SVT ablation issues

Ablations have some risk for collateral damage to other tissues, depending on where the ablated tissues are located, and depending on the type of energy and how much of it was applied. If we are talking RF energy, then it is thermal, and if the energy is applied near the phrenic nerve or near the esophagus, they can be damaged as well. That is why RF ablations often have a TEE (trans-esophageal echocardiogram) inserted down the esophagus while the patient is unconscious band being ablated. The scope display can show how close the RF tip is getting to those two items.

I say this because it is always possible that you have collateral damage, maybe to the phrenic nerve, probably NOT the esophagus since you are swallowing well and report no heartburn or other pain associated with swallowing, but maybe even the Vagus nerve might be affected. Or, this is something entirely new and might have been developing all along. Or, you have another arrhythmia at play, one not known and left untreated at the time of the ablation.

If I were you, I would request a long-term heart monitor to see what might turn up, or get a Kardia 6L (they are not a lot of money, try amazon) and use it each time you're having a 'spell'. A cardiologist who is the least bit interested in your case will take a look at the Kardia's uploaded ECG and immediately know what to do, including assigning a longer term Holter or other device.

@gloaming
Thank you for responding.
I'm currently wearing a 7-Day monitor, issued yesterday from my new EP. He is baffled by my symptoms, but does not deny that I am experiencing them. These symptoms are debilitating and have ruined my daily life. Per your comment, I am hoping to obtain the information regarding the kind of energy that was used and where, and if there was any damage. As well if there was a TEE performed during the procedure. The symptoms feel systemic now--with the internal tremors, internal sunburned feeling, intolerance to the slightest amount of "activity", and the feeling of inflammation body wide. There are a couple of days a week that I'm feeling as though I might feel some improvement--then I walk a bit too much (.5 mile +/-) or do a bit too much home yoga (gentle 20 minutes), and I'm thrown back into the internal tremors internal sunburned feeling, as well as heart pounding/thumping. Yesterday, after the EP appointment, I was hit with severe symptoms for hours (which happen 2-3 days a week--and last for hours). While yesterday's attack has lightened up a bit, I am currently still feeling it and being careful not to do much of anything. Since I'm wearing a 7-Day monitor, do you have any other suggestions for next steps? Possibilities? Specialities to consider? Is this a long & severe recovery to the heart tissue being burned, that will work itself out? Any thoughts on triggering dysautonomia? Your thoughts are sincerely appreciated. Thank you very much for your input~

@kthrn1 '...Yesterday, after the EP appointment, I was hit with severe symptoms for hours (which happen 2-3 days a week--and last for hours). While yesterday's attack has lightened up a bit, I am currently still feeling it and being careful not to do much of anything...'

This says a lot to me. I think you have an irritated heart that is hyper-responsive to adrenalin, which we all produce in response to stress....which in turn is what we experience when consulting a physician/expert about a significant problem....which you were in the process of doing at the time. This is why metoprolol or another suitable/well-tolerated 'beta-blocker' (meaning a beta-adrenergic blocker- https://www.bhf.org.uk/informationsupport/heart-matters-magazine/medical/drug-cabinet/beta-blockers ) might be the ticket for you for the time being. This is something to raise with your physician as it may be needed to get you over a rough patch, and then, maybe six weeks from now, all the way up to six months, you can wean yourself off of that 'crutch' and then resume normal living.

@gloaming
I appreciate your input greatly--thank you!
I am currently on 25 mgs of Metoprolol in the evening for the high resting heart rate, up from the original daily dose 12.5 mgs. I have been on 25 mgs for the last 2.5 months--and honestly the internal tremors & internal sunburn feeling, have remained the same.
I agree regarding the trigger yesterday, it was a long day--yes, a long appointment then waiting for the appt. to place the 7-Day monitor. However, most of my triggers happen at home--walking a bit too much (over 2500 steps total in a day) or a bit too much gentle yoga (20-30 mins). Everything that brought stress relief and joy (yoga, hiking, horseback riding, even working), I no longer can do, as they actually trigger the symptoms. Is this something that needs to be "waited out"....even though it's been over 16 weeks? Also, any thoughts on Ivabradine for the internal tremors & internal sunburn feeling, as well has the heart thumping and pounding?
Thank you, sincerely!

@kthrn1
First let me say how sorry I am that this has happened to you. It sounds as if the ablation really ruined your life.
You say you had the procedure for SVT but you haven't mentioned it again. Did it stop the palpitations? I had an ablation for the same reason and even though my palpitations are much better, I still get them occasionally. The doctor wanted me to stop the Metoprolol but I insisted on staying on it since I still have an arrhythmia . My dose is 50 mgs which I take at night because it causes fatigue.
You say it's been 3.5 months since the ablation and doctors consider that the amount of time it takes to heal and see the true results but it took me much longer than that to feel better. I have other issues with my heart though so that may have something to do with my slow recovery.
I truly hope you're able to find a solution to that internal sunburn. That sounds like inflammation. Best of luck.

@

@bch72
Thank you for your response and concern.
Yes, I had the ablation for SVT approximately 16 weeks ago. I am aware of one, possibly two, episodes of SVT since. My resting heart rate remains high, in the low 90s, which for me is approximately 15 points +/- higher than is normal.
Are you still working toward recovery? I am sorry you have had a difficult time.
Sending best wishes to you and for your health~

@kthrn1 It is surprisingly common for the apparently successful treatment, via ablation, for one tachyarrhythmia to lead soon after to another tachyarrhythmia. For example, both PACs and AFL (atrial flutter) are common after a simple PVI ablation for AF, but both are relatively easily treated....with yet another ablation. The key is that the EP doing the procedures is skilled and experienced enough to know how to do it successfully.

It would seem that, on the face of it, as you relate your experiences, that.....yes....you are probably best waiting this out for now. You don't want to be in AF or have too many PACs in a day if you can avoid it because it puts inordinate stress on the heart, notably the valves, and it tends to make the affected vessels want to enlarge.

The criterion for a 'successful' ablation is one full year free of the treated arrhythmia. This means that some patients' ablations are obvious failures inside of a few months, or they develop a follow-on arrhythmia, or they remain on a high resting HR, sometimes in the high 80's and 90's. Usually that high rate subsides inside of a few months, but if it stays high, it needs to be addressed. You shouldn't need ANY metoprolol after the blanking period....period! Nor should you need an AAD (anti-arrhythmic drug)...otherwise, what's the point of incurring the risks associated with an ablation?!?

About Ivabradine, I have no experience with it, and have not learned of it....sorry.