Two month update post Cryo ablation

I've now completed month 2 post Cryo ablation.   I must say that the recovery has been a lot worse than I expected.  The good news is that my EKG and 24 hour halter monitor at month 1 showed no signs of AFIB.  The bad news is that I've been experiencing very uncomfortable PAC's of a high intensity and duration (pretty much 24/7) along with a chronic cough that occurs every few minutes along with esophageal discomfort that has made my throat raw   I know it is still "early days" but I'm not feeling confident about having gone through this procedure as I feel worse than before    While my heart rate has mostly stayed below 100 when at rest, it generally is in the high 80's to mid 90's which is much higher than my usual rate of 72 and my heart feels like it is going to jump out of my chest  when experiencing PAC   

My EP has not been helpful at all. He told me the coughing would go away two weeks after the procedure   Now he says that it may just may take longer but offers no advise on treatment in the mean time   I think from his perspective as long as my heart rate is below 100 and not in AFIB, clinically I'm in NSR and clinically fine, despite the contractions. But, I've been feeling progressively worse each week with the PACs and cough getting worse rather than better   I know, that even healthy folks get PACs but they are typically silent, periodic and often not noticeable.  I'm feeling as bad as when I had AFIB, maybe worse, since the AFIB would subside eventually  while this is nonstop  

I also wonder whether my esophagus might have been  compromised during the procedure in a way that may have caused significant damage  my EP says about 20 percent get a cough with 90 percent resolved, but couldn't pinpoint a time frame  I did take Prilosec for five weeks post ablation was told to get off of it

I would like yoir thoughts whether I should just suck it up and wait this out until the three month point and see where I stand with my Recovery at that time  or go for a second opinion now  

Thanks much 

Jeff

11 Replies

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  • Hi. What's PAC. ?

    Phil

  • Premature atria contraction?

  • You don't say what drugs you are on.  PACs happen but it sounds like yours are out of control.

    Coughs are common and usually go away within a few months (mine did) so not sure what to advise.   You don't mention what exercise and diet you are taking as these can be key to any recovery - at least an hour of light exercise a day is essential.

  • I'm on Flecainide, Diltiazem and Pradaxa.  Actually, I exercise daily and that is the one thing that provides some relief or diversion.  I eat well and avoid alcohol and stimulants.  Doing what I can.....

  • Flecainide is prescribed post-ablation to prevent breakthrough arrhythmias.  Ask your EP if they present any threat to your heart muscle.  My guess is he will say no, but you might have to ask the question in a pointed way to get a direct answer.  Mine admitted that they did not present a threat, but he said that my heart had been under a lot of stress and I should make it as easy as possible for the poor thing.  Weasel words?  You bet.

    He said the same thing about diltiazem.  My pulse was 77 after the ablation a year ago - yes, that's 5 points over the population norm (but 17 points above my resting pulse).  Same weasel words.

    But he did a fantastic job on the ablation.

    Anyway, if you're on diltiazem with a pulse in the 90s, maybe it isn't doing the job for you.  Although flecainide and diltiazem increase each other's effects, my inclination would be to chuck the flecainide and see if there's another rate control drug that might work better.  Also, I strongly suggest doing your homework on various drugs - look especially for interactions, side effects, and other info.  Sources like drugs.com and rxlist.com are OK.  It's even better if you can find NIH reports that don't get into the mainstream.  Search on terms that include the drugs you're trying to learn about.

    Then talk to your EP again about flecainide dosage and why you've been prescribed the dose you're taking (at this point you've seen the study that shows 150mg/day won't prevent post-ablation arrhythmias - it showed that 200mg/day are needed).

    Also ask about specific rate control drugs that you've learned about and see what he thinks about them.

    If I had it to do over again, I would not have taken either flecainide or dilitiazem simply because I didn't need them.  My EP never mentioned flecainide as a PIP ("pill in the pocket").  Side effects were so bad I quit both drugs after 5 weeks and never noticed a single blip or unusual heart rate.

    As I preach (perhaps ad nauseam), ya gotta be your own doctor.

    Good luck!

  • Agree with Mike, my cough lasted about 6 months + and was really irritating, but it lessened and disappeared over time.  These are the things they don't tell you, but then not everyone gets them and for me it was a small price to pay for no AF.  Mine was due to TOE because my esophagus spasmed and it got stuck but I had RF ablation.  I understand there can also be a problem of esophagus from the cryo-ablation because it is so close to the area of burn but I doubt there will be lasting damage but if you are concerned you could ask for a scope?

    I did have just a few runs of tachycardia and ectopics and found gentle exercise, walking whilst still being able to talk, really helped them and helped build stamina.  If you are not already doing so, start gently and gradually build up your distance and intensity, just slow down or stop if you cannot walk and talk at the same time.

    Hope you feel better soon.

  • Thanks.  Good to hear that the cough will likely go away at some point, hopefully sooner rather than later.  I exercise daily and actually feel a bit better when I exercise as it provides a diversion from my discomfort. Hopefully PACs will subside over time

  • Hi Jeff. I had my cryo ablation nearly 12 months ago and have had a pretty slow recovery. I have to say that my AF episodes have stopped and I mustn't let myself forget that, but I have had a lot of digestive problems and a lot of PACs. I feel as if my heart has been reconfigurated with the AF suppressed but leaving me with a greater susceptibility to ectopics. Of course, that's a layman'sview and my EP is happy that with no recurrence of AF it is a job well done. Sounds similar to your experience. I think the main difference is in timing. It's a fact that your heart can take up to 12 months to recover after an ablation. Also it is a fact that the procedure can speed up your resting heart rate. The heart rate should come down and maybe the PACs will get a bit better. For this reason I think you might want to sit tight for at least your 3 month review or you risk being told to give it more time..I waited until approx 9 months to suggest all wasn't well with my recovery, which has felt like an age, but to ensure that the docs would take notice. I'm due another holter test soon to look at the PACs but not sure what can be done as they are generally considered benign. For me they are pretty non stop therefore a great intrusion, and I'm trying all sorts of things to see what I can do to help myself, with diet, exercise,and vitamin supplements. Relaxation is very important as I think anxiety is a big friend of ectopics. Easier said than done, of course! My cardiologist is concerned about my digestive problem and has suggested a gastroscopy to take a look in my stomach. Ablations have been known to cause both throat and stomach disturbance, although my symptoms are a bit different with no cough but definitely all not well down there. I think one problem is that the doctors don't tell you what to expect, in terms of potential side effects, but maybe they feel we wouldn't go in for the procedure if they spelt out a long list of things which "could" happen. All I can say is that you are not alone, and maybe give it a bit more time before assessing other options. Good luck

  • Thanks for the advise, will try to hang in there

  • Hi Jeff

    Sorry to hear you are struggling, you must be feeling really low and fed up.

    I am just over 4 weeks post ablation and I agree that it can be a bigger deal than first "sold"to me! However, I have been lucky as very settled heart still( fingers and toes tightly crossed,) but my back is the problem and tissues surrounding the heart area. At first so stiff and painful in bed and walking round so tiring with constant aching etc and sore diaghfram area. No real help from hospital other than " sit it out" so decided to contact my cranial osteopath. She explained how my body was still in trauma and holding on so tightly round the chest and. Heart area which is hardly surprising I felt! Had 3 sessions so far, one weekly for the moment, and I am really starting to feel a little less restricted and painful, although I am being cautious still. Have even managed some pottering in the greenhouse and garden ( very gently") but it has really helped me to feel more confident in the success the ablation may have with quality of life etc. I would highly recommend you get a bit of "hands on help" which is experienced and gentle. I don't know where to live, but I am happy to ask my osteopath who I know is good, (been seeing her 11 years now..) about a possibly good one in your area. Apparently no acupuncture though I was told! I did check with hospital before starting treatment.

    Think we all need a little extra help and support in recovery sometimes.

    Sorry for long reply

    Wish you well soon

    Sarah

  • Thanks for your thoughts.  Perhaps a "non-traditional" medical approach for some relief is worth a try until my symptoms hopefully subside over time. I think my wife has used a cranial osteopath before so I will discuss with her.  I live in California so you don't likely have any contacts here. But, you've given me some food for thoughts regarding another approach. 

    Thanks much

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