Resting HR increase after ablation, but why?

[splashrollandplod]

So I had AF 2019-21, ablation 6 months ago, AF gone (touch wood) RHR was 60 now 70.

I know this is expected but what causes it? I’ve been on Edoxaban blood thinners, rhythm control Flecainide and calcium channel blocker Verapamil since ablation - I was on none of these before ablation.

My understanding is that the meds should reduce HR but does that include RHR?

I am 66, was very fit (triathlons) and am reasonably fit now - I cycle and run-walk at low/medium intensity 3 or 4 times a week. I haven’t noticed the meds constraining my effort at all - I understand beta blockers have that effect?

As I increase exercise duration and intensity I hope my HR doesn’t get too high but fear it will and that might bring AF back.

If Cardiologist decided to reduce/phase out meds will my RHR increase/reduce?

Thoughts and science please!

[BobD Volunteer]

Raised heart rate is normal post ablation . Although my EP did warn me about this I'm not sure even he knows why. From memory it took around nine months to return to pre ablation levels. Please don't try and return to pre AF levels of exercise or you will likely see a return of the AF.

[splashrollandplod in reply to BobD]

Yes as I said I knew it was normal and that there isn’t an explanation why, just would like to understand why it happens and wondered if there are any theories. As to returning to exercise levels - I know a few who have and successfully so. Some have even returned within a few weeks. Recommendation was not to do anything more than light exercise for 3 months then wait for cardiology review. That got delayed and is planned for this month, so I I extended the light exercise period, increasing a little - as I regain fitness I have been able to increase duration and intensity and keep the same HR level (nothing like the level before, 40 bpm less). I’ll be talking to my cardiologist and a sports cardiologist about the possibility of returning to semi-competitive sport. I also watch for minor signs eg ectopics on my Kardia 6L - I was getting 5-10 per 30 second ecg in the first 6 weeks after ablation, after a 20 minute walk . Recently I have had single ectopics 3 times in 3 months from a total of over a hundred ecg’s. I am hoping I am on top of this and am ready to adjust lifestyle as needed.

[TracyAdmin Partner in reply to splashrollandplod]

You are absolutely correct in checking with your health care professionals for advice before attempting any new exercise regimes. AF is a very individual condition and affects many in various ways, just as everyone recovers from procedures differently. It is important to listen to your body and not push yourself too excessively.

[KMRobbo]

My resting HR is still higher than it was 4 years ago pre ablation . I am less fit now than then but it was raised straight after the ablation. I read that a raised resting HR post ablation was a good sign for ablation success. ( I have posted this study previously but if you can't find it I will look).Anyway it was for me no AFib since the ablation !

[splashrollandplod in reply to KMRobbo]

Yes I remember the post about it being a sign of success. But it would be good to understand it. Is it the trauma, is it a nervous system response …?

[KMRobbo]

No idea, but maybe some wisdom is contained in these three articles!

3 links to articles that appear to indicate raised HR is a good sign of success:-

link.springer.com/article/1...

researchgate.net/publicatio...

link.springer.com/article/1...

academic.oup.com/europace/a...

You may have to copy and paste to your browser

I suspect no-one really knows why, but good is good!

Cheers

[KMRobbo]

sorry links did not work - updated the post so they do now!

[splashrollandplod in reply to KMRobbo]

Thanks very much, I’ll get reading.

[blulla1]

I'm 65, a former triathlete, have had PAF almost 5 years. I've had to reduce exercise intensity over the years since I've had this to the point of keeping a very low intensity. Last summer, I got semi-fit at one point and picked up the pace pretty good on the bike on one ride. I am sure I should have backed off those last 15 minutes but didn't. Had a bit of irregular heart beats later that day and went into AF the following day. Of course, many years ago, overdoing it for an extra 15 minutes wouldn't have ended up in AF, just tired for a couple days, so in that case I would just go easy for 2-3 days. I'm sure you know the drill.

Long story short, I have my 1st ablation scheduled for early March. In the mean time, I've been trying Steve Carr's protocol. carrafibdietinfo.com/

He is now about 68. He's a runner whose AF began at 50 years old, so he quickly tried to get to the bottom of it by varying his diet in a very methodical, scientific way. 9 years later, he apparently succeeded, and he's been free of AF and ectopic beats for the last 8 or 9 years and he says he has been running at faster pace each year to the point where he now is running as fast as he did in his late 20s.

I do think his protocol works and so for you, who has had an ablation already, I think you would be able to get rid of those ectopic beats for the most part by following his protocol. This has been the case for me but I will go ahead with an ablation anyway because, currently I feel that I don't have a lot of room for error and I am tired of getting smacked upside the head with AF for a small indiscretion.

[splashrollandplod in reply to blulla1]

Thanks, an inspiring reply! I’ll look at that protocol. I have just about eliminated ectopics but haven’t been exercising intensely.

[Bennera513]

I read that during ablation (PVI specifically) that structures called Ganglionated Plexi (clusters of nerve cell receptor sites) are destroyed and or ablated along with the rogue/offending heart cells in the region. The autonomic nervous system has to compensate vagal tone between sympathetic and para-sympathetic and this push/pull is thrown into distress when those structures are modified. After the heart recovers from the acute inflammation of the procedure, these nervous system parameters and sensors must remodel to adjust to the new inputs and electrical distribution. You'd expect to have ectopics, maybe some arrhythmia, tachycardia, inappropriate heart rate responses, etc. My theory is an uptick in heart rate is correlated with success because it indicates more of the plexi were destroyed and thus, more heart tissue was affected which is exactly the intent of the ablation. An over generalization for sure as everyone would respond differently. No doubt though the nervous system must adapt. As for meds like beta blocker I think you'd definitely expect a further disruption if coming off. Your rate might be even higher. But I suspect not as high as if you hadn't been through an ablation. This was my experience. I came off beta blockers for the procedure and experienced rebound, including an uptick of 10-15 bpm in the short term. After the procedure I intended to stay off the meds but symptoms from a single afib episode and PAC ectopic storms pushed me back on them. After 2 months things settled and I did a quick wean and came off entirely (all meds). This time the rate didn't rebound as I'd learned to expect over 20 years of beta blocker therapy. Instead I noticed only a 5 bpm or so adjustment upwards. Luckily, the rate is starting to inch it's way down but my EP has warned that it will never reach pre-ablation levels, which were quite low, and yes,...was influenced by long time adrenergic blocking.

Just to put this in perspective for my personally,....my heart rate is easily up 15-30 points higher than before depending on what I'm doing. I wish I could say that makes me feel better but honestly it associates with feeling gassed much of the time. So, I govern my efforts and attempt to progress very slowly. Prior to ablation with beta blocker resting rate was low 50's....low 40's while sleeping. Immediately after on beta blocker (25mg Atenolol) resting rate was 90's morning, 80's afternoon, high 70's night. Now, 4 months later and off beta blocker it's high 80's morning, low 80's afternoon, low 70's night and a consistent low of 59 while sleeping. My heart rate is ultra responsive now....almost too much. And with exercise it sky rockets but seems contained. For example, with cycling,...I have to warm up much slower,....but no matter what I do it's headed to 120. With effort it goes to 140 and with a quick spring it's 155 easy. I don't push any harder. Wattage wise I can maintain 100-150 watts with spikes into the 300's, but that's about it unless I redline the heart rate. I did have a few inappropriate sinus tachycardia (140-166 while walking). EP was unconcerned. I have a 4 month followup in a couple weeks and can't wait to dig into this a bit further. Good news is things seem headed in the right direction and I appear to be able to do more on fewer bpm as time progresses. I limit myself to 1 hour rides/walks currently and no more than 30-45 minute strength training sessions at no more than 50% intensity/volume/load. Well enough about me, just wanted to give you another comparison point.

[splashrollandplod in reply to Bennera513]

Great stuff thanks! Plenty reading for me to do now.

[Rainfern in reply to Bennera513]

3 weeks post-ablation, this is a very helpful and interesting post, thank you. I had wondered what further “damage” beside the very necessary scarring, occurs with ablation. I’m aware on a subjective, symptomatic basis that the para and sympathetic nervous system are kind of confused and very jumpy! I’m normally well able to fine tune the balance with a bit of mental effort! Being a long term meditation/mindfulness practitioner, and also someone who used to experience anxiety to the point of panic attack, I’ve been wondering what the hell is going on! Thank you so much - of course we don’t know if your theory re HR is correct, but I shall be talking to my heart in a whole new way today - healing goes a whole lot wider than faulty wiring.

[Bennera513 in reply to Rainfern]

Congrats on the ablation. I am now 2 years further down the line. The first 6 months for me were a bit rougher than expected. The ablation was a glowing success and I have not experienced Afib since that lone episode 5 days post procedure. The prevalence of ectopics continued to morph across those two years, finally subsiding significantly to a point where I felt released from the anxiety, worry and concern that had spiked in the years leading up to ablation. So, I am keen to your comments about meditation and physiological symbiosis with our thoughts and psychological states. Though there still seems to be an invisible low HR threshold while asleep (59 bpm) my resting rate has settled a bit.....65-75 while sitting, 85 while toddling about, 105-130 with moderate cycling, and 135-150 with tempo training. My max is around 160 at 55 years old. Life is good! Good luck with your continued recovery.