Month 2 and 3 Ablation Recovery Diary

[thumpthump]

Hello all, greetings from lockdown.

I previously wrote a 1 month ablation recovery diary here: healthunlocked.com/afassoci...

For the benefit of those who’ve had an ablation or are considering it, this is my journey so far in recovery. It’s not representative of every recovery as experiences will vary I’m sure.

What I hope it gives is some insight into what could occur during your recovery, perhaps provide some reassurance if it’s happening to you right now.

I have no idea if my recovery can be considered ‘normal’, I hope perhaps those a bit further along with their recovery can confirm this?

It’s a long and detailed read and won’t be for everyone!

—Month 2–

25/02/20 - no remarkable symptoms.

26/02/20 - felt wiped out today, cancelled plans for day and just took it easy. Some mild occasional ectopic/palpitations. Sudden bout of hiccups in evening, lasted a few mins and got pain in right shoulder (I’m thinking perhaps still some phrenic nerve irritation)?

27/02/20 - Felt very tired again this morning, even though had fairly early night. Some mild occasional ectopic/palpitations.

28/02/20 - better energy levels today, but stronger more noticeable palpitations / flutter towards afternoon / evening.

29/02/20 - did gym session today, felt good. Also did 10 mins of racketball (HR peaked at 185bpm) felt ok. Some mild palpitations throughout day.

01/03/20 - occasional ectopic/palpitations / very light flutter, nothing major

02/03/20 - occasional ectopic/palpitations / very light flutter, nothing major. Very poor night sleep, didn’t get off until 3am. Not sure why, HR around 85bpm but noticeable ‘bomp’ in my chest.

03/03/20 - tired tired tired due to poor night sleep. No remarkable symptoms however. Walked the dog and forced myself to go to the gym. Did 2 short bursts of very intense cardio (too soon maybe but screw I went for it) got to 186bpm which quickly came down with rest both times. No AF symptoms at all just a good heart beat! Lucky day maybe?

04/03/20 - occasional ectopic/palpitations / very light flutter, nothing major.

05/03/20 - no episodes during day, some ectopic/palpitations /very light flutter in evening more intense when lying down on sofa.

06/03/20 - fairly noticeable and regular ectopic/palpitations started this morning. Did gym session - no issues. More small episodes later on in the day.

07/03/20 - did medium-intense training, got light Afib after for a short period which corrected. Some some ectopic/palpitations rest of day.

08/03/20 - woke up wiped out, struggled with energy levels during day. No other symptoms noticed.

09/03/20 - better energy today. No remarkable symptoms

10/03/20 - No remarkable symptoms. Went gym - all ok.

11/03/20 - No remarkable symptoms

12/03/20 - a few very light ectopic beats / flutter. Chest feels a little sore / light mild heartburn.

13/03/20 - very light ectopic beats / flutter and mild heartburn

14/03/20 - very light ectopic beats / flutter and mild heartburn

15/03/20 - very light ectopic beats / flutter (less than 5 instances)

16/03/20 - very light ectopic beats / flutter (less than 5 instances)

17/03/20 - Feel a little wiped out today. very light ectopic beats / flutter (less than 5 instances)

18/03/20 - very light ectopic beats / flutter (less than 5 instances). Went for a light jog round the park - got pain in my throat / thoracic / gullet area as a stride (feels a bit like dull pain) - could be still tenderness from op? Did gym class in evening - all ok, no episodes.

19/03/20 - low energy. Very light ectopic beats / flutter (less than 5 instances). Some mild heartburn / throat / gullet pain.

20/03/20 - low energy. very light ectopic beats / flutter (less than 5 instances). Some mild heartburn / throat / gullet pain.

21/03/20 - low energy - wiped out. very light ectopic beats / flutter (less than 5 instances) Some mild heartburn / throat / gullet pain.

22/03/20 - energy better today. No remarkable symptoms.

—Month 3–

23/03/20 - energy better today. light ectopic beats / flutter.

24/03/20 - light ectopic beats / flutter

25/03/20 - very light ectopic beats / flutter. Slight heartburn.

26/03/20 - no remarkable symptoms

27/03/20 - no remarkable symptoms

28/03/20 - strange quivering type palpitations today, not strong but feel a little uncomfortable, almost like indigestion.

30/03/20 - no remarkable symptoms. Did first HiiT training this evening, struggled did 18 mins and out 38m class. No heart issues and got back down to resting rate quickly.

31/03/20 - very light occasional ectopic beats / flutter < 5 times.

01/04/20 - very light occasional ectopic beats / flutter < 5 times.

02/04/20 - very light occasional ectopic beats / flutter

03/04/20 - quite a few light palpitations today, slight heartburn

04/04/20 - very light occasional ectopic beats / flutter. Did 30 mins workout - no problems.

05/04/20 - very light occasional ectopic beats / flutter, less than 5 episodes.

06/04/29 - some light palpitations today, slight heartburn

07/04/29 - some light palpitations today, slight heartburn

08/04/20 - some light palpitations today, slight heartburn

09/04/20 - no heartburn today, lots of light palpitations after eating white chocolate Toblerone.

10/04/20 - some light palpitations, noticed more when lying down

11/04/20 - light palpitations

12/04/20 - light palpitations

13/04/20 - major flutter / palpitations lasting about 5 seconds happened once today.

14/04/20 - 3 month post ablation today, and worst palpitations / flutter I’ve had for a long time started this morning since at desk Stopped by around midday. Typical!

15/04/20 - better day today, some light palpitations / flutter.

16/04/20 - some light palpitations and flutter today, slight heartburn. Did 30min+ workout, peak HR 160bpm, no major issues. Some light skips in recovery but only a few.

17/04/20 - some very light palpitations / flutter. Stopped post operation blood thinners today Rivaroxaban, (Xarelto). Consultant said I could stop at 3 month post op, not had any bouts of actual AF. Glad to be off them for now!

18/04/20 - very light occasional ectopic beats / flutter, less than 5 episodes.

19/04/20 - very light occasional ectopic beats / flutter, less than 5 episodes. Bad sinus / eye headache all day, went to bed. Withdrawal symptoms of blood thinners maybe?

20/04/20 - very light occasional ectopic beats / flutter, less than 5 episodes, cycle today and walk both ok.

21/04/20 - fair amount of light flutter / ectopic beats nearly all day, become l more noticeable in evening. Did a walk and a light jog earlier - no issues during exercise.

[BobD Volunteer]

Other than your exercise which to me is maybe a little too much too soon it all seems unremarkable. Plenty more recovering to do yet.

[thumpthump in reply to BobD]

Hi Bob thanks for your reply. Yes you are absolutely right I’ve pushed exercise too hard and too soon. Trying to prove to myself I’m well and the operation has worked, will be toning it down.

[bambi57 in reply to thumpthump]

I had my ablation on the 29th June 2016 I never did much for the first 6 months then I started out slowly with my exercises and I have been AF free since the operation it is best not to do any exercise for at least 6 months good luck

[thumpthump in reply to bambi57]

Thanks for the advice and glad to hear you are AF free 👍

[CDreamer]

Sounds good, I think this would be fairly typical and you are wise to tone down the exercise and not push yourself and that’s very hard when you are used to ‘pushing’ yourself. Only other comment would be about the Toblerone and your symptoms - far too much sugar in white chocolate and would suggest you switch to a bitter, dark chocolate - which is actually good for you and doesn’t cause me any symptoms whereas milk chocolate does.

I think you have given a good example of how we expect to be well and energetic after a few weeks and get back to how we used to feel and maybe some do but for the majority I have heard from the reality is full recovery takes a lot, lot longer.

Stay well.

[thumpthump in reply to CDreamer]

Thanks for your thoughts! I happen to love dark chocolate so no major compromise from me Yes, I was convinced I was that person who thought all would be fixed after a couple of weeks, the reality is a little different!

[CDreamer in reply to thumpthump]

Been there........

[Morzine]

Yes don’t push excersise it sometimes comes back and bites you with tiredness.

Continue to be well

Sue

[thumpthump in reply to Morzine]

Thank you ☺️

[Jajarunner]

Very interesting, thank you. I disagree with the no exercise idea that others have suggested (well, I would do as a cardiac rehab instructor, wouldn't I?!). I would say exercise is fine once you feel up to it.

Perhaps something like: Start with walking (one month?) then simple aerobic stuff like cycling and rowing. I think I would wait three months before jogging. No hard, eyeballs out stuff for at least six months.

Please be advised this is my opinion only as my cardiac rehab course didn't cover Afib at all ,(unbelievable, I know). This is my plan I hope to follow after my planned ablation.

Just for reference after a heart attack you are allowed to work up to 80 percent of your maximum if all is well. 80 percent is " hard" or up to 15 on the Borg RPE scale (that's the 6-20 scale, not the 1-10 scale obviously 😆😆😆). Check with your rehab team first, of course.

Hope this helps someone. Good luck and keep safe.

[thumpthump in reply to Jajarunner]

Interesting thanks for sharing 👍

[Morzine in reply to Jajarunner]

I think though a lot of us are still kept in tablets after ablation....some for a bit ......for instance bisoprolol is popular and that slows the pulse down......so my question there is if bisoprolol slows the heart rate down ,isn’t aerobic excersuse goung against it?

It’s a question that I’d like someone to answer if they can??

[Jajarunner in reply to Morzine]

Well, aerobic exercise will raise the pulse, but betablockers will not let it go too high to avoid issues with Afib. Exercise is still advised for all its myriad other benefits and because it strengthens the heart muscle making it more able to cope with Afib when it happens.

You usually are given a heart rate zone (range,) in cardiac rehab or you can still use the Borg scale. If you are not used to exercise keep it light to moderately hard and start with 5-10 minutes to begin with. You will find the betablockers mean you are breathless at any easier pace than without them. By breathlessness I mean speaking in short sentences, not constant chatter (bit easy ) nor gasping.(too hard).

People who are used to exercise notice that after five or 10 mins they feel less breathless and like to start with a long gentle warmup before they increase to a jog and the a run. Apparently some of the discomfort you feel on betablockers is not affecting your performance rather your perception of it. Don't ask me why!!!!!

Obviously check with your Electrocardiologist or GP first, but they are usually delighted if people want to do stuff to keep fit...

Remember start gentle, walk before you run figuratively and literally!!

Hope that all made sense. Keep safe everyone

[johnMiosh]

I am guessing that you, like myself were pretty active prior to the AF. I did a lot of research about returning to exercise after ablation and the evidence was contradictory. Many cardiologists seemed to suggest getting back to normal after a couple of weeks, (I suspect they found it difficult to imagine an athlete's "normal"). Here is what I did.

I live in the Peak district and rode very hilly rides averaging around 16.5 mph over several thousand miles per year. Prior to AF, my Resting HR was 57 and my ramp-tested max was 185. After my ablation, I started to ride flat trails, keeping my HR below 130 for four months. I then allowed it to go up to 140 for another couple of months. After seven months I came off all medications and was advised that I could exercise without restriction; although my resting HR had risen to 90 without the bisoprolol. I continued riding the trails, keeping my HR to 165 on cardiologists advice.

After a year, I returned to the roads, starting relatively flat and still keeping to 165 max HR; I was averaging around 14mph. Over the following year, I gradually introduced more hills, but kept the same HR and average speed.

It is now three years since the ablation, my resting HR is back to below 60, and AF and its associated medications are a distant memory. The cardiologist has advised me that I can exercise how I like, but his own view is that a HR above 150 is not necessary to maintain health and may be counter-productive (for anybody, not just AF patients). I am back out riding in the peak district, on the same mileage as previously, but at a speed of 15.5 mph. I am going out on rides with friends, but at social rather than fast pace. Overall I am very pleased with my progress. My HR limit is still a self-imposed 165

I cannot be sure whether a faster return to exercise or continuing to push myself to previous levels would have caused me to relapse. Similarly those whose ablations failed early after exercise may also have had failed ablations if they had remained rested. The one thing I based my recovery plan on was that i knew the cause of my AF to be excessive exercise at high intensity, so I have avoided repeating my earlier life. Hopefully, I will be on track to continue to exercise healthily for many years.

[thumpthump in reply to johnMiosh]

Hi thanks for sharing, great to hear about your recovery. Yes prior to my ablation I was very active and doing a fair amount of endurance level cardio. I think my mistake was initially not waiting long enough, so the plan going forward is to be more progressive with exercise.

[Heart1234Wisconsin]

After my ablation I had a couple little episodes that didn’t last long. I noticed that my heart rate was pretty sensitive to exercise. With minimal exertion, walking up a slight hill, etc. my heart rate could hit 190. Given that I’m 70 and my targeted Maximum heart rate was 180 or so, I decided to keep it under 160 or so for awhile. I felt like I could go higher, but I felt that going a bit longer would work for me. After a few months, I felt like I was back to ‘normal’, whatever that means.

[thumpthump in reply to Heart1234Wisconsin]

Thanks, I hope you continue to be well

[Ecki]

Hi, I had my ablation a few days after you, on 25th January 2020. I've been told that I will need to stay on anticoagulants (rivaroxaban) for life. Is this unusual? I had a phone appointment with my EP last week and he also wants me to stay on bisoprolol (2.5 mg) and will review in 4 months. I've only had a few runs of AF, lasting seconds, and feel fairly well, resting HR is mid 50s, walking 2 to 3 miles each day. Is it usual to stay on the same drugs after ablation?

[thumpthump in reply to Ecki]

Hi, I think everyone’s ongoing treatment is different and depends on many factors. I was in the very early stages of AF before my ablation (< 1 year) and only needed to take medication on 1 occasion to control an episode. I have no other heart conditions, am 38 and in excellent health. My EP advised I could stop anticoagulants after 3 months, however probably would have been equally happy for me to stay on them. It’s more of a personal choice for me right now.

[David1958]

When I had my ablation back in February 2011 (52 years of age), I was already on Flecinide and Metoprolol. The Flecinide slowed my heart down so much my wife would wake up in the middle of the night to check that I was still breathing. I also would notice that when I exercised, I could feel my heart beating like mad, yet the heart monitor would just sit there for 3 to 5 seconds before it would rise. The Flecinide made me feel like a rundown toy. I took myself off of Flecinide because of this. I eventually weened myself off of Metoprolol too. The only thing I take now is Enteric Aspirin 80mg. My progress was interrupted by prostate cancer and surgery. That extended the recovery period. I do HIT on a stationary bike and in the lap lanes of the pool when those are available. The highest I like my HR to go is 150, but usually it goes to 145. My resting heart rate is 57.

[thumpthump in reply to David1958]

Hi David thanks for sharing and my best wishes for your ongoing health.