The blanking period after ablation

[UK_5010]

I didn't think it was possible to hate AF more than I did before the ablation. Constantly waking up in the middle of the night and not being able to get a decent night's sleep. It wasn't always like this but it has been getting worse - probably 5-6 times a week. And then an ablation is offered - light at the end of the tunnel and, hopefully, getting my QOL back.

But, after a few days of relative quiet after the cryo-ablation which seemed routine - in AF before and out during the procedure - then on the 4th day (Sunday) loads of ectopics, bigeminy heartbeats, some bradycardia and a few tachycardia episodes. Attempts to sleep were impossible so a midnight trip to A & E. Monitored and given more bisoprolol (I thought the idea was to try and reduce you meds?). Increased levels of triponin but with aspirin and clopidogrel some reduction and eventually settles sometime Monday morning and sent home after seeing the cardiologist and advised to increase Bisoprolol to 2.5mg in the morning and 1.25mg at night. Tuesday night repeat but more tachycardia at 150 so 111 and another ambulance to A & E. More aspirin and clopidogrel and a further reduction in triponin levels and more bisoprolol to eventually return to NSR. Sent home again and advised it's probably the blanking period. Be patient. And here I am again on Thursday evening trying to sleep and, on lying down, back to 150 bpm. I will take more bisoprolol as advised and see where I am in a couple of hours and, if still at 150bpm, probably head for A & E again. So I find I can hate AF even more!

Seriously though, this is my first ( and hopefully only ) ablation - is this normal or, at least, not too unusual or have I gone from PAF into something even worse?

Stoke said they would leave me in the very capable hands of the local A & E department but will follow up on Monday afternoon when I am scheduled to go back to work. I used to be in NSR probably 80% of the time before the ablation but now, with the ectopics, bigeminy heartbeats, bradycardia, fast and irregular heartbeats, it's probably dropped to 20%.

Sorry for the amount of detail but your experience of the blanking period would help provide some background to how it is supposed to go and whether I'm just unlucky or have to just try and work through it. Many thanks.

[Singwell]

I had a very rough 3 weeks post ablation #1. In fact, like you, it felt worse than before. I recall crying to my nurse on the phone about it. I was in highly symptomatic AF on and off for about 8 days. Episodes got shorter after that, sometimes self terminating. After 3 weeks it settled down. We knew that this procedure wasn't successful from the start due to problems. Nevertheless after those 3 weeks I settled into bimonthly Episodes (my former pattern as it happens) but they were noticeably milder and short lived. I felt so much better after 6 months generally I almost turned down the offer of a 2nd chance. So yes, there should be light at the end of that tunnel. Am now 11 weeks into my own blanking period.

Highly unlikely you'll be ready to work next week. Book yourself out for another and rest up. For some of us it takes time and you want to give yourself the best chance of healing.

[UK_5010 in reply to Singwell]

Thanks Singwell. That gives me some hope. We are trying Sotalol at the moment and that seems to be working better than the Bisoprolol. If a 2nd ablation is required I don’t think I’d hesitate. Best wishes for your recovery too.

[Thomas29]

It’s not clear in your post if you were told to stop all meds after ablation. I had an ablation 2 weeks ago at Blackpool… was told to take full meds for 3 months, then a review. It is normal to have some irregularities in the first few weeks but you should be on previous medication I would have thought . When you have an episode you could increase your meds rather than go to hospital every time… very stressful for you.

[UK_5010 in reply to Thomas29]

Tried increasing bisoprolol to 8.75mg in 24 hours with no effect but local consultant trying Sotalol now. Seems better so far but will see how sleep goes tonight under their supervision.

[Ppiman]

I can only add that a week after my ablation for atrial flutter, in 2019, I was told to stop all tablets and within days I had my first major attack of afib. That was quickly controlled with bisoprolol, thankfully, but meant that I was then put back on rivaroxaban for life. Since then, I've had wide QRS, left branch bundle block, lots of ectopic beats, long runs of them at times, in fact, and continue with occasional AF but with lower heart rate than before (85-130bpm).

From what I've read, your experience would be considered as a normal part of the "blanking period" as the scars form in the atrium around the pulmonary veins. This can take 3 or ore months, I gather. Is there a reason you've been given a different anticoagulant? I thought apixaban or rivaroxaban were the standard in the UK?

Steve

[UK_5010 in reply to Ppiman]

Was still on Apixaban but the others were administered by A & E in case it was a cardiac event. Hopefully you’re right & am trying Sotalol which, so far, seems better than Bisoprolol. Normal sounds good & hopefully things will improve.

[BobD Volunteer]

Have you read and understood the fact sheet on recovery? heartrhythmalliance.org/res....

It is obvious that you should not go back to work next week of course. We often explain to people that recovery can be very fluid so they need to have meaningful conversations with employers before the event to explain the situation. Just because you haven't had open heart surgery doesn't mean that your heart is going to be happy with what it has suffered.

Many people are still improving nine months or a year down the line so be patient and love your self.

[Achant1 in reply to BobD]

I’m a year past my second ablation having pvcs and odd bumps here and there but I’m off flecainide and taking beta blockers only, the pvcs are dying down and I can feel the scarring blocking the Af now. It’s a long haul, be patient and take care of yourself 👌🏻

[UK_5010 in reply to Achant1]

Thanks for your support & hope your recovery continues to go well. Sotalol has replaced the Bisoprolol so fingers crossed that helps.

[Achant1 in reply to UK_5010]

Last night I had a run of pvcs and pacs on and off for about five minutes then nothing, I’ve got an echo soon, hopefully all will be ok. I think it took over a year before my first ablation really worked, it’s a long haul for some of us, before my first ablation my Af was up to nearly 300 bpm, so even when they fail I think they still offer some protection, please take it easy on yourself.

[UK_5010 in reply to Achant1]

Wow, my worst is about 175bmp. Point taken although I've spent 5 of the last 8 days in Burton's hospital, 4 visits so far! They've prescribed an increasing dose of Sotalol instead of Bisoprolol. Not sure I fancy visiting hospital every other day for the next year! The ectopics are a real pain when it comes to trying to sleep but at least I've avoided the fast AF for a couple of days. Hopefully that will continue. Also have an echo on Thursday but the Burton cardio says that will show nothing useful - will still try and get there though. It has been suggested there have been more patients with heart issues - not sure if that may be a consequence of Covid - certainly mine seems to have got worse since my Nov 2020 brush with it. Thanks for the advice - the hospital did sign e off until the end of next week so will take it steady.

[pottypete1]

You do have to give it time. However sometimes a second ablation is necessary.

Try to keep calm and avoid stress if you can.

It always took a while for my heart to settle down after an ablation.

I am very much an exception to the rule but even in my case my heart calmed down after my last ablation.

The main aim isn’t necessarily to take you completely off meds and I still take Flecainide each day but it is worth it and not really a problem as I see it.

Hope all goes well for you.

Pete

[Achant1 in reply to pottypete1]

My first ablation failed two years ago, when my Af came back it hit 180 and not nearly 300, as you say it’s all about quality of life, I’m a slow healer and it’s nearly a year since my last ablation but it has eliminated Af runs for now, just got bloody pvcs to deal with now 🤯

[pottypete1 in reply to Achant1]

I had 7 ablations. After the last one in 2017 it took 18 months before the ectopics stopped.

I am now pretty well free of both AF & ectopics.

So the mantra is give it time.

Pete

[Achant1 in reply to pottypete1]

Were your ectopics pvcs or pacs?

[pottypete1 in reply to Achant1]

Not sure but probably PACs as all my troubles have been atrium related. I know that whilst having ablations I have often gone into AF following an ectopic.

My problem now is Bradycardia but apart from little physical energy it is not too bad to deal with. They want me to have a pacemaker but I have resisted it because I have serious Urticaria whenever anything is stuck to my skin such as a cardoversion pad.

They are trying to assemble all the components of a pacemaker to enable them to carry out patch testing on my skin.

Pete

[UK_5010 in reply to pottypete1]

Glad to hear you’re now sorted. Hope to go back to long walks again so it sounds like it isn’t an impossible dream. Many thanks.

[UK_5010 in reply to Achant1]

Wow that’s not good! They don’t mention it could that problematic. Glad it’s better for you this time.

[Achant1 in reply to UK_5010]

I was being positive, sorry for the mix up, even though the first failed it was three years later and when the Af came back it was nowhere near as fast 👌🏻 It takes a while to heal and you’ll have all sorts of funny bumps and runs.

[UK_5010 in reply to Achant1]

No problem. I agree pvcs can be almost as disrupting as af. Sotalol seems to be working better than Bisoprolol so far so I’m feeling more positive plus all the helpful experiences of others have provided reassurance too. The road may a bit longer than I’d hoped but should get me where I want to go.🙂

[UK_5010 in reply to pottypete1]

Thanks Pete. I guess patience is the name of the game but I wasn’t expecting quite such a reaction. Sotalol has replaced Bisoprolol & seems a bit better so fingers crossed. Thanks for your advice.

[Hidden]

I had a rough time after my first ablation and I can remember being very upset that it seemed to make things worse with different irregularities and AF. Immediately after the procedure, the EP did say that I would need another go as they couldn't get all the 'bits' so you can imagine how disappointed I felt. Roll forward 3 months and things started to improve, fewer ectopics, shorter bouts of AF until what bouts I had were no longer a problem, few and far between, something I could tolerate without impacting much on my life. 10 years later I had to have a second ablation. I really hope your symptoms improve so hang on in there, give it time.

[Singwell in reply to Hidden]

Sounds very similar to my experience. I was conflicted about having a 2nd go a year later as QOL had improved so much. However, glad I did because they found the work had held in only 1 of the 4 pulmonary veins. Onwards!

[UK_5010 in reply to Hidden]

Thanks for your support. It’s useful to know other peoples experiences as I’ve none of my own to fall back on & to understand the process I need to go through and be patient. I’ll bear in mind a second ablation but hope one will do the trick. I’m glad your QOL improved.

[Snowgirl65]

My first (cryo), and rather botched, ablation, left me with more a-fib episodes than before the procedure. A particularly long episode was terminated with a cardioversion. Subsequent episodes were shorter, until after 3 months (blanking period) they stopped completely. That's not to say they didn't return about a year-and-a-half later, necessitating another (RF) ablation which apparently did the job.

[Singwell in reply to Snowgirl65]

You're still good? I'm 11 weeks in now and looking forward to my review.

[Snowgirl65 in reply to Singwell]

Surprisingly, yes. My last episode was in February -- snowstorm anxiety and all that -- but nothing since then. You're doing well then after 11 weeks. I think this one worked for you!

[Singwell in reply to Snowgirl65]

Glad to hear this. Yes, aside from anxiety over carper replacement - almost as bad moving - I'm doing well. Be good to be rid of it for a while at least.

[UK_5010 in reply to Singwell]

Not so good but hoping for improvement in time to come. Glad you’re going well.

[UK_5010 in reply to Snowgirl65]

Thanks Snowgirl. That gives me hope. They’re trying me on Sotalol which, early days, seems to be doing a better job than Bisoprolol. Fingers crossed🙂.

[Snowgirl65 in reply to UK_5010]

Yes, fingers crossed indeed! I went through different changes of meds until I got one that works. Hope things improve for you now.

[Nigel2000]

That must be very hard! I’m sure it will get better —- try to give yourself another week off work if you can possibly afford it. Where are all those folk that our EPS and the literature says can resume their normal activities within 2 weeks!

[UK_5010 in reply to Nigel2000]

Thanks Nigel. I agree 100%! So far Sotalol seems to be doing a better job so fingers crossed. Will definitely extend the break from work👍

[bassets]

I had a very rough three months after my ablation in August but have only had mild af since the with infections. I was told mine was a success, but I still needed reassurance fro the cardio nurses afterwards. Give yourself more time to heal and take it easy

[UK_5010 in reply to bassets]

Thanks Bassets. It’s good to hear others experiences as it gives reassurance that it will all turn out fine. Sometimes the info is a bit optimistic &, as you say, patience & taking it steady as well.

[Steve_]

Post ablation I experienced blips when getting into a lying position. Not as bad as you describe. I used to take it in gentle stages to lie down. I also found lying on my right was less of an issue than on my left. As others have said, it takes time for things to physically settle and for the anxiety to subside. Good luck.

[UK_5010 in reply to Steve_]

Thanks Steve It was difficult to be positive after ending up in A & E 3 times but hearing other peoples' experience has made me feel a bit more hopeful. I guess I'm not a patient person by nature but needs must sometimes! I will try the gentle stages and see if that helps - many thanks.

[tim3320070]

this post is 3 weeks old but thought I would add my experience here in the US- had my 2nd ablation for AT 2 months ago, the first 6-7 weeks were not fun, several short runs of AT early on (1 trip to ER) and a ton of PACs from then on, waking me up at night (this was on metropolol and Flecainide), having them the majority of the day and night. Was to be put on a monitor to count PACs for a possible 3rd ablation but in the 5 days prior to this, and going off the meds, things improved a lot- almost zero PACs in the last week. I felt there was no end to this and was pretty down but things improved so much lately that I am cautiously hopeful for the future- so hang in there!

Side note- going of the meds is giving me fast heart rate (but NSR) during any physical activity like going up stairs, etc but Dr assures me this is the heart reacting to the loss of the drugs and should improve soon.

[UK_5010 in reply to tim3320070]

Thanks for the reply tim3320070 and passing on your experience of post ablation. I managed 5 trips to A & E with a heart rate that varied between 150 and 60 so the ambulance felt it best to take me in. The 5th time they gave me intravenous amiodarone which dropped my heart rate to zero (frightening to watch on the monitor) and the longest pause was 6 seconds. They decided not to give me amiodarone again! Since then it has settled a bit more but still bigeminal beats and ectopics especially at night which is disruptive to sleep similar to yourself. I'm a bit more hopeful and was supposed to undertake a 48 hour monitor test but the unit failed due to a low battery in less than 24 hours. I haven't had the 150 heart rate since that last trip 2 weeks ago so hope it is a positive move and taking it steady will help the healing process. Heading for our hills next week on holiday but will stick firmly to short walks on the flat and a weekly bus pass!

[Jackiesmith7777]

Just read your message from a year ago and wondering if it eventually improved for you

[Buzby62 in reply to Jackiesmith7777]

Hi again, little tip for you, if you click on a members name to see their profile, you can choose to look at all their posts or in this case all their replies to see their latest activity on the site.

Should get you to here

healthunlocked.com/user/UK_...

Hope this helps, I was interested too.

[Jackiesmith7777 in reply to Buzby62]

Thank you.

[UK_5010 in reply to Jackiesmith7777]

Hi

Thanks for asking. It seems to have settled down. I've managed to cut down on the Sotalol to 80mg twice a day along with the apixaban. Heart rate seems to not go above 100 and I still tire going uphill quickly although ok on the flat. Never heard a word from Stoke after the ablation and not heard from the cardiologist since Sept 2022 so a bit disappointed although with waiting lists not surprised. Feel the ablation was well worth it in spite of a few issues and the traumatic few months afterwards but life is much better after the op. Wish I'd done it sooner and would recommend it to anyone...although I consider myself one of the lucky ones to have benefited.