How long to stay on blood thinners …and after ablation heart symptoms….

[Chrissy7]

Good morning all,

Since I haven’t heard from a doctor about blood thinners, how long should I stay on them after ablation? Thinking blanking period but I think here they said one month?

After I eat dinner and walk the dog I start to get increases in heart rate (sitting down normally 60 but will be in 80s and 90s and hading to 100)

….and I start feeling sick similar to how I did prior to ablation but not as bad .. my heart rate starts wanting to increase … I had to start taking Diltiazem again — does this mean ablation failed or just healing symptoms?

Really it is not as extreme as before.. and my only issue before it was my extreme symptoms of feeling like passing out and feeling so sick if I even was a few minutes late taking a pill.

To me, these symptoms seem like an arrythmia is always present…?

I dont have typical AF…

some people told me they take Diltiazem for many years… but I was hoping to avoid that.

I dont think it can be good for you long term?

[BobD Volunteer]

There is little evidence to suggest that ablation removes stroke risk so unless you were only anticoagulated for the purpose of the ablation and recovery I suspect that like most of us you will remain on anticoagulants for life.

[Chrissy7 in reply to BobD]

Thanks Bob .. I was only put on the one month before ablation for the ablation.

There was a long discussion couple years before on here whether or not I needed them or not long term. I was on daily aspirin.

Drs here decided I didn’t need them since my Chad score was zero. Oh I meant to report that I brought my Cholesterol down naturally from 7 to 5.5 in one year… proud of that..,

Diet and exercise and have lost a little weight….

Disappointed to be having episodes again so soon.. probably need a top up..

[mjames1]

That's a shared decision you should have with your doctors who best know your medical history. If you don't remember, contact them

In the United States, where I'm more familiar, the blood thinner/AC decision, varies from ep to ep. Factors taken into consideration are the current CHADS score; afib frequency and duration; bleeding risk from medical conditions, work or hobbies; risk factor management; and your own preference.

Given you are CHADS 0 -- and that you were not on thinners prior to your ablation -- my non professional opinion is that you will be taken off them when your ep feels it's safe to do so.

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"...After I eat dinner and walk the dog I start to get increases in heart rate (sitting down normally 60 but will be in 80s and 90s and heading to 100.."

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Sound perfectly normal for anyone. Also keep in mind that an increased heart rate after ablation is very common and actually a positive indication that your ablation will be successful.

Jim

[Chrissy7 in reply to mjames1]

Thanks Jim .. much appreciated

[Chrissy7 in reply to Chrissy7]

What I dont understand is why when this happens I feel sick tired and weak.. similar to being in AFib.

And if im not really careful .. and lie down, HR would keep on increasing….

It jumps from 70 to 80 to 90 and back in a split second (shows no points in between) and makes me feel dizzy…

[Singwell in reply to Chrissy7]

Hi Chrissy. I think you're very tuned into the sensations you experience with your body because of having had quite a traumatic journey with your AF. These experiences can make us super vigilant and it helps to know that; and then to have strageies to help calm those physical feelings when they show up. Just so you know- I haven’t had any traceable AF since May 2022 but I DO get palpitations and ectopics and - like you - feel weak, nauseous and suddenly tired when they come. They're my warning signal. I don't know why your heart would be jumping around by 20 like that - if it's within say 1 minute. But I agree with Jim that HR increase after eating and exercise of course is normal. Eating increases our metabolic rate. I always take a few minutes to sit down quietly after eating and dont start rushing about while my stomach is dealing with the food intake.

You are still in early days post ablation and your heart is adjusting. The medics call this remodelling - your heart is literally learning to behave differently.

There are two things you can do to help when these odd palpitations happen.

1 is to palate your own pulse - you must be touching - not looking at a device - and count the beats. I touch my wrist and tune into my pulse and mentally count along with it. If we do this during a fast heart beat episode and are sitting still then apparently it helps the heart-brain realise we're in charge, and the rate will come down. I got this from a science programme on the BBC about research into helping people with panic attacks. It really does work.

The other tip is to slow your breathing down to less than 6 cycles a minute. I'll send my route to that via DM if you'd like as it'll make my post very long otherwise.

[Chrissy7 in reply to Singwell]

Interesting .. thank you Sing ., I will try this

[GrannyE in reply to Chrissy7]

Is your bp normal?

[Chrissy7 in reply to GrannyE]

Im not sure but think my BP drops when my HR increases…

Makes me feel faint.

[SusieQ2023 in reply to Chrissy7]

Please check with your doc. No matter how rare they tell you it is, pulmonary vein stenosis can occur after ablation--usually within a month or two. In my case it was 6.5 years before I was diagnosed. It is a wonder I am still alive.

[Chrissy7 in reply to SusieQ2023]

Wow.. sorry to hear this Suzie. Whst were your symptoms and did you have them for 6 years?

[SusieQ2023 in reply to Chrissy7]

No, I started having spells of extreme weakness and breathlessness. Some days I could easily do an hour on the cross trainer, and the next I wouldn't be able to walk around my small yard. Over time, I developed a terrible cough that my doc blamed on recurring asthma. I had an angiogram that showed all was well. The problem with an angiogram and an echo is that they don't reveal the status of the pulmonary veins! I have had four ablations and by March this year had been cardioverted 18 times. I took amiodarone for 10 years until my liver enzymes became elevated. I was still going in and out of a fib, so my EP did another cardioversion and put me on Fleccacide. My heart went insane on that. Went to Barnes for a consultation about a mini maze where it was discovered through a chest CT that my upper left pulmonary vein was 98 percent occluded. Ususally, pulmonary vein stenosis is diagnosed shortly after ablation. Prior to my case, the longest ever was two years. It took three months to find a doctor who could (or would ) attempt to stent the vein. At that, it was a pediatric cardiac surgeon at Barnes in St. Louis who finally performed it. I truly believe that everyone who has an ablation should have a chest CT in the months following. Obviously, my scarring developed slowly. I truly yhink that if I hadn't gone for that consultation, I would be dead by now. I am not having the mini-maze, nor will I have another ablation. Ablation and maze surgeries(unless it is open-heart cut and sew) are like playing whack -a-mole. I am feeling well enough in a-flutter that my life isn't disrupted. I am taking xarelto and metropolol, and my rate is controlled. Right now, I am just celebrating being alive. However, I would warn anyone feeling bouts of extreme fatigue to get the chest CT if you have had an ablation. That was my first symptom.

[Chrissy7 in reply to SusieQ2023]

I jusy looked up the symptoms of pulmonary stenosis and I dont have them…. Thankfully …

These episodes are the same as I always hot prior to ablation at the sane time if day- when Im a bit tired. Only difference is my heart used to shoot up to 180 or so and now it only goes to 100 so episodes are not as severe and symptomatic as prior to the alblation.

[Cundara1234 in reply to SusieQ2023]

Excuse me, can you explain to me how they found out that you have stenosis of the pulmonary vein .How did you discover it with which diagnostic and what kind of problems you have as a result?I had an ablation three years ago for Atrial Tachycardia and I constantly have shortness of breath and skips after that. I had it before, but differently than now. The ultrasound of the heart is normal. Thank you very much.

[Chrissy7 in reply to Cundara1234]

Cundara she said

“Went to Barnes for a consultation about a mini maze where it was discovered through a chest CT that my upper left pulmonary vein was 98 percent occluded. Ususally, pulmonary vein stenosis is diagnosed shortly after ablation. “

Think thats how they found out….

[Cundara1234 in reply to Chrissy7]

I will also ask for a CT scan, but I don't know what CT? My pulmonary pressure is 35, measured on an ultrasound of the heart, and up to 25 is normal.

[Cookie24 in reply to mjames1]

Why is increased heart rate a positive sign about the ablation?

[mjames1 in reply to Cookie24]

"...Conclusion: PV isolation in patients with AF may result in increased HR, which positively correlated with the ablation success. This change does not seem to resolve spontaneously after a follow-up of 12 months. Approximately 5% of patients may develop symptoms due to an increased HR, necessitating treatment with rate-controlling drugs..."

pubmed.ncbi.nlm.nih.gov/160...

[Chrissy7 in reply to mjames1]

Thanks James…my resting heart rate is the same .., has not increased.

Normally, my heart rate stays around 60 to 65 as it did before the Ablation.

however what I was saying is that some days I’m getting attacks it feel like AF around 5 or 6 pm- can be before I have, or after I eat - where my heart rate increases and will jump from 80 to 90 in one increment just for an example. I get dizzy and start feeling sick.

I take one diltiazem and those symptoms resolve after an hour or so….

[mjames1 in reply to Chrissy7]

In that case, only an ekg will tell the story. Since the episodes seem short, you would want to wear a 7-14 day patch, or alternatively capture the ekg with a home device like the Kardia 6L or Apple Watch. Taking Diltiazem may or may not be indicated, depending on what is going on. Of course, keep your doctor on board.

Jim

[Chrissy7 in reply to mjames1]

Thanks again

I always took diatiazem for these episodes, which I always thought were a F however, I realize that I’m in normal sinus rhythm when they happen….

Anyway, the AP after my application, told me that if I had this episode again to take a diltiazem as i havent been taking them since my ablation

It’s my rate that is all over the place.

I will try to capture it !!

[riffjack846]

Of all the medications I took prior to my successful ablation my anticoagulant is the only script I still take. Once you have Afib past or present it's best to take anticoagulents forever. This is because we don't know if afib will rear it's ugly head again and we don't want a stroke. Good luck.

[dmac4646]

Hi was told must be on anticoagulents for an uninterrupted 6 weeks post ablation

[House55]

I had my ablation in early June and was told to continue the blood thinners for at least 3 months and then the consultant will review

[Jetcat]

Hi chrissy, the best person to ask is your EP. You will or should get a follow up appointment with him/her.? My app was 3 months after. Depending on your chads score etc and how you are doing they may indeed take you off anticoagulants.? But they also may not.? Don’t be in a rush to come off anticoagulants as they do a very good job at reducing stroke risk with us afib folk.👍

[Chrissy7 in reply to Jetcat]

Here we dont get follow up with EP .. only with cardiologist…

[Jetcat in reply to Chrissy7]

I see.!!! that just leaves you with the cardiologist to speak to then I guess. Best wishes.Ron.

[SeanJax]

keep this in mind. If you got a stroke, it would be your brain cells which got affected and nobody else in this forum neither the ep. It is a personal decision guided by the ep. Brain cells don’t grow back and blood clot due to Afib is always big size which can cause massive stroke.

The only thing I don’t like about ablation is it leaves alone the left atrial appendage unlike the mini maze or hybrid convergent which removes or clipped it off removing the necessities of taking blood thinners. So many people in this forum keep taking anticoagulants for life without side effects, which is the right decision for them.

Now I have a question . For whatever reason they could not take any longer the anticoagulants what would happen to the stroke risks? It happens all the time, i.e. bleeding gastric ulcer, bleeding colitis, etc . It is a million pounds question. I don’t have an answer. You can treat bleeding ulcer but you cannot remove a portion of the colon because of colitis because it happens again.

[Buffafly]

You take the tiniest dose of Diltiazem so I wouldn’t worry. I take 180mg a day but in theory could go up to 400 if necessary. If it helps why not accept it. Don’t forget your case is ‘complicated’ so it may take your heart a long time to adjust. People who wake up after an ablation feeling as if they could dance out of the ward probably haven’t had an arrhythmia for long enough to remodel their hearts ❤️‍🩹

[Chrissy7 in reply to Buffafly]

So true… not like when you have to wait 3 years for ablation like me..

[Chrissy7 in reply to Buffafly]

Thank you for the reminder Cassandra… it was because I was taking the tiniest dose that I was having a lot of dizziness and fainting feeling in between pills. I Don’t get that anymore so that’s a plus … honestly, I was hoping to get off these forever, but I guess some people do take them forever without harm.

[Elizka]

There is evidence out of UCSF that even when AFIB is treated there is still risk of stroke or clots. Aspirin does not target the same blood components as blood thinners that could lead to stroke. I'm on it for life.

youtu.be/8OpM4W73vvk(Not working as expected?)

Around 17 minute mark.

[Chrissy7 in reply to Elizka]

Thank you Eliza… great info!

… my doctors are quite open here, and will probably allow me to stay on Eliquis if I want to… I only take a small those 2.5 MG 2 x day so think since I don’t have any side effects, I think I might stay on the long-term….

After hearing all this …