Atrial Filbration

I, too, would certainly be worried about him if I were you. Please know that I had an ablation on 11/24/25 and also had some arrhythymias in a period about three or four weeks afterward, but not A-fib. The APRN I saw for followup stated that it takes 3 months or more before the ablation is considered to be a "failure." (Horrible choice of words--I am a psych nurse and I was really upset with her!) Anyway, you didn't tell us how long he has had A-fib, or how persistent; you also need to know how extensive the ablation was (like just the standard treatment around the pulmonary arteries, or more aggressively looking for foci that trigger the arrhythmias.) You will find that others report ablation failures since it is not a cure, but it is critical, I think, for him to be taking his meds. Can he crush them and put them in water or juice? Is he trying any supplements like Magnesium that would help to stabilize the arrhythymias? Didn't the EP doc schedule a follow-up appointment at 6 weeks and 3 months? Mine did and I thought that would be the standard for care. As for the legs, that is most certainly a circulation problem and should not go ignored. If he has diabetes, does he follow a routine to check his blood sugars regularly. Even though we are not diabetic, my husband and I check our blood glucose levels regularly on our own. You can get a glucometer at any drug store; they are not expensive. I know that there are many people who hate to go to the doctor or are fearful, but if he is still working then he is too young to give up on his health. Make him an appointment and go with him; insist that the doctor answer your questions! I can assure you that if you don't get assertive, you won't get the help he needs. I have a husband that sounded like yours, but I have really gotten him to be more pro-active and he is doing better and he is 80 years old. I just want you to feel supported. Please keep after him; there are ways to make this better. As for the trip coming up, I would seriously suggest not going unless he gets some treatment. Nothing is worse than being ill a long way from home. (We were stuck in France on vacation for 30 days due to a bike accident that my husband had; it was very challenging to say the least.) Good luck to you both, sincerely!

Does he have sleep apnea....formally diagnosed in an over-night sleep lab (called a polysomnography)? His sitting up might indeed by due to heart arrhythmia, which would be interruptions of his sleep...never a good thing. It's bad enough people have to rise to void several times each night as they age, but adding to that burden is awful and harmful. But, sitting up could also be a response to the fight-or-flight reaction when his brain awakens him due to very high CO2 levels in his blood.

Every patient is different, but every patient knows themself well. If he were previously symptomatic, and knew when he was in arrhythmia, then he must still sense when he enters arrhythmia. So, I'm guessing it really is happening. Happened to me after my index ablation. Happens to about 25% of all index ablatees, unfortunately, statistically across all EPs doing ablations. The very best EPs in the land do better, about 85% on their patients' index ablations. So, there's that....

Blanking periods, like their host hearts, are all unique. I have heard of people needing a full year after an index to calm their resting HR to around 70-75 from 85-95, if you can believe it. But their hearts all returned to a calmer rate. Similarly, some people report ectopy or AF later in their blanking periods, but then a year goes by and no more AF. However, and I have repeatedly sought and reread the literature on this, ectopy and cardiac crankiness early in the blanking period is a better sign than going for weeks with an apparently happy heart that suddenly begins to get ectopy or AF. So, early AF, short runs, self-limiting, in the blanking period are a good sign. Later, after two months or more, it's not a great prognosis and the probability that it's a failed ablation is higher. The reason is that the scarring done during the ablation 'fills out' or spreads and each lesion meets the one next to it during the first two-four weeks after the ablation. This seals off the pulmonary vein ostia with a good seal. One 'n done. But for that unhappy 25%, of which I was regrettably one, those scars don't completely close off in a nice full circle around one or more of the pulmonary vein ostia. Happened to me. Second ablation, seven months later, he found the gap when he applied the tip to a place around my third vein. My heart went into steady NSR as he withdrew the tip, and the crew watched my heart for a minute. He said he didn't even bother to electrically cardiovert my heart before sending me out to recovery, something he does for all ablatees.

One other point in this long post....sorry...I get wordy: AF is a progressive disorder. Most patients progress in this disorder as they age, and an ablation that worked in 2025 may not hold out all that long before the heart finds new places to grow those rogue signalling cells. If enough of them can join and send a signal out into the atrial endothelium, another path outside those circular dams of scarring created the first time, your heart WILL lurch into AF again. So, many/most ablations have a life, a limit. Most patients learn they'll need another ablation in a few years. And this phenomenon, of a progressive disorder, may be what has happened. The ablation did its job, and so did the earnest EP, but meanwhile, his heart has found another 'way' to enjoy its chaotic state. Every living creature and thing moves with time, including their diseases and disorders. Everything advances somehow. Ablations can nub that for a while, but in time most patients will need a touchup ablation or a whole new approach, including a pacemaker....eventually.

I don't mean to be a Debbie Downer about this, but it's what I have learned, what seems to be self-reported by many patients across fora that I frequent, and so it appears to be empirically true.

Does he have sleep apnea....formally diagnosed in an over-night sleep lab (called a polysomnography)? His sitting up might indeed by due to heart arrhythmia, which would be interruptions of his sleep...never a good thing. It's bad enough people have to rise to void several times each night as they age, but adding to that burden is awful and harmful. But, sitting up could also be a response to the fight-or-flight reaction when his brain awakens him due to very high CO2 levels in his blood.

Every patient is different, but every patient knows themself well. If he were previously symptomatic, and knew when he was in arrhythmia, then he must still sense when he enters arrhythmia. So, I'm guessing it really is happening. Happened to me after my index ablation. Happens to about 25% of all index ablatees, unfortunately, statistically across all EPs doing ablations. The very best EPs in the land do better, about 85% on their patients' index ablations. So, there's that....

Blanking periods, like their host hearts, are all unique. I have heard of people needing a full year after an index to calm their resting HR to around 70-75 from 85-95, if you can believe it. But their hearts all returned to a calmer rate. Similarly, some people report ectopy or AF later in their blanking periods, but then a year goes by and no more AF. However, and I have repeatedly sought and reread the literature on this, ectopy and cardiac crankiness early in the blanking period is a better sign than going for weeks with an apparently happy heart that suddenly begins to get ectopy or AF. So, early AF, short runs, self-limiting, in the blanking period are a good sign. Later, after two months or more, it's not a great prognosis and the probability that it's a failed ablation is higher. The reason is that the scarring done during the ablation 'fills out' or spreads and each lesion meets the one next to it during the first two-four weeks after the ablation. This seals off the pulmonary vein ostia with a good seal. One 'n done. But for that unhappy 25%, of which I was regrettably one, those scars don't completely close off in a nice full circle around one or more of the pulmonary vein ostia. Happened to me. Second ablation, seven months later, he found the gap when he applied the tip to a place around my third vein. My heart went into steady NSR as he withdrew the tip, and the crew watched my heart for a minute. He said he didn't even bother to electrically cardiovert my heart before sending me out to recovery, something he does for all ablatees.

One other point in this long post....sorry...I get wordy: AF is a progressive disorder. Most patients progress in this disorder as they age, and an ablation that worked in 2025 may not hold out all that long before the heart finds new places to grow those rogue signalling cells. If enough of them can join and send a signal out into the atrial endothelium, another path outside those circular dams of scarring created the first time, your heart WILL lurch into AF again. So, many/most ablations have a life, a limit. Most patients learn they'll need another ablation in a few years. And this phenomenon, of a progressive disorder, may be what has happened. The ablation did its job, and so did the earnest EP, but meanwhile, his heart has found another 'way' to enjoy its chaotic state. Every living creature and thing moves with time, including their diseases and disorders. Everything advances somehow. Ablations can nub that for a while, but in time most patients will need a touchup ablation or a whole new approach, including a pacemaker....eventually.

I don't mean to be a Debbie Downer about this, but it's what I have learned, what seems to be self-reported by many patients across fora that I frequent, and so it appears to be empirically true.

@gloaming thank you so much for your reply it is very helpful and informative, unfortunately my husband has his head in the sand and will say everything is fine ok and perfect, when his body is obviously saying the complete opposite. He wont discuss it with me, i can just tell by how little he is sleeping and how often he gets up and goes downstairs. I do think he might have sleep apnea but to get him to do anything about, it would be near impossible. Thank you again for your time I really do appreciate it so much.

Does he have sleep apnea....formally diagnosed in an over-night sleep lab (called a polysomnography)? His sitting up might indeed by due to heart arrhythmia, which would be interruptions of his sleep...never a good thing. It's bad enough people have to rise to void several times each night as they age, but adding to that burden is awful and harmful. But, sitting up could also be a response to the fight-or-flight reaction when his brain awakens him due to very high CO2 levels in his blood.

Every patient is different, but every patient knows themself well. If he were previously symptomatic, and knew when he was in arrhythmia, then he must still sense when he enters arrhythmia. So, I'm guessing it really is happening. Happened to me after my index ablation. Happens to about 25% of all index ablatees, unfortunately, statistically across all EPs doing ablations. The very best EPs in the land do better, about 85% on their patients' index ablations. So, there's that....

Blanking periods, like their host hearts, are all unique. I have heard of people needing a full year after an index to calm their resting HR to around 70-75 from 85-95, if you can believe it. But their hearts all returned to a calmer rate. Similarly, some people report ectopy or AF later in their blanking periods, but then a year goes by and no more AF. However, and I have repeatedly sought and reread the literature on this, ectopy and cardiac crankiness early in the blanking period is a better sign than going for weeks with an apparently happy heart that suddenly begins to get ectopy or AF. So, early AF, short runs, self-limiting, in the blanking period are a good sign. Later, after two months or more, it's not a great prognosis and the probability that it's a failed ablation is higher. The reason is that the scarring done during the ablation 'fills out' or spreads and each lesion meets the one next to it during the first two-four weeks after the ablation. This seals off the pulmonary vein ostia with a good seal. One 'n done. But for that unhappy 25%, of which I was regrettably one, those scars don't completely close off in a nice full circle around one or more of the pulmonary vein ostia. Happened to me. Second ablation, seven months later, he found the gap when he applied the tip to a place around my third vein. My heart went into steady NSR as he withdrew the tip, and the crew watched my heart for a minute. He said he didn't even bother to electrically cardiovert my heart before sending me out to recovery, something he does for all ablatees.

One other point in this long post....sorry...I get wordy: AF is a progressive disorder. Most patients progress in this disorder as they age, and an ablation that worked in 2025 may not hold out all that long before the heart finds new places to grow those rogue signalling cells. If enough of them can join and send a signal out into the atrial endothelium, another path outside those circular dams of scarring created the first time, your heart WILL lurch into AF again. So, many/most ablations have a life, a limit. Most patients learn they'll need another ablation in a few years. And this phenomenon, of a progressive disorder, may be what has happened. The ablation did its job, and so did the earnest EP, but meanwhile, his heart has found another 'way' to enjoy its chaotic state. Every living creature and thing moves with time, including their diseases and disorders. Everything advances somehow. Ablations can nub that for a while, but in time most patients will need a touchup ablation or a whole new approach, including a pacemaker....eventually.

I don't mean to be a Debbie Downer about this, but it's what I have learned, what seems to be self-reported by many patients across fora that I frequent, and so it appears to be empirically true.

@gloaming I 'enjoyed' reading all of your response - so much great information. I had one isolated AF incident 11 years ago, was cardioverted in the ER. Took Eliquis for a year, did not even need a heart rate med. Fast forward to a month ago. I had schedule right total hip replacement. I woke in recovery feeling 'off.' Not just nausea from the general anesthesia, but fluttery, short of breath, etc. After about an hour, my heart rate started to climb. I immediately told the nurse I was in AF and to do an EKG. She was not super responsive, until my HR got above 150, then an anesthesiologist showed up, started barking order, gave a bolus of metoprolol and an amiodarone drip. I felt much better for about 15 minutes, and then I felt like I needed to vomit and I coded. Compressions brought me back. Over the next 2 days in the hospital, I converted back into sinus rhythm on my own. Now I am faced with figuring out my future with AF. I do have sleep apnea, and at times, even propped up in bed (I have to be on my back due to the hip recovery for another couple of weeks), I wake feeling so claustrophobic and gasping. I am 'eventing' more times per hour. I wore a monitor for 2 weeks, no results back yet. EP cardiology appt is not for another 6 weeks. I am taking time-release metoprolol and Eliquis. The metoprolol makes me so short of breath when I do my hip PT exercises. I am 68 and certainly feeling my mortality (and a very sore chest). Echo done in the hospital did not show a need for ablation, but I would prefer to have the EP review and discuss. Any advice or thoughts? Sorry to hijack this thread, but I have similar issues.

@lucyvt Many EP's won't even meet with you until you have other 'issues' cleared up or under control. It's the same with the other specialists: my ophthalmologist referred me to an eye surgeon because I have vitreomacular traction syndrome....the thin membrane lining everyone's eye shrinks with age and pulls away from the retina uneventfully. In some, a few cases, the membrane sticks to the retina, but it still wants to shrink away and move toward the front of the eyeball...all inside. This traction can tear the retina. But my ophthalmologist said she was certain he would not seem me until I had cataract surgery in that eye, and she was right. I did meet with him, but he asked me to get the cataract removed, by my ophthalmologist, first. I learned my EP would not deal with me until I was healthier, had no unmanaged ischemia (lack of oxygen to organs, but chiefly the heart), was not an alcoholic (minimal use of alcohol all my life), didn't smoke, etc. So, I had to have numerous tests to rule out ischemia. He felt that trying to fix AF that was probably due to an unhealthy heart was a waste of resources, and I can't argue otherwise.

So, Lucy (sorry to meet you here, for this..., but it's still nice to meet you), it might have been the anesthetic, it might have been a wee bit of stress on your Vagus nerve if a TEE was administered or a lot of burning was done near it...? Or the stress of the entire experience, and its subsequent discomfort, might have reduced your 'Vagal tone' (you can google that and what it means, especially with respect to AF patients), or it was a drug sensitivity, or just a temporary reduction in the drugs your system was used to getting regularly but that were suspended for 24 hours or longer until your ablation was over......just guessing at any/all of these. And yup, it could very well have been a rise in AHI events while you were 'out'. Anesthetists always ask me if I have apnea (they would routinely ask that of any male with a bit of a paunch whom they know is over 50), and I tell them what my cm of H20 setting is on my machine. I don' recall ever awakening with a mask over my face, so I must not have shown any hypoxia or struggles to breath during any of my ablations, two of them now.

Monitor results usually take a week to three weeks, depending on the outfit receiving the device and its recording, and then getting it to the person responsible for debriefing you and prescribing a way forward. You may even have them by the time you read this.

Oh, I just realized: it might even be that your prescribed PAP treatment has gotten out of date and that you need a revision, maybe even monitoring to see if your needs have changed...it's possible, and this is why you're having events.

If you are interested in learning more from fellow PAP travelers, head on over to apneaboard.com and read in. You can even use their OSCAR freeware to get a lot more useful information from your CPAP machine's onboard SD card....if yours has one. I have been using OSCAR for about six years now...it's great, free, and it's safe.

A much smaller and less busy site is afibbers.org run by two fellas, one of them a retired EMT who has had six ablations. There's tons of great anecdotal and published paper links to be found, if you'd care to go over and take a look.