Sternum and upper stomach pain after PFA

I am very sorry to learn of your deteriorated condition when everything seemed to be optimistic and positive for a good outcome going into the ablation. I'm sure, as you are, that you have a change that your body doesn't like one bit.

I don't know how much reading and learning you have done in preparation for managing your arrhythmia leading up to the ablation, and if you are comfortable with what AF is and how it can progress and affect your heart. But more-so, ablations are not foolproof and do have a risk of damage to adjacent materials. The dangers of all forms of energy delivered to parts of the heart come from inadvertent energizing of the nearby phrenic nerve, the esophagus, and even of the Vagus nerve. PFA delivery is supposed to be safer for the phrenic nerve and the esophagus, but it comes at the expense of more exposure to fluoroscopy than the radio frequency and cryo methods require typically. So, I don't know that I would expect, or decide, that you MUST have some damage to those components. Instead, my suspicion, as an uneducated bystander who has read widely on AF and its treatment, is that your head was held well back, out of the way, and maybe even so that they could insert a TEE (trans-esophageal echocardiogram) which is commonly used for cardiac procedures to help see where the implements are at any one time, but also to keep the RF energy and PF energy tips, those little probes, well away from the problem spots you DO NOT want burned or scarred....like the esophagus and phrenic nerve. The TEE probe, all by itself, can leave you with discomfort, generally in the throat, but I wonder if its withdrawal, or even its insertion, meant they had to hold your head tilted well back, down, over the edge of the operating table, to get it past all the narrow spots. And that left minor tears in ligaments or other damaged tissue that is now objecting strenuously to its treatment.

I do recommend that you insist on an audience with your cardiologist or with the EP, and get some support for pain management. You may also still be anxious. You feel you're by no means out of the woods, and you are left doubting, wondering if anything is wrong..................? Maybe, especially if you're not sleeping well, you might need a little nudge to get off that high shelf of worry and pain. It's not unknown in medical circles to offer temporary relief to get you over a psychological and pain-filled hump, and that comes from analgesics and maybe some Ativan or whatever. I'm not talking six weeks, either. More like six days.

Above everything......let yourself and your operating team off the hook. They did their job, and your recent reports show you have no more obvious runs of AF. So, that's a huge bonus. Now, you have to figure out how to live with some change in you, probably not going to last more than a few more weeks, how to calm yourself, and if you need a little 'help' for a week.....for gawd's sake.....USE IT!

Thank you so much for the insight. When I first got diagnosed in December I was in the ER 4 times and the hospital for a few days, and haven’t slept well since. I have been on Ativan nightly for 3 months. I’m just concerned and confused as to what is causing the symptoms I have and need to ask my EP for the proper testing to see if it is heart or procedure related before I move on to a gastroenterologist. I read that I should be asking for a sniff test and a chest x ray at the least to see if there is vagal or other nerve damage, or my diaphragm was affected etc. it’s so hard to know what to even ask so I will just tell him how I feel and hope he can help. I was very healthy, exercising daily, working full time and that’s all gone. I don’t feel well physically and the ablation is healing so I need to know now what is causing me to feel this way. I also know that my HR report showed I was in bradycardia 53% of the 2 weeks because of the Diltaizem so I’m sure that’s partly why. It’s been the hardest thing I’ve ever been through because I feel as though there is no real support from the doctors and no one to ask all of these questions to. I’ve been forced to use AI for many things as it’s been scary. Thanks for taking the time to respond.

@ltb7 Ah, with that added shared information, thanks, you could be thinking correctly all along. The calcium channel blocker might be putting you into bradycardia, although the technically accepted upper limit for bradycardia is a pretty hefty 59 BPM. Most adults in good health, heart working well, reasonably fit for their age, will have a resting/sleeping HR well below that, 45-53 BPM. Technically in bradycardia, but try telling your heart that!

If you can, tell your EP directly that you don't want to take the diltiazem as you suspect it is counterproductive at this point. He may agree, but he may emphatically disagree....which puts you in a bind. Whatever the case, you have lost nothing by inquiring first, maybe getting him to take you seriously for once, and if you simply cannot go against his prescription, continue to take it as prescribed. After all, ya hafta work with the guy...for a while anyway. Hopefully....only a while longer. 😀

@ltb7
Hi- I can relate to some of what you’re experiencing. I had very minor afib episodes for several years. I was always super fatigued and lightheaded with it but it would resolve within hours. I was very active tho older than you and retired since an episode of many PEs and an infarct of my RLL 3years ago. Worked hard to recover from that. Then in December I had afib for 11 days w severe shortness of breath, presyncopal, weakness, wicked indigestion and couldn’t eat much at one time due to nausea- nonfunctional with activity. Comfortable only if I sat with my feet up. A shocking change in functional level. Hospitalized a couple of times. Cardioversion helped but afib recurred with all the symptoms if hr went over 115 which it did if I walked across the house.ugh.
In NSR since an ablation but I still notice that mid sternum sense of pressure and discomfort along with a real intolerance to activity- B/P v low, 80s/50s, hr goes up, feel SOB etc. I’m not on any meds other than Eliquis, a statin & those for preexisting (and worsened) GERD and midodrine which has helped keep B/P at a safe level. I am improving over time. Takes longer to get depleted and I recover more quickly but if I’d still been working, I never could have kept a job. I do see occasional folks on line saying that their ablation recovery took months. So even tho some people are up and running in a week or so not everyone is. Not us. I have a wonderful pcp who’s been v methodical checking every possible issue but it all seems to be a v slow recovery at this point.
Hopefully you will find improvement over time and a more supportive care team. It doesn’t seem reasonable for them to be as dismissive as they sound from your description. Hugs

@babheart sorry to hear you are having a hard time too. After hours of reading about how I feel, I think it may be some type of PCIS and inflammation issue. I go this week and will tell my EP my symptoms and hope he listens and orders the proper testing. My PCP is retiring in 2 months and has not been there as much as I need her. Hoping I get some answers and can get back to feeling between. Hope you do as well.