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Afib after ablation

Posted by RN Linda @vermontrob, Feb 15, 2017

My husband had afib ablation 5 months ago with complications- perforation of atrium, bled into pericardium, tapped for 600 cc blood, all of which caused pericarditis with symptoms. Has been back in afib several times despite Tikosyn and metoprolol, trigger seems to be pulse over 110 while exercising. He can't do what he wants to do, which is even moderate exercise, without going into afib. What to do?? A "cleanup" ablation after his horrible experience? Stop being active? He is now on metoprolol 100mg twice daily. Thanks.

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RN Linda | @vermontrob | Feb 16, 2017
In reply to @yoanne "@vermontrob hello linda,. it must have been a great shock for both of you: a very..." + (show)
@yoanne

@vermontrob
hello linda,. it must have been a great shock for both of you: a very serious but rare complication of an ablation.
you did not mention enough details, for example, did your husband have a pulmonal isolation (PVI), was it done by radiofrequency or cryo. is/ was there an underlying heart disease, hypertension or no heart disease? before deciding your following steps, I would recommend you both to look for a cardiologic clinic with a good reputation (many expericiences with ablation strategies) and -this is very important- with a department of electrophysiology.because only these cardiologists are able to localize the foci which initiate the atrium fibrillation (AF). in the last few years a lot of research has been done in this field, as they want to get an answer why patients get early or late recurrences of AF in spite of isolated pulmonal veins. they also try to find reliable predictors of AF recurrences before the ablation procedure. so you need somebody who is highly informed about the new results.
I am not sure that the trigger you mentioned, i.e. the high sinus heart rate, might be responsible for the AF episodes. unfortunately it is not that easy.
keep us informed,please.

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He had PVI using radiofrequency I believe, in a reputable center at a teaching hospital. 65 year old with history of hypertension but otherwise fit, healthy and a competitive athlete his whole life. Thanks for your interest and advice.

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martishka | @martishka | Feb 16, 2017

Its been my understanding that there are two different types of meds to treat rhythm and rate problems. Since I had both types of rhythm problems I took two meds- one for each problem. I took propafenone or rythmol for atrial fib and I took metoprolol (and other drugs over the years) for my SVT (supra ventricular tachycardia or rapid rate). Until my 50's I only took rate drugs. My rapid rate was even and fast (up to 230 BPM) When I developed AFib I was put on rhythm drugs. My rate was still very fast but with the AFib it was also uneven or "all over the place". Over the years I was prescribed a variety of cocktails as the ones I was on became ineffective over time and I had a lot of break through problems. Sometimes the drugs are interchangeable. I agree with vermontrob - your husband would benefit from seeing cardiologists who are trained in this area- electrophysiology. A reputable EP lab would be a good start. Let us know what you decide.

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1 reply
yoanne | @yoanne | Feb 17, 2017
In reply to @martishka "Its been my understanding that there are two different types of meds to treat rhythm and..." + (show)
@martishka

Its been my understanding that there are two different types of meds to treat rhythm and rate problems. Since I had both types of rhythm problems I took two meds- one for each problem. I took propafenone or rythmol for atrial fib and I took metoprolol (and other drugs over the years) for my SVT (supra ventricular tachycardia or rapid rate). Until my 50's I only took rate drugs. My rapid rate was even and fast (up to 230 BPM) When I developed AFib I was put on rhythm drugs. My rate was still very fast but with the AFib it was also uneven or "all over the place". Over the years I was prescribed a variety of cocktails as the ones I was on became ineffective over time and I had a lot of break through problems. Sometimes the drugs are interchangeable. I agree with vermontrob - your husband would benefit from seeing cardiologists who are trained in this area- electrophysiology. A reputable EP lab would be a good start. Let us know what you decide.

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@vermontrob
hello linda, I am glad you decided to get an second opinion. I had an surgical PVI ablation last april. before the ablation my BP was low, sometimes very low, due to the b-blocker because of the tachycardia.I had all my life). everything changed after the ablation, BP high and heart rate also high. doctors did not worry, they say, this is not uncommon. I had to continue the b-blocker I had before, namely bisoprolol. nothing changed. last september we decided to replace bisoprolol by metoprolol ( I also hoped that this drug would prevent my migraine attacks, did not!) 6 weeks ago we changed again, now nebivolol in combination with a small dosis of an ACE- blocker (lisinopril). a positive effect on the BP was seen 3 weeks later, now normal. the heart rate is still higher than normal .honestly said, I was not happy with an ACE blocker, as I was never a hypertensive patient before the ablation. so I started a literature search , mainly in PUBMED. and I found something interesting. your husband is a hypertensive patient .so probably he needs a medication (ACE-bl. amlodipin or an Sartane). last year there was a publication with the title: perindopril for the prevention of AF recurrence after radiofrequency catheter ablation.one year experience (https://www.ncbi.nlm.nih.gov/pubmed/27374309).
maybe a bit unusual to read a chinese paper, perhaps you should discuss it ,when you go for a second opinion. perindopril is a ACE blocker. (in germany not on the market, as far as I know in switzerland, In the united states??)
Yoanne

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debcrawford | @debcrawford | Feb 18, 2017
In reply to @martishka "Hello Linda, I too had perforation of the atrium during one of my 5 ablations. It..." + (show)
@martishka

Hello Linda,
I too had perforation of the atrium during one of my 5 ablations. It is an unpleasant experience. And I totally understand how your husband feels about the meds. I found metoprolol difficult to tolerate as well as some others. I had 4 "regular" ablations; one of them resulted in the perforated atrium and the other four were unsuccessful since the doctors couldn't find the origin of the "rogue" electrical signal. My 5th ablation was a PVA (pulmonary vein ablation) and it was terrifically successful! That was 4 1/2 years ago. In my situation the assumption was that when I went into SVT (supra ventricular tachycardia) or a very rapid, regular rate , it triggered atrial fib. I had SVT all my life and developed AF in my early 50's. I'm 65. So I was eager to solve the problem since the AF was really complicating the SVT and the symptoms were becoming too difficult to sustain as well as having emotional repercussions. It was dampening my enthusiasm for sailing into remote areas! Anxiety is a very normal response when this happens! If your husband's doctor feels that ablation is a viable choice I would jump at it. It sounds like mild exercise is triggering your husband's AF. That is what happened to me during a 5 month sailing trip. I finally had to leave the boat by ambulance and that's when I had my successful PVA. There are several drugs that can be tried but it seems that if there is a chance to resolve the problem permanently it might be worth another try. I wish your husband luck and please let me know how it goes.
All the best,
Martishka

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I'm also on Metoprolol, what were your issues and symptoms with this drug?

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darrellb | @darrellb | Feb 18, 2017
In reply to @vermontrob "When you say controlled by meds, are you in afib and the rate is controlled? Or..." + (show)
@vermontrob

When you say controlled by meds, are you in afib and the rate is controlled? Or on antiarrthmic that keeps you in sinus rhythm? My husband started with afib at age 55, trigger appeared to be very strenuous exercise, such as running in 92 degree, humid day, another time pushing his truck which was stuck in a snowbank. He always needed electrical cardioversion, about every 9 months for 10 years. He decided on ablation hoping to get his life back, he was fit and a competitive runner. He had the near disastrous ablation described already, not only the perforation of his atrium but the ablation didn't work. Now his afib is more frequent and the rate goes right to 200 so he needs to go to the hospital. It seems more clear that he will need a second opinion in a few months for advice about options. Thanks for sharing your experience, all of you, it helps us to get ideas.

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Early on I had two major events where I needed electrical cardioversion. After we got my dosage of Digoxin right, I have never actually felt my AFIB since, although my doctor tells me I'm always out of rhythm... just not enough top cause me to feel any discomfort. This has been for about the last 10 years. I've also lost over 100 lbs in the last two years so, now I no longer need meds for BP or diabetes.
I just went off of Metoprolol a week ago and my BP is on the low side of the normal scale.

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prescott | @prescott | May 23, 2017

I haven't been on this site for a while i had a cardiac ablation 6 months ago thought i was feeling better but for the last month i been having more pvc or extra beats been to hospital 2 times and had to go last night i was having pounding heart beats plus skip beats but of course soon as i get there they stop so nothing was determined i am on flecanite and antenolo took me off my blood thinner last wk dont know if it could be stress i worry alot i try to walk everyday looking for anything to make me relax.

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RN Linda | @vermontrob | May 23, 2017

I am happy to report that my husband is greatly improved, it has been 8 months since the ablation. I am convinced that the heart muscle needed to heal after the trauma of the procedure (plus he had big complications). It is after all the burning of many places in the heart and it is the scar tissue that blocks the afib, at least that is my understanding of it. My husband had pulse that was too fast for what he was doing, after the ablation, for example one flight of stairs would bring his pulse to 100, and he is a conditioned man. Very recently that improved, and he had a treadmill stress test with perfect response plus no afib. So not to minimize your fear, (I was frantic with worrying) try to give yourself time to heal. His cardiologist suggested yoga to help him relax, and surprisingly he is going to try it. You WILL get through this and the year will become a bad memory...

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mac4life | @mac4life | May 24, 2017

Glad to know ablation worked even if later rather than sooner. Its been almost 6 weeks since my ablation for paroxysmal afib and still experiencing spikes in HR and occasional lows. Movements like brushing teeth, making bed, or even a normal walk cause high rate. At rest it is usually in 50's and 60s. Im on flecainide (50mg) and metropolol (12.5mg) and Pradaxa--2x day each. I get fatigued easily .. is all this normal? What symptoms will determine need for 2nd ablation? How long between first and second can it be done? I'm eager to get my life back!

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3 replies
prescott | @prescott | May 24, 2017

i had my ablation 6 monts ago i had same issues you are having it takes 6 months to heal thats what my doctor said i am still taking flecanite also plus a beta blocker they took me off of my blood thinner i still have issues lots of pvc heart beats hard sometimes havent went into afib in 6 months so hope it worked guess wont know for sure unless i go off all meds dont know when my doctor will try that .

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RN Linda | @vermontrob | May 24, 2017
In reply to @mac4life "Glad to know ablation worked even if later rather than sooner. Its been almost 6 weeks..." + (show)
@mac4life

Glad to know ablation worked even if later rather than sooner. Its been almost 6 weeks since my ablation for paroxysmal afib and still experiencing spikes in HR and occasional lows. Movements like brushing teeth, making bed, or even a normal walk cause high rate. At rest it is usually in 50's and 60s. Im on flecainide (50mg) and metropolol (12.5mg) and Pradaxa--2x day each. I get fatigued easily .. is all this normal? What symptoms will determine need for 2nd ablation? How long between first and second can it be done? I'm eager to get my life back!

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That is so interesting to me- my husband kept telling doctor that minimal activity - like making a sandwich or walking on a flat boardwalk- caused his pulse to go over 100, and it did not come right down as it should but took 30 minutes or so to reach normal. His cardiologist who did the ablation thought that was strange and asked if he had that before the ablation- this is a marathon runner, of course he didn't have that symptom before! Anyway, the person who is 6 weeks out and asking about a second ablation- I would suggest waiting for at least 6 months, maybe even a year unless your symptoms cause serious problems. My husbands cardiologist told us about the fact that the heart muscle needs to heal, think of how long it takes for a broken leg to heal. And your heart is constantly beating, plus you are on blood thinners, which must make healing more lengthy.

Of course you want your life back, try to be patient though...

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