center.  Preferably a center that has a group that specializes in it and do more than a couple hundred procedures per year.  80% of the AF ablations in the USA are done at centers that do less than 25 procedures per year - not close to being enough to be skilled.  You can get additional helpful comments at the LAF forum.
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1807132 tn?1318743597
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