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RN Linda
@vermontrob

Posts: 18
Joined: Oct 08, 2016

Afib after ablation

Posted by @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.

REPLY

Hi Linda,
I’m so sorry to hear about the complications your husband is experiencing. I’m tagging @martishka on this discussion. As you know she’s had several ablations and may be able to speak to your query about a “cleanup” ablation. You were talking with several members about ablation in this discussion:
– Should I consider ablation? http://mayocl.in/28ReaNr

I’m also tagging @darrellb @jhoffmanj and @predictable to join this discussion to see if they have any thoughts to share.

@colleenyoung

Hi Linda,
I’m so sorry to hear about the complications your husband is experiencing. I’m tagging @martishka on this discussion. As you know she’s had several ablations and may be able to speak to your query about a “cleanup” ablation. You were talking with several members about ablation in this discussion:
– Should I consider ablation? http://mayocl.in/28ReaNr

I’m also tagging @darrellb @jhoffmanj and @predictable to join this discussion to see if they have any thoughts to share.

Jump to this post

Hello Colleen,I clicked the link you included in your email below and it took me to a submission from May, 2016.  I am not sure where the up to date discussion is regarding a “clean up ” ablation,I would be happy to respond if I had the reference.Best,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

@colleenyoung

Hi Linda,
I’m so sorry to hear about the complications your husband is experiencing. I’m tagging @martishka on this discussion. As you know she’s had several ablations and may be able to speak to your query about a “cleanup” ablation. You were talking with several members about ablation in this discussion:
– Should I consider ablation? http://mayocl.in/28ReaNr

I’m also tagging @darrellb @jhoffmanj and @predictable to join this discussion to see if they have any thoughts to share.

Jump to this post

Hi Colleen,My apologies, I found the link!Martishka

Hello @vermontrob, your own insights and those of @martishka are well beyond my experience and capacity to join in this vital discussion. My main (but limited) involvement was my wife’s diagnosis of SVT almost 20 years ago now. It arose with her diagnosis of Diabetes-2 and is now not a symptom — thanks either to the 25mg daily Tenormin beta blocker or to her success in managing her Diabetes-2 with Glipizide and smart nutrition. She never had symptoms of A-fib. That may help home-in on a complex of symptoms that you won’t have to worry about.

The A-fib in my family is mine. Gratefully, it is essentially asymptomatic and has raised no thoughts of ablation. Perhaps my daily 50mg Carvedilol put my A-fib under control. My only inconvenience is daily 7.5mg doses of Coumadin and lab tests every six weeks to make sure that this anticoagulant is within proper bounds (INR=2.0-2.8). So I have not much to offer, other than my persistent interest and concern in your progress and future good health.

@predictable

Hello @vermontrob, your own insights and those of @martishka are well beyond my experience and capacity to join in this vital discussion. My main (but limited) involvement was my wife’s diagnosis of SVT almost 20 years ago now. It arose with her diagnosis of Diabetes-2 and is now not a symptom — thanks either to the 25mg daily Tenormin beta blocker or to her success in managing her Diabetes-2 with Glipizide and smart nutrition. She never had symptoms of A-fib. That may help home-in on a complex of symptoms that you won’t have to worry about.

The A-fib in my family is mine. Gratefully, it is essentially asymptomatic and has raised no thoughts of ablation. Perhaps my daily 50mg Carvedilol put my A-fib under control. My only inconvenience is daily 7.5mg doses of Coumadin and lab tests every six weeks to make sure that this anticoagulant is within proper bounds (INR=2.0-2.8). So I have not much to offer, other than my persistent interest and concern in your progress and future good health.

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Can’t really comment on ablation procedure in that my MD has told me another ablation ( I have had two.) is not a good option fof me. I have HCM. I did have a rough Sept and Oct. I had to be cardio verted after being hospitalized twice. I was put on Norpace that really had side effects that I tried to gut out but ended up losing my appetite, being constantly gaseous, apathetic and constipated. I am now on Amiodenone (sp) and am doing better but still have some side effects, plus I get the feeling the Dr.’s see this as a last. Any other HCM out there with some cheery words of advise on meds etc. Thanks.

@predictable

Hello @vermontrob, your own insights and those of @martishka are well beyond my experience and capacity to join in this vital discussion. My main (but limited) involvement was my wife’s diagnosis of SVT almost 20 years ago now. It arose with her diagnosis of Diabetes-2 and is now not a symptom — thanks either to the 25mg daily Tenormin beta blocker or to her success in managing her Diabetes-2 with Glipizide and smart nutrition. She never had symptoms of A-fib. That may help home-in on a complex of symptoms that you won’t have to worry about.

The A-fib in my family is mine. Gratefully, it is essentially asymptomatic and has raised no thoughts of ablation. Perhaps my daily 50mg Carvedilol put my A-fib under control. My only inconvenience is daily 7.5mg doses of Coumadin and lab tests every six weeks to make sure that this anticoagulant is within proper bounds (INR=2.0-2.8). So I have not much to offer, other than my persistent interest and concern in your progress and future good health.

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Forgot to say last resort.

@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.

I was in the ablation trial at Cleveland Clinic 17 years ago. While I did develop AFIB 6 years later, it has been controlled with meds, so I’ve had 17 productive years since the ablation. It was my best option at the time and I would have likely died within a year without it.
There may be better options now, but I will never regret doing it then.

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.

@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.

Jump to this post

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.

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.

@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.

Jump to this post

@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

@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?

@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.

Jump to this post

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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