How can I calm my heart after my 3rd ablation?

Posted by pedaled @pedaled, Feb 11 12:17pm

I have been battling with AFIB since my Covid vacation and 5 weeks ago I had my 3rd ablation to correct my irregular heart beat. I am in my 50’s and whilst I still remain fit and healthy, prior to qthese issues I was very fit, loving cycling and running.
Unfortunately both the 1st and 2nd ablation failed, but the 3rd feels more successful although rather than the heart getting triggered out of rhythm it is now continually running fast, and any minor movement or minor stressful situation fires a load of adrenaline and a faster heart rate.
I have been on an off beta blockers but following my 2nd ablation I suffered with severe acid reflux so a few months later the ‘pill in the pocket’ Sotolol was replaced with a daily dose of 2.5mg of Bisoprolol. To calm the reflux I was also taking omeprazole. Prior to the 3rd ablation my heart rate and heart rate variability were fairly stable and the reflux had calmed, although I was still getting AFIB and SVT episodes when cycling.
Since my 3rd ablation my heart has not calmed. I wear a Garmim and so I have 6 years of Heart rate, resting heart rate, body stress and heart rate variability metrics. All of these metrics are now considerably worse than after ablation 1 and 2. Food has always been a major trigger of my AFIB and there is a definite correlation with food and all of my metrics. For reference, most of my Garmin life (10 years) and prior to my 2nd ablation my resting heart rate was 45-47, and after my 2nd this rose to 60, but lowered to around 50-52 with Bisoprolol. Now, after my 3rd ablation and with me still taking Bisoprolol my resting heart rate is 62-64, and during the day rarely falls below 70-75. I can see with my Body Stress score that I am rarely getting any recovery and following any food or exertion my heart rate and body stress can take several hours to settle, albeit still to around 70 beats. This is all impacting my day and the quality of my sleep, and so I am completely exhausted and somewhat lost of where to now go. I acknowledge there is a blanking phase after my procedure, but this is identical to the symptoms after my 2nd ablation and after 3 months of battling I went on the Bisoprolol.
Sorry for the rambled summary, but my cardiologist and doctor currently cannot give me any advice bar give it more time, and so any recommendations or advice would be appreciated.

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gloaming | @gloaming | Feb 11 4:51pm

For you.....this is the current normal. Almost all of us have an elevated HR after any kind of fiddling with the heart, and ablation is no different. I have had two, the first deemed a failure inside of six days. Even on my second, three months later, my resting HR was in the 80's. My normal waking HR was 34-38 (competitive runner, but it was during cycling that I seemed to work the hardest and it eventually brought on some tachycardia lasting few minutes only). Now, post Ablation The Second, I am typically at 62-66 , but I'm two days away from the anniversary. What I hope you take away from this is:
a. if there is no measurable and definitive AF at this point, your ablation was successful:
b. your heart is changing, not only as a result of the ablation and the damage the procedure does to the atrial endothelium, but as a result of wanting to return to its normal stroke and volume, and moreso with its usual effort...which may not be possible after months of ablation and the morphology/remodeling that takes place in a heart with persistent/frequent atrial fibrillation. It may not have been the case when you were last imaged, or when you had an angiogram, and maybe it was determined recently that this is not the case for you, but often there's a valvular deterioration that either precedes the AF or that comes on as a result of the effort of the left ventricle to compensate for the poor seal and regurgitation back past the mitral valve.

Many, if not all, EPs will recommend a short period of prophylaxis with at least metoprolol, often combined with a low dose of flecainide or propafenone post ablation. This is to keep the heart's irritability to a modicum and to keep those pesky recurrent bouts of AF from happening.

I would exercise cautiously, but do at least brisk walks after a few minutes of warm-up. Maybe much else is too ambitious right now. There's nothing wrong with relaxation, being calm, getting good rest, and avoiding those triggers. Let your heart do the driving for now, and enjoy being AF-free!

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