Atrial Tachycardia following Ablation for Atrial Fibrillation

[Nickr282]

I am 47 year old male in decent health (apart from this). In September of last year I went for an annual Blood Pressure test at my GPs. The nurse doing the test thought my heart rate was high and suggested I have an ECG. After having the ECG and visiting the hospital I was told I had persistent AF. At the time I didn't think that I had any of the classic symptoms but looking back now I know that the fatigue, tiredness, occasional dizzy spell etc weren't just down to being tired or having a stressful job.

Since then I have had numerous DC Cardioversions, a catheter ablation, tried natural remedies and taken the full gourmet of drugs including Amiodarone all in a bid to rid myself of this awful condition. When I started out I set myself a deadline of 1 year to be cured and be drug free - how naive was I!! How little did I know!!!

Anyway my ablation was in April of this year. A few days after the operation I was back in AF. This lasted for 6 weeks until I was cardioverted. I then stayed in NSR for 9 weeks or so and was beginning to think the op was a success when things suddenly changed again this weekend.....

I flew out to Denmark on Thu and come Fri morning I was back in AF with a pulse that ranged from 120 to 140bpm. It pretty much stayed like that all weekend (still managed to do some sightseeing lol).

After returning home on Sunday I managed to arrange to see my consultant at Harefield yesterday.

Turns out that I have developed Atrial Tachycardia as a result of the ablation. Consultant seems to think this is a good sign. I have been booked in for another ablation (waiting for date) and have been prescribed Flecainide to accompany the Bisoprolol that I'm already on in effort to control my heart rate whilst I continue to work etc.

My question is has anyone else developed AT following ablation and what was the outcome? Did it resolve itself? Was another ablation required? Did any of the drugs help control it and heart rate?

Thanks Nick

[BobD Volunteer]

I had three ablations for AF until 2008 when it finally went but have had to be cardioverted from atrial tachycardia three times since then. NO AF which is good but the A Tach can be a shock till you understand it all. I don't take any drugs for rate or rhythm control unless things go awry by the way. Most DCCVs done within a day or so of event starting but then I am properly anticoagulated all the time so no need to wait four weeks.

[Nickr282 in reply to BobD]

Thanks for the prompt reply Bob. ATach certainly does take some getting used to though apart from getting more breathless than usual it wasn't too bad for me just worrying when your rate hits 140 and doesn't go down.

My consultant didn't think DCCV was the way to go and suggested another ablation to tackle the ATach hot spot(s). The drugs I'm on do seem to have taken my pulse down so provided I'm not waiting too long for Op then I think that's fine.

[BobD Volunteer in reply to Nickr282]

DCCV is fine if it lasts. Mine averaged about four years each. My EP said one more event and he would do another ablation but best leave things alone if possible as it is NOT an easy fix. He is one of the original few London based EPs and I have been under him since 2005.

I agree that 140 is a pain. I once went into A tach as I was driving to Stansted to fly to see my sister in France. Spent a week almost OD ing on my pills until I could fly home. My Arrhythmia nurse had organised a DCCV for the week after I got back thanks to the wonder of e mail. As I said, I never stopped warfarin so no problems having to wait four weeks at a stable INR.

I was taking Propafanone which my EP prefers to Flecianide. Don't need a beta blocker with that. yippee!

[Nickr282]

Given that the longest period a DCCV has worked for me is 9 weeks then I would take the 4 years right now - that's not a bad return!

My EP wants to target my hot spot ASAP so with a bit of luck and fingers crossed it might just work.

Glad to hear you managed to get back from France ok and have a DCCV arranged and waiting.

The 140 was a pain but it didn't prevent me from site seeing around Copenhagen even though it was a struggle.

[mincde]

How is a-tach different from a-flutter?

[CDreamer in reply to mincde]

It is fast heart rate - Flutter is a regular, irregularity in one atria.

[pottypete1]

Morning Nick

I am now in virtually the same situation as you are.

I had AF for many years and have had ablations for both AF and for Atrial Flutter.

The last AF ablation I had was in March and a few weeks later I developed what has been diagnosed as Atrial Tachycardia and my heart rate is >115 resting.

As you have been told by your EP at Harefield my EP Consultant has told me that my condition is now much more treatable.

I have an ablation planned for a week from today.

It is good to hear a similar diagnosis and comments. Harefield is well respected and I also have confidence in and respect for my EP.

Pete

[Nickr282]

Morning Pete,

Yes very similar situations.

I think we are in good hands at Harefield. The team there have been brilliant.

My resting pulse is also high currently hovering around the 100 mark and I am just about managing to get through a full working day.

I understood from my EP that conversion of AF to one or more intermediate ATs is an important step in the maintenance of lasting sinus rhythm.

To quote a recent paper "Recurrence of AF is rarely seen after this conversion occurs, while it is the most common recurrent atrial arrhythmia when it does not. In other words, experiencing atrial tachycardia after an AF ablation is a good rather than a bad sign".

Good luck with the ablation. Please keep me updated with your progress.

Thanks

Nick

[pottypete1 in reply to Nickr282]

Hello Nick

One of the benefits of this forum is when you compare notes and the prognosis is positive.

My EP has given me hope at last after 26 years of AF.

I should have had this next ablation 6 weeks ago but it was cancelled due to an allergic reaction I had in the days leading up to the procedure. My EP expressed disappointment because he said that not only was he more confident this time but has also has some new mapping equipment that should help in stopping the Atrial Tachycardia.

I know all about disappointment from my past experiences but I am really hopeful this time.

Thanks for the information.

This time next week I should be away with the fairies on the table in the Cath Lab.

Pete

[Nickr282 in reply to pottypete1]

That's great Pete. Sounds really positive. I'm sure it will all work out for you.

I have to wait a bit longer for my operation and should get a date early next week. Hopeful it will be sooner rather than later.

26 years is a long time. Was your AF persistent and did you suffer with all the classic symptoms?

It's certainly a very frustrating illness to live with, a rollercoaster of emotions with little certainty of outcomes and hopes regularly dashed.

Please let me know how you get on.

[pottypete1 in reply to Nickr282]

Hello Nick

My AF was Paroxysmal Atrial Fibrillation. It occured any time between 2 days and 3 months in an unpredictable manner and lasted between 5 and 24 hours. Not knowing when the next bout was coming or when in it how long it might last was not good for the mind. Rollercoaster is the right word. Depression set in within a minute of going into AF each time despite my best efforts at positive thinking.

I have had probably 20 cardioversions, all of which worked and often gave me NSR for months.I have also had 5 AF ablations and 1 Atrial Flutter ablation. During one of the AF ablations they also did an Atrial Flutter ablation too so 2 for flutter really.

I was told that my heart was so scarred that the last ablation I had, which was in March would have to be my last. However, as my condition changed to Atrial Tachycardia as you are aware my EP has now said something along the lines of 'now we are getting somewhere' and has told me that it was good news.

I have now been at around 120bpm since the beginning of May and an ECG I had earlier today confirmed that I am still in Atrial Tachycardia.

Whilst exhausting being in Atrial Tachycardia I have found it easier to deal with than PAF as I am permenently at this rate.

I hope you get a date next week the waiting is often the worst.

Pete

[Nickr282 in reply to pottypete1]

That's terrible Pete, feel for you. It's an awful condition to live with and difficult for others who don't have it to comprehend. It can dominate your life. I like yourself have good days and bad.

My AF is of the persistent type. Don't know how long I've had it as didn't really suffer from any symptoms until I realised that feeling like crap wasn't normal!.

Good luck and stay positive.

[Ashburton51]

Hi Nick

I had a cryoablation at the beginning of May this year and developed atrial tachycardia the following day. A week later I had two cardioversions which didn't put me back into NSR. However I was put on amiodarone on three months and within three weeks it had put me back into NSR. The consultant has now said that I can stop this medication and hopefully my heart will now be used to a normal rhythm and will stay that way. Only time will tell.

Very best wishes in your recovery.

Gloria

[Nickr282 in reply to Ashburton51]

Thanks for sharing your experience Gloria. Great that you are back in NSR and won't need to take the medication any longer.

I have tried Amiodarone but didn't get on well with it. At present I am taking Flecainide and Bisoprolol. Early days but hope over the coming days that the tablets will start to work and reduce my heart rate.

Best of luck. Nick

[Tapanac]

Hello. I was on flecainide following cardioversion, not because the cardioversion didn't work because it did, but hospital error with wrong tablets. The flecainide was brilliant. It sorted me out and I even asked if it was necessary to have an ablation which "they" said it was. After the ablation I was still on the flecainide for nearly 3 months when I was told to stop it (??). I did and now fast irregular heartbeat, palpitations and ectopic bears returned.

So after all that in answer to your question flecainide is very good as an arrhythmia pill in my opinion. What I don't know is why many consultants want to stop it after an ablation other than to see if the ablation has worked? I haven't received a satisfactory answer from any medics.

Good luck and hope all goes well for you

Ps....when I had the fast irregular heartbeat before the ablation according to the hospital monitor it was in the range of 240-250 which was very frightening.

[Nickr282 in reply to Tapanac]

Sorry to hear you are having difficulties post cardioversion since stopping the Flecainide.

What have they advised as your next course of treatment? Another cardioversion, Flecainide, Ablation?

In respect of my own story after a while the AT I got as a result of ablation developed / worsened i/ mutated into fast AF. Anyway I had a second ablation about 11 weeks ago and so far all seems well and good (fingers crossed).

At the end of September I am due a review where they will start the process of reducing and then ultimately stopping my medication (Bisoprolol and Flecainide) to determine whether ablation has worked or not and to get me ‘drug free’ which is the best possible outcome.

Hope all goes well for you.