Heart Rate after Ablation

I'm 71. (F) Brady when resting in the 40's and as low as 35 overnight.

Your EP can have you wear a Holter monitor 24 hrs/day for a week or two to see what's going on.

My ablation was July 18, 2024. On 25 mg Metroprolol 2x/day and Amiodarone 200 mg 1x. (and Eliquis, Hydralazine 50 mg 2x, and amlodipine 1x for HTN from hypercortisol).

I had an AFIB occurance with racing heartbeat 2 weeks later for 2 hours then it converted on it's own. I still had intermittent HR spikes when doing normal tasks.

My EP failed to tell me using my arms would cause racing spikes and my Internist was like "STOP peeling carrots" "STOP mopping the floor" "Stop reaching, Stop lifting" "AFIB beegets AFIB!" ! And they mostly stopped (for the whole blanking period.)

THEN I got Covid for the first time 3 weeks post ablation and my BP stayed slightly higher ever since but no AFIB.

Nothing happened then, until January 2025 when I had an allergic reaction to a Holter monitor adhesive. Got massive hives AND a big lesion on my nose overnight! Biopsied, it was a SHINGLE! So it's all related.

Then a couple days after the hives, had another AFB with only a few 150 HR spikes for two hours and it converted. I blame the hives/histamine.

Co-Morbidity: Mild sleep apnea I just found out and ongoing Cushings Syndrome with hypercortisol so that doesn't help at all. (from the Covid vax)

My holder monitor 5 days was ok, everything in acceptable ranges.... but I've noticed some spikes lately like, three times in two weeks of 118 and 130. But my hives are not resolved yet. So we'll see if something is brewing. Those spikes sorta freak me out but the EP's PA is casual about it.

Regardless, the EP said get off the Ami and Metoprolol - in progress. Since I'm still Brady. But used to be called TACHY-BRADY but the tachy disappeared...for now. I plan on very limited activity to not produce heavy spikes while the Metoprolol is fighting me tooth and nail to wean. It does that!

Anyway, get the Holter monitor and make sure they give you the report after discussing the results. I notice they tend to gloss over stuff.

Do I understand correctly that you were on several medications, including amiodarone, for several weeks post ablation? If so, would you share why? It's most unusual.

Yeah but it's not unusual at all. Not universal but common. Not sure why you think that. It's temporary prophylactic. And NOW, like I said, I stopped it now that I had a good Echo at the 6 month mark. Yes I was on the Ami for rhythm and Metoprolol for rate.

The blanking period is three months. I live in Jacksonville and my EP has the greatest number of ablations with patients traveling from all over.

There's a bunch of articles you can google about it.
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Antiarrhythmic drugs after ablation

AF ablation is increasingly used as an effective invasive rhythm control treatment. Still, many patients experience recurrences of AF after ablation that requires treatment. Antiarrhythmic drugs have synergistic rhythm controlling effects in addition to AF ablation. Their effects are particularly useful in the first months after ablation or cardioversion, when the reversal of electrical remodelling and the healing of ablation wounds render recurrent AF likely. This chapter reviews the evidence and provides guidance on short-term antiarrhythmic drug therapy.
https://www.ncbi.nlm.nih.gov/books/NBK571342/
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Short-course amiodarone post AF ablation cuts hospitalizations

Eight weeks of oral amiodarone beginning right after catheter ablation for atrial fibrillation more than halved the rates of cardioversion and arrhythmia-related hospitalization for 3 months in the AMIO-CAT trial.

This was a consequence of the sharp reduction in the incidence of AF lasting more than 30 seconds during that interval: 34% in the amiodarone group, compared with 53% in placebo-treated controls, Dr. Stine Darkner reported at the annual congress of the European Society of Cardiology.

Dr. Stine Darkner
“Patients undergoing catheter ablation for AF quite often experience arrhythmias within the first few months after ablation. The ablation itself is thought to cause some of these arrhythmias.
https://www.mdedge.com/chestphysician/article/87345/arrhythmias-ep/short-course-amiodarone-post-af-ablation-cuts

Thanks for all of that. Thinking about your situation a bit more, I now realize that you must have been on amiodarone prior to your ablation, so it would make sense to continue it for a while and then to wean you off several weeks before you Holter. In my case, I was not on anything by metoprolol, and I was asked to discontinue it upon release from the cath lab, apparently in steady NSR and fully ablated. Not so. I needed a second ablation seven months later, and in the interim, with a really nasty AF and flutter, was on amiodarone for seven weeks total. I was told to go off it two weeks before the Holter, which showed a '..LOT of PACs!' This quoted from my telecon with the outreach nurse who offered to tell me what the results of the Holter were and what to make of them.

Also, you say that your blanking period was three months, whereas mine were only less, and I had my Holter at the 10 week mark. Different EPs....I guess.

There was a study released about 15 months ago that found that people who had the odd run of AF earlier in their blanking period were much less likely to need a second ablation any time soon, and other outcomes were better. The report said that people who were free of AF for several weeks, but who began to experience ectopy later in the blanking period were much more likely to be deemed 'failures' for ablation determined at the 52 week mark/one year post ablation.

The same outreach nurse told me that if metoprolol isn't sufficient, that they would prescribe propafenone during the blanking period, but I was not offered that when I was in the ER six days after my index ablation. The internist consulted with my EP (how he got ahold of him is a mystery to me because that man is extremely busy), and they decided to cease metoprolol immediately, due to severe bradycardia, and to start me on a loading of amiodarone...which converted me after two doses of 400mg. Phew!! Don't want to ever repeat that experience.

Anyway, enough about me. Thanks, again, for the links and for reminding me that sometimes a patient needs assistance to get through to the Holter assessment 'in one piece'. 😀

FOLLOW UP ON THIS: It’s been a year since I posted this so here’s an update: I felt fine during this period except for the rapid HR. And I didn’t see any indication of AFIB on my home BP device. My cardiologist was not concerned because it was still in the “normal “range. But I got him to refer me to the EP who recommended another ablation. I had that in August and my HR went back to the mid 60 range. Interesting that my Ejection Fraction improved significantly following that procedure. It went up from 47 before the ablation to 69 on my recent test.

Wow good for you!!! So much for "it's normal to have a higher resting HR after an ablation".

Thanks. Yeah, I thought it would come down sometime during or after the “blanking period “,but it never did. But it never went over 100 bpm. The second ablation was easier and quicker than the first because they knew where to go for the fix while the first one was more of a shotgun approach.

https://www.bartsaf.com/why-does-my-resting-heart-rate-go-up-after-ablation/
https://heartrhythmdoc.com/top-10-things-to-expect-after-afib-ablation/
https://a-fib.com/faqs-a-fib-ablations-increased-heart-rate-post-ablation/
https://healthunlocked.com/afassociation/posts/146450500/high-heart-rate-after-ablation-procedure-i-am-new-to-this-community...
https://pubmed.ncbi.nlm.nih.gov/27256421/
As these citations clearly indicate, a higher-than-normal HR is often one of the outfalls of a catheter ablation. However, each individual is just that...an individual, and there is a wide variance in how well people tolerate the symptoms of AF and of the post-operative effects. It is everyone's responsibility to decide when, and if, they need to seek help because what they're experiencing seems abnormal or is merely disconcerting, even to the extent of making them feel unwell.

That your ejection fraction ratio jumped significantly after new ablation resulting in reduced resting HR seems to indicate that the high resting HR was actually decreasing heart function. That sticks out to me. That it never went over 100 bpm your original EP got stuck with that line in the sand of 100 bpm instead of investigating further the and listening to the patient.

This reminds of a time I had been moved out of the ER into the cardiac unit. They had got my resting HR down to 60 with drugs but I didn't feel comfortable. I got into an argument with a cardiac nurse who kept saying "I see you are in sinus on the monitor. I've been in this unit for 25 years and know what I am talking about." I kept saying it doesn't feel right. The doc was standing there and was quiet. I told the nurse that my resting HR is in the lower 50s to hight 40s. I repeated to her that every time I convert to sinus my HR will drop into the 50s. This argument went on for a good 5 minutes and then just like that it dropped to 54 . The doctor looked at my monitor and said " it looks like you are in sinus". Nurse ratchet had to eat her words.

That’s really interesting. Thanks for sharing.