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Athletic heart with heart rate abnormalities post ablation for a fib
I’m writing about my daughter, 24 yo athlete who started having palpitations in July after a significant cold, presumably covid in 2024. At that time she hadn’t had a vaccine for 1.5 years. By 5 months later these palpitations worsened, by March she got a monitor that showed v tach vs aberrant a tach? With a rate of 311 while backcountry skiing. She got an ablation August 2025 and all that triggered was atrial fibrillation. One year post ablation she’s having fast rates at rest and slow rates with exercise. But no dizzy spells and is currently wearing a monitor again. She was a competitive swimmer for 15 years, very dedicated and had a resting HR 42 and I often wondered if she developed an athletic heart. She had little follow up and no rehab. I wonder if young people and athletes with this problem aren’t properly training their hearts after ablation. How is the medical community addressing this? There are heart centers in Boston and Chicago for heart training in athletes, but what about if you live in WYOMING. Anyone else have similar experiences? Thoughts on rehab?
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https://www.healthgrades.com/clinical-cardiac-electrophysiology-directory/wy-wyoming
I know none of these and cannot vouch for them. But it might be the beginnings of an inquiry.
You need to find an EP who does complex ablations. Clearly your daughter's case is complex....not just a simple PVI like most newly diagnosed patients (pulmonary vein isolation).
If you have the means and motivation to travel, look to Dr. Andrea Natale at the Texas Cardiac Arrhythmia Institute in Austin. He has privileges at numerous hospitals in the central and western USA and travels to them often. Dr. Natale is a top tier EP, world renowned. He trained under the vaunted guru of all things EP, Dr. Pierre Jais in Bordeaux, Fr.
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1 ReactionThank you. We looked at the Mayo and she ended up in SLC for her ablation. The other problem is being 24, invincible and in denial. Not easy. Thank you though, I will look at this EP you mentioned.
Provide her with this link:
https://www.ncbi.nlm.nih.gov/sites/books/NBK551564/
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1 ReactionThere was a fairly young man, a competitive runner, near where I live who knew he had heart issues (I don't know what his heart problems were), but thought that he could exercise his way through his heart problem; he was wrong and died while out running a few years ago. I'm glad she's on her way to getting what she needs from a good medical center. All the best!
@gloaming
A good article. Thanks for posting the link.
Yes, that’s what keeps me up at night. Thanks for the article.
I would also recommned UCSF and Dr. Gerstenfeld. I spoke with Dr. Natalie and he was hell bent on ablating my atrial appendage without seeing me. Saw Dr. G and my appendage was fine. He and his team took the time and used both RFA and PFA with the Aferra system this last May. I am now 3 months out and no fib no flutter and exercising regularly. I was an avid cyclist doing 100 mile rides in about 5 hours. I will add this was my 6th ablation. Dr. G and team spent 5 hours finding the problems. I will add to that Dr. G specializes in abnormal rythms following ablations.
@labexperiment I won't presume to speak for Natale, but based on what you said in your comment above, a 6th ablation suggests that the previous five attempts were done incompletely. He may have looked at your records and seen that your LAA was a possible next candidate for an ablation because your records showed no previous attempts at doing that part of an ablation. Even so, as a highly skilled and renowned electrophysiologist who is very highly regarded in his field, he would have performed an initial mapping procedure to actually pinpoint the area(s) where you needed ablating. Your LAA was merely a good first place to look.
@gloaming
Thanks for your reply, my point is Natalie had his mind made up before he saw me. For your info I am a health care provider and have been in practice 41 yrs. When a physician pre judges a patient and comes up with treatment without seeing the patient that is BS and I don't care what his or hers qualifications are.
As for your other comment, I have had 5 ablations over 14 years and the 6th this last May. My appendage has been fine every time and still is. My arrythmia started with typicaal flutter, simple fix. The typical came back - again another simple fix. Was good for several years and got fib. The recovery took some time but was fine for 6 years. The I began with atypical flutter and was ablated in Dec 25, this did not work tried again another procedure and that worked for a wek. The Dec 25 and January 26 were both PFA with the Farapulse. I would stay away from Farapulse - it just seems to stun tissue and causes incomplete ablation lesions. I consulted with Dr. G who specializes in flutters post ablation which is why I recommended him to the family above. He used the Aferra system for mapping and ablation. The aferra PFA is more robiust and it also does RFA and used an 8.5 mm ablating tool. I am back 100% now.
I do not give advice here that's not covered in my malpractice insurance. I do offer resources for learning and can share my experiences.
That’s a lot of ablations.
I’ve also looked at Mayo in Minnesota. Anyone have experience there?