Erratic heart rate after ablation

Posted by janicemmccarthy @janicemmccarthy, Feb 20 7:19am

My husband had a hert ablation one week ago. Day of surgery they said it worked. Three days later his heart rate was up and down, all over the place. Is this normal? Will he need to repeat the surgery? Or does it take time? Thank you for any information.

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gloaming | @gloaming | Feb 20 2:45pm

His heart has been backhanded, and it ain't happy. Most initial ablations are successful, but 25%-ish are not. Those people need a touchup later. In this case, your hubby is only a whole week into a 10 week blanking period, as it is called. During that time, even more AF can show up for short periods. Waaaaaaaayyyy too early to be concerned at this point.

That aside, it is surprisingly common for a heart to turn to flutter for its entertainment when it can't fibrillate anymore. But flutter tends to be intractable and won't respond to flecainide or other remedial drugs, not even diltiazem. So, some EPs prescribe a prophylactic dose of both metoprolol and flecainide to keep the heart in rhythm while it heals the lesions created around the pulmonary vein ostia inside the atrium. Not all do.

The standard treatment for a heart that has resorted to flutter after an ablation is a simple cardioversion. This is done with a supervising internist or other ER physician, a nurse, and a respiratory therapist who monitors breathing while the patient is out and being paddled.

I know this is all worrisome, and it is mysterious, which begets more worry. But really, calm and rest are what he needs, and if the heart rate climbs to 135 and higher and doesn't want to come down, make a trip to the ER for a cardioversion. Also, make sure his EP knows what's gone on.