Connect
← Return to Heart Rate after Ablation
Discussion
Comment receiving replies
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.
___________________________________________________
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/
________________________________________
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
Replies to "Yeah but it's not unusual at all. Not universal but common. Not sure why you think..."
Connect
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'. 😀