Afib in weeks after ablation

This is what I understand from what I have read (widely by now) and by my own instructions given when I was released from the cath lab:
a. Expect to have 'some' ectopy in the first few weeks. It should back off and you'll be free of ectopy by the time your Holter assessment happens at about the 10 week mark, give or take two weeks;
b. If you do experience ectopy/decided AF, do not let it go longer than 24 hours...if...the heart rate exceeds 100 BPM. If it goes 24 hours above 100, to to the local ER. I would add, as a personal instruction, that if your measured rate exceeds 160 BPM, you should probably seek help at the hospital inside of about 12 hours as you may profit from a metoprolol drip (via IV bolus); and
c. My readings have found several articles saying that AF in the first three/four weeks is much better than having three/four weeks free of ectopy, but then starting to get breakthrough ectopy in the last half of the blanking period. If it comes later in the blanking period, it usually indicates a failed ablation. This is not a hard and fast rule, just that the probability is quite a bit higher according to the research. Early ectopy, short runs, self-correcting = Good! Frequent runs of ectopy, especially if they last several hours, and if this happens after week 5/6 = Not good...probably...not absolutely. Does that make sense?
The reasoning is that the lesions imparted to the endothelium and substrate of the left atrium where the energy was applied continue to 'cure' and heal over time, but included in the process is a mild expansion of the scarification that prevents the signal from emitting from the pulmonary veins or whichever reentrant/focus/rotor was isolated. The blanking period allows for the healing, but also the 'overlapping' of the scarred tissues so that they make an effective and 'signal-tight' dam around the affected emission point(s). This takes a few weeks, during which the heart is also meant to calm down...climb down off the proverbial wall from stress. So, with this idea in mind, one should expect to experience less and less ectopy if some small bit of signal is still getting through tiny gaps in the scarred tissues. If they don't close fully, and this is often what happens in the approximately 25% of failed ablations, then a redo is needed down the road, and you'll have to go back on an anti-arrhythmic if that is in keeping with your circumstances, and also metoprolol/bisoprolol/Sotalol/propafenone...whichever is prescribes. Also a DOAC (direct-acting oral anti-coagulant, like apixaban or rivaroxaban) due to continuing risk of stroke.
Last answer to 'Should I have waited..?' Yes, it turns out. Oh, don't beat yourself up..I have been 'there', several times now, and virtually every AF patient who knows they're in AF, especially if they're highly symptomatic as I was/am, want rid of the horrible sensations and anxiety. However, especially after an ablation, you should tough it out for 24 hours...according the instructions I was given (two ablations, the first failed...badly). That it only lasted an hour is actually a good sign. For one, it's still paroxysmal, the easiest to treat, and it's short duration is textbook 'you'll have some mild ectopy in the first couple/three weeks after your ablation..' instructions. So...calm....cool off....keep puttering and beating back the indulgence that is anxiety.

The discharge information that I received after my ablation (PFA) said that I MAY have episodes of Afib. Information did not give any time frame for when or for how long. It has been about 7 weeks since my ablation and I have not had any episodes of Afib. But that is just me. I am still on Eliquis and Metoprolol and will be for another 6 or 8 weeks. Since the ablation my heart rate has never gone above 80 BPM and most of the time is in the mid to upper 60s when resting. Mid 70s with exercise. BP has been 115/75 or below, but not so low as to be a concern. I was asymptomatic with Afib and only found out about it when being prepped for cataract surgery. I was in Afib for about 6 weeks and then had a successful cardioversion which kept me out of Afib until the ablation. Never went to the ER.

As far as waiting to see if the Afib goes away or going to the ER, is really how you feel comfortable with waiting.

Thank you so much. I didn't get much in the way of information or instructions before I left the country. I was aware of the blanking period but not of the expected duration of afib episodes. I'll keep this in mind for the rest of the trip. Again many thanks.

Thank you so much. I too did a fair amount of research on post ablation but was unable to find anything about duration or severity of an episode. This was my first one in the 3 weeks since my ablation. I just wish it had happened before I left home. Tomorrow I embark on a 3 week cruise so knowing that a few hours of afib are OK makes me feel better about it.

Traveling invites stress due to disruption of routine, but also having to keep an eye on luggage and to lug it around. Also, dehydration if you have flown any distance....it's easy to get behind hydration. One other possibility, although it's not a strong possibility if you eat properly....low magnesium, possibly low potassium. Most of us are somewhat low, or chronically low, in levels of available magnesium. If this is you, then taking 100-200 mg of a magnesium salt capsule once a day for a week or more shouldn't hurt, and it may help (healthy kidneys excrete all the electrolytes they don't need, so you'd have to work hard, popping pills two/three times each day to develop hypermagnesemia). You can take your pick of formula. The citrate salt is most readily absorbed, but it can also loosen your stools quite a bit if you overdo it. There are popular salts like bis-glycinate, malate, taurate....
Please note that I don't know IF you have hypomagnesemia and if you need more magnesium. I'm just offering that it is possible, including that you're just dehydrated. I'm not on the cruise with you, nor am I a health care professional. Just giving you possibilities. Still, I wouldn't sweat a single blip, especially self-correcting and of short duration. Enjoy the cruise!

I found that staying hydrated, especially during physical activity, is key for me. I do believe that the reason I had my one and only Afib episode was because I was doing some heavy farm work, and since it was winter, I was not staying hydrated. I went from a clean bill of health to 2 weeks later with Afib and no symptoms in between. Oh yeah, being old doesn't help. I am now 85 years 9 months and 25 days of age. When you get to be my age you start counting like you did when you were 5 years, 9 months and 25 days of age.

I'm 83 so I get it.