Three months post final procedure in hybrid ablation

[johnMiosh]

i had the mini-maze in April and completed with an RF catheter ablation in early October.

I did not have an official review three months after the second procedure as the Cardiologist did not think it was necessary after my six week review; he was very happy with my progress. My next visit is in April, which will unfortunately include a TOE to check the Atriclip.

Overall, I am much improved on how I was two years ago, and am far better than I ever expected or even hoped for. I didn’t actually feel any better after the second one than before it, but the EP had severed re-connections on two of the pulmonary veins and dealt with Atrial Flutter so there must have been a further improvement.

The biggest bonus is no longer being on the drugs; no need to take Anticoagulants because of the Atriclip and no need for the bisoprolol as the AF is no longer present

I have tried alcohol; no effect from one or two units, but got a little carried away on New Year’s Eve and regretted it.

My current resting HR is around 90BPM, compared with 57BPM before I went into persistent AF. I am not sure how much of this is due to inflammation and how much is a drop in fitness level.

I am still struggling for fitness; I am not pushing too hard on the bike, but I am still slow and walking is more of an effort than it should be. I will continue light exercise and see in April what the views of the cardiologist are on my steadily increasing my efforts.

[Hidden]

John

Your story is fascinating. Hats off to Sheffield and to you.

3 months post ablation, second stage of intervention, in an athlete like yourself who has been given such a good prognosis.......and walking is more of an effort than it should be?

That is surprising. Resting heart rate 90 sounds high for such a fit man, even though ablation generally resets the resting heart rate higher in vagal afibbers particularly. Does your new resting heart rate suggest that your exercise related rate is much higher than previously, making your usual regime more challenging. I wonder if a tiny dose of say propranolol might help. Then again, RHR post ablation can take 6+ months to settle to it's new level I believe.

tachp may have a view on that.

Your EP will not want his star man compromising his trial results,

Ring his secretary, he will ring you back or see you next week in clinic, if you tell him exactly how things are and that you are a little disappointed about your exercise capacity even if your arm of the trial does seem to have had a remarkable effect on your AF.

This is not what he will have been expecting I suspect.

[johnMiosh in reply to Hidden]

I am not back to fitness, but these things are relative. The cardio said "No interval training, but normal exercise is fine". Normal for me would generally be seen as excessive. So I have stuck with the fat tyred bike and flat canal paths. Using a HR monitor, I have kept to 155 max, which was previously below my aerobic threshold. I can do 30 miles in just over 2 hours, averaging 13 mph. My average times are half a mph slower than at the same stage after the first ablation, but that was summer and the weather has been horrific here recently.

Just before Xmas, we had a meeting in Manchester. We all stopped in a (cheaper) hotel a mile across town and walked to the venue in the morning. I was carrying a laptop etc. and my overnight bag. I found this more taxing than some of my colleagues, who are less fit than my normal self and had spent the night drinking. I think this is through lack of practice; I cycled rather than walked to regain fitness from the second week of my recovery. I don't see a problem; it is improving slowly.

My resting HR was a steady 57 before my AF started (45 in the eighties). Being a sad scientist, I have produced a graph of most of my health data, and you can easily see the changes over time from normal (57) beta blockers (48) post op (78) post op 2 (85) six weeks later with no beta blocker (95) and now slowly reducing.

I am not concerned by any of this and it seems to be a good outcome.

[Hidden in reply to johnMiosh]

Ouch.

I obviously misinterpreted your comments about struggling for fitness and walking being harder work than usual.

I note you describe your current regime as "light exercise" (first post).

If you do get back to serious club levels, your fellow AFib cyclists will be queuing at your EP's door.

I think you might be pushing your luck in the long term. But then what do I know, I'm neither an EP nor scientist, just an ex cyclist with substrate mediated near persistent AF after a double ablation procedure at St George's. And a long acquaintance with Rahere and his acolytes at West Smithfield.

On reflection, I can see your OP was merely to inform, not seek an opinion. And thank you for that, yours is an intriguing ongoing story. giving hope to all frustrated athlete AFers.

[johnMiosh in reply to Hidden]

Sorry if I offended, Badger. It was not meant that way.

I live in the peak district and my typical rides used to be around 30 to 40 miles with 3500 ft of climbing averaging 16 mph.

I am under no illusions. I dont expect to ever race/TT again or even achieve anywhere near the climbing speeds of a few years ago. My plans are to slowly get back to a reasonable fitness, join the slow club group (15mph for 2 hours around the flatter areas) and possibly get in a few training sessions in the velodrome.

The cardiologist is over optimistic, talking about only a 20% chance of recurrence over 20 years, based on the cox maze results. I do not believe those figures.

[Hidden]

Hi johnMiosh. glad you're doing well after your surgery and hope you will feel even better as time passes. It's great you are able to be off drugs. I am also off cardiac drugs since having an ablation and pacemaker insertion in Nov 2016. All is well. The only drug I am still on is coumadin BUT! this coming Monday-Jan15th I am scheduled for a Watchman procedure so I can wean off anticoagulants. It's a little scary but getting off coumadin ( or any AC's) is a great motivator. I have been doing my own weekly INR testing which has never been a problem. But AC's can be harsh drugs and I will be glad to be done with them. You're right about the TOE's (TEE here in the US.) Not fun! irina1975

[johnMiosh in reply to Hidden]

I had an endoscopy a few years ago due to a a gaul bladder problem, I opted for the local anaesthetic only. It was unpleasant but OK at first; unfortunately, the anaesthetic wore off before they had finished. So next time I think I may ask for the sedative as well.

[Hidden in reply to johnMiosh]

Good idea Over here even if a procedure is done under local, there is anesthesia 'standby' and they usually sedate you pretty well even with local. Also, not up on all the current anesthesia drugs but something they use seems to cause me to'forget' what was going on even if not completely out. Makes post op memories very comfortable.Maybe you could ask 'not to remember.

[fluttered]

John

A higher resting heart rate after an ablation is fairly normal. Some studies indicate that this may be a good sign. My resting heart rate is higher also after my ablation.

Dick