Heart Rate after Ablation

In my 70s and resting heart rate has always been mid-50s. Have taken Bisoprolol-HCTZ and Amlodipine for 20 years or so. Afib detected Oct. 2019 during yearly physical. Had 4 cardioversions between Oct. 2019 and May 2024. Each duration became shorter. Cardiologist recommended it was time for a catheter ablation. Had it done in June 2024. Went well except for the following incidents.

6/23/2024 @ 11:30 AM - Afib starts. BPM 108.
6/27/2024 @ 6:30 PM - Afib stops. BPM 85 and remains close to that until 7/17/2024.
7/17/2024 - Afib (aflutter?) episode at @ 9:15 PM. BPM 127. Subsided at 9:45 pm. BPM is now 66 and remains so.
Pulse eventually dropped back to mid-50s and remained there until 12/10/2024.
12/10/2024 @ 12:30 PM - Pulse began racing while laying in bed. Checked using Kardia Mobile device. BPM 81 and displayed ‘Normal Sinus Rhythm’. Checked again at 4:30 AM and 8:00 AM. BPM remains low 80s and displays ‘Normal Sinus Rhythm.
12/31/2024 - Pulse has remained between 88 - 91 with Normal Sinus Rhythm indicated. Cardiologist recommends monitoring it for now and saw no issues with Kardia EKG. Felt it was okay as long as below 100 and no Afib indicated.

My questions are:
Why would this have happened 6 months after the procedure?
Will it eventually revert back?
Does it indicate another issue?

Thanks for any information, theories, etc.

I don't believe that anyone, not even an expert, could/would/should answer your second question...when will it stop? You are quite apparently still paroxysmal, meaning your arrhythmia stops on its own before 7 days have passed while in continuous arrhythmia. That's a good place to be if you must have an arrhythmia. I'm speaking mostly about atrial fibrillation (AF) and I claim no enhanced knowledge or understanding of other arrhythmias (I believe there are 15).

Your devices show normal sinus rhythm, so you have what is called a 'tachyarrhythmia'. Still technically an arrhythmia because its an abnormal rhythm, but it's still sinus. Your heart has multiple quickly repeating beats on what we call a 'run'. Quite often tachycardia and premature atrial contractions (PACs, which fall under the general rubric of 'supra-ventricular tachycardias'). https://www.merckmanuals.com/professional/cardiovascular-disorders/specific-cardiac-arrhythmias/ectopic-supraventricular-arrhythmias), arise from catheter ablations. Even flutter happens to some patients treated for atrial fibrillation, and it's usually easily treated....comparatively.
https://my.clevelandclinic.org/health/diseases/22152-svt-supraventricular-tachycardia+/8*752
Catheter ablations have, across the average of electrophysiologists practicing everywhere, about a 75% chance of succeeding, meaning you go a full year with no treated arrythmia. If you have the same arrhythmia as before, and it is just now three months after the 'blanking' period, you are quite possibly an ablation failure, but your EP should be the one to say yay or nay. He/she will be the person analyzing your ECG, not me.

Lastly, the heart is continually looking to establish new focal points, or re-entrants, for the extra cells that are causing the dysrhythmia. So, maybe further catheterization is in your future...again, your EP will be the one to tell you.

If it's another issue, that has to be established via tests, formal ones. If it's the return of the same type of arrythmia, then I would think it's just a new growth of 'node cell's that are substantial enough to want to begin to send out their own clarion call for the hear to beat to their tune. Except that their tune is out of synch with the SA node and AV node.

This is disappointing, quite obviously. Happened to me with my first ablation...I was in hospital six days later with a runaway heart. I had to go on amiodarone for almost ten weeks, but a second ablation six months later did the trick for me. Second ablations have a somewhat higher probability of succeeding in nipping the extra voltage, about 85% across al EPs. The very best EPs do a bit better.

I hope that helps. Please do contact your care givers and experts and let them know what's going on. Also, HOW YOU FEEL is going to let them know you need relief...and soon, please.

There is a ton of useful information there to unpack and your knowledgeable reply is greatly appreciated. I was more concerned with my BPM returning to my normal. Could/should it happen at some point?

Yes, although some people take a year, even a bit longer, before they suddenly notice that their HR (heart rate) returns to their previous rate, or to something close to it. Some report HR as high as 90 for weeks after an ablation, some say they were going for hikes a day or two later and had no problems, and that their resting HR was normal. So, it depends on the person.

An HR less than 100 BPM is still considered to be 'normal', provided it is also above 50 BPM. In this case, as I understand it (I could be mistaken), as long as you are confirmed to be in NSR, even if you have an annoyingly high rate near 95, you're still good...technically. But, you have to live under your skin and with your heart, so if it's uncomfortable, you should probably get help, or at least consult someone who knows what's happening and who can assure you.

You are apparently not fibrillating. You have short runs of tachycardia which bears scrutiny, and that is why I urge you to see your EP. But you are well outside your blanking period, and you had only early (typical) short runs of AF while in the blanking period....which is excellent. It's when you begin to fibrillate near the 6 week mark and beyond that the literature I read suggests that the prognosis is not good for a 'successful' ablation. Your runs were all within the first couple of weeks or so, which the same article said bodes well/normal for a great many ablatees. In fact, the pamphlet given to me upon release was by an American heart surgeon who warned that it is perfectly normal to have some minor AF during the blanking period and to not sweat it. The other article I mentioned did warn that it seems that later arrhythmias, say six/seven weeks and later, do not bode well. Early bouts, good, later bouts, probably not good. And so, to address your last question above, quite possibly you have, or your heart has found, some other way to make your heart beat atypically.

So, to summarize, I would agree with your cardiologist because you ARE in NSR. No arrhythmia. Just some tachycardia, which, if it persists and becomes quite intrusive, might stand further investigation and perhaps a 'touchup' ablation. But that decision would come from the experts treating you.

In my time on fora dealing with ablation and what follows, about four years now, I usually see people report an elevated HR, often as high as 90. Those who respond tell them that they, too, had an elevated HR, but it returned to normal, or near normal, in as much as one full year. Some say it's just a few weeks, often by the end of the blanking period.

Your HR is technically in the bradycardia range (< 50). Your HR isn't that much lower, and is probably nothing to worry about. What may have changed is your Q-T interval, which should be determined and dealt with, but this is usually more to do with medication. Also, if you you are still on diltiazem or metoprolol, those are the most likely culprits, and you should seek an adjustment from the cardiologist. If you're taking 25-50 mg BID (bis in die, or twice daily), you might need to take only 12.5 twice, or none at all to see if you're stable and go off metoprolol permanently. Some cardiologists and electrophysiologists want their recently ablated patients to remain on flecainide or something else for a few weeks as well, but maybe you should not be on it...if you are. Again, consult your cardiologist.

I have to correct myself. I have gotten to the point where I take it that bradycardia = < 50 BPM, especially after I encountered a cardiologist who opined that the true demarcation point, 60 BPM, is too high in his opinion. My bad....I should have said that an HR of less than 60 BPM is officially 'bradycardia' in pretty much every site one could find by asking the question.

I do agree with the cardiologist because most in good condition with a fit heart will be in bradycardia while asleep. A great many of us have HR in the 45-55 range while fast asleep.

I have to correct myself. I have gotten to the point where I take it that bradycardia = < 50 BPM, especially after I encountered a cardiologist who opined that the true demarcation point, 60 BPM, is too high in his opinion. My bad....I should have said that an HR of less than 60 BPM is officially 'bradycardia' in pretty much every site one could find by asking the question.

I do agree with the cardiologist because most in good condition with a fit heart will be in bradycardia while asleep. A great many of us have HR in the 45-55 range while fast asleep.

My pulse has been 32 to 42 but doc says I have a strong heart. But have chest pain and shortness of breath company that monitors me wants me to go to er for an ekg. Not sure what to do myself. Bradycardia at its finest.