Chest pain after pulsed field ablation

I had no chest pain after my RF ablations, two of them, but I have read numerous accounts of people who ask if whatever they've begun to experience after their own ablations is worrisome or normal, and is it going to go away over time. The answer is.............................wait for it!..................................yes.....but....it might be a long time. For example, most often I see people asking why their heart rate at rest is now 80 when it was 72 before their ablation. The response is universally that it's normal after an ablation to have an elevated heart rate, and that the return to normal is almost certain, but it might stay elevated for many months...a year even.

There are risks during an ablation, one of them being inadvertent burning of the phrenic nerve and even of the esophagus. Usually a trans-esophageal echocardiogram plug is inserted into the patient's esophagus while the patient is unconscious. This allows the surgeon to see how close the burning wand is getting to danger areas that he/she does NOT want to burn. There can be throat pain after this, but also some of that inadvertent burning they wanted to avoid. Or, because of the activity in general during surgery, you can get a bit of pericarditis, meaning the sac around the heart can get inflamed.

You are doing the right things. Monitor yourself, and anticipate that this will subside in time. If it persists more than a few days, or seems to be getting worse, if you become feverish, feel unwell, make sure you contact the EP or your cardiologist right away. If you can't reach them inside of a couple of hours, get to Emerg.

Follow your doctor's advice about Advil/Motrin. There is some danger of gut bleeding, but if you ingest it with food, you should feel better in no time and the risk is very low. Personally, I like Aleve, but I only take one of them a year...just 'cuz. I virtually never take analgesics except for a sore back or whatever, which happens about once a year.

Thanks for the thoughtful reply. I assume by RF ablation you meant radio frequency ablation? My understanding of pulsed field ablation is that the risk of inadvertent burning of nearby tissues was much less. And yes, I am monitoring myself and hopeful that this issue will resolve and it is as you say, a bit of pericarditis. Interestingly, my heart rate has not increased at all post ablation.

Yes, PFA is much safer, even to the extent of obviating the need for a TEE (trans-esophageal echocardiogram, like an endoscope put down the esophagus). Even so, it is damaging tissue. Otherwise, the spurious signals that make the atrium fibrillate would still pass over the PFA'd tissue. It's the scarring, or fibrosis, that makes the signal stall...it can't get over that tissue like it can healthy endothelial tissue.

It's a good sign that your heart rate is near normal, but an HR nearly 90 would not be cause for concern, not in the early weeks after the procedure. An EP might want to consider an intervention if it were at or above 90 for more than a few months, but I am out of my depth on this. I just know from anecdotal reports that a significantly elevated HR is to be expected for many/most of us.