PACs after ablation

Posted by tugboater @tugboater, Jun 1, 2019

Hello I am a 37 year old male 9 months ago I had ablation done for a fib and a flutter . Ever sense ablation I’ve been having pacs that come and go on metoprolol 25mg twice daily have The option to go on Flecainide but very hesitant .tried everything any advice would be greatly appreciated thanks

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I’m scheduled for my first ablation tomorrow morning, nearly 12 months after my first AFIB episode. My question to others who have had this procedure: were you able to reduce or eliminate dependence on Metoprolol (or similar drugs)? How about blood thinners?

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I've had epusodes of AFib since late 2914, which have gradually become more consistent in recent years. I believe I had mild COVID in February 2020 before tests were available. After that, especially as summer arrived and since then, they became even more frequent, sometimes as long as two weeks apart and sometimes just days apart. I take Metoprolol Succinate 50 mg once daily. I also take about 400 mg magnesium and drink coconut water for the potassium, which seemed to help for awhile. But after my husband's stroke in 2014 also, I started living more anxiously and so recently I'd heard that Klonopin could help people with AFib from relieving the anxiety. I only take between ,25 to.05 mg daily. This was a huge difference in the amount of AFib attacks and when they did come, even the several hours kind was easier to tolerate. I'm not on blood thinners. Low Chad score and when I tried one it made my stomach so upset that it precipitated AFib. So my cardiologist said I probably didn't need it anyway. I did have two several hours episodes in October. One 7 hrs on Oct. 6 and one 3 hr on Oct 8. Since then, my kardiamibile has only recorded me having normal rhythm with supraventricular ectopy, sometimes after eating or toward evening. But I feel like I can't do as much or I wear out easier these days. Also, this happens nearly every day at some point. I almost wish for the AFib back as usually after a big episode, it sort of reset everything for a few weeks and I felt good. Anyone else go from having mostly AFib to having mostly supraventricular ectopy or occasional ventricular ectopy? I just don't know if this means it's getting better or worse.

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Profile picture for slynnb @slynnb

It is very common and even NORMAL to have PACs for weeks to months after an ablation. Sometimes people have some PVCs, too. PACs are NOT dangerous, by the way. I had an ablation over 15 years ago and had them and still do sometimes (just because most people do). I would advise you try to get your worry under control which would well help the PACs. And for heaven's sake, talk to your doctor and ask him or her if it is not true that PACs are common, frequently occur for a while after an ablation etc. Of course, if you prefer medications which can come loaded with their own side effects , that's up to you.

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Thank you for this. I had a double ablation 7 weeks ago. Cryo for afib and RF where they addressed 2 areas of “PAC morphologies.” Since I’d only had three episodes of Afib almost a year ago I have no idea how successful that was. But I had two weeks completely free of all PACs and it was miraculous to have a calm heart for the first time in 50 years. Then all of a sudden they came back with a vengeance. I have been so disheartened and my EP just said when they ablate one area for PAC new ones can pop up. They are so bad it’s very hard to go to sleep and being overtired has always been a trigger. Then I get upset and that’s a trigger. I am harboring a hope that it’s just part of the so called “blanking” period but then why did I have two amazing weeks of freedom from arrhythmias? I know they are not dangerous, I’ve had them most my life. But not like what I have now which is relentless. And very pronounced.

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Profile picture for cappcoach @cappcoach

Thank you for this. I had a double ablation 7 weeks ago. Cryo for afib and RF where they addressed 2 areas of “PAC morphologies.” Since I’d only had three episodes of Afib almost a year ago I have no idea how successful that was. But I had two weeks completely free of all PACs and it was miraculous to have a calm heart for the first time in 50 years. Then all of a sudden they came back with a vengeance. I have been so disheartened and my EP just said when they ablate one area for PAC new ones can pop up. They are so bad it’s very hard to go to sleep and being overtired has always been a trigger. Then I get upset and that’s a trigger. I am harboring a hope that it’s just part of the so called “blanking” period but then why did I have two amazing weeks of freedom from arrhythmias? I know they are not dangerous, I’ve had them most my life. But not like what I have now which is relentless. And very pronounced.

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Cappcoach, how are you doing now since the ablation for Afib and PAC? Did the PACs calm down? Did you take metoprolol or flecainide? I’m experiencing something similar—Relentless PACs 2 weeks after afib RF ablation. Let me know!

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I had an ablation in July '24 and my PACs worsened significantly after the procedure and triggered Afib, A-flutter and atrial tachycardia. I am now on amiodarone and metoprolol to control rhythm/rate. Amiodarone isn't a great option, it's known as a "last resort" medication and has harsh long term side effects on other organs. I was previously on dofetilide (another anti-arrhythmic) which didn't control my symptoms and is the reason they went to amiodarone. Whichever treatment you end up having, I wish you good luck and hope you feel better soon! (F, 42, tricuspid atresia/Fontan patient)

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Profile picture for rubywitch67 @rubywitch67

To tugboater...…….I agree 100% with slynmb about having PAC's or PVC'S after an ablation. I am a 68 y/o woman who had PVC's for YEARS before I developed AFIB. I didn't like them (who does?) but was reassured over and over by my cardio that they were benign, that EVERYBODY had them, just that some of us could feel them, sometimes quite strongly, while many people were completely unaware of them. I eventually learned to live with them. My own husband was one of the lucky ones who NEVER felt a PVC or PAC and had no idea what I was talking about! When I'd tell him my heart was doing its "flip-flopping again," he'd just look at me like I was imagining things. After the ablation, for about 5 months, I had no episode's of AFIB and my PVC's had "magically" gone away as well. But a few months ago, I once again began to feel the occasional PVC, which caused me concern. When I talked to my cardiologist about the return of the PVC's, he once again reassured me that this did NOT mean my AFIB was returning and most likely meant that the ablation had simply "interrupted" them during the recovery period of the surgery and said that many people with PVC's or PAC's felt some relief from them after an ablation, but they almost always returned, often at a much less frequency, which is what I am experiencing. I usually only feel them now if I overdo the coffee or if I'm REALLY tired. I would like to say to you to not worry about them, but since we are all different, and I am NOT a doctor, my advice is to speak to your cardiologist about them. He/she is the ONLY one who is going to be able to give you the answers and reassurance you're seeking. I hope you get the peace of mind you are looking for.

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I had an ablation 3 1/2 yrs ago for PACs, over 16,000 per day and felt them all.kept me up at night and put me in a constant state of anxiety.
Ablation got rid of 99% until last week when I suddenly had an anxiety attack after stressful death in family.
Had 2 glasses of wine and bread with dinner and that night PACs were back like before the ablation.
Am again anxious about going to bed at night as that’s when it’s worst.
Last 3 years have been heaven with peace in my chest and now it’s gone!!

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Profile picture for hatemypacs @hatemypacs

I had an ablation 3 1/2 yrs ago for PACs, over 16,000 per day and felt them all.kept me up at night and put me in a constant state of anxiety.
Ablation got rid of 99% until last week when I suddenly had an anxiety attack after stressful death in family.
Had 2 glasses of wine and bread with dinner and that night PACs were back like before the ablation.
Am again anxious about going to bed at night as that’s when it’s worst.
Last 3 years have been heaven with peace in my chest and now it’s gone!!

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Al I can suggest is that maybe you're deficient in magnesium....a possibility. You'd want to know if you are before taking supplements, but it might be worth checking out.

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