breathing difficulties 9 weeks post ablation

[Oak321]

Hi my husband had an ablation on 12 thJune he had not had AF to his knowledge for the past year but was advised to have the ablation due to problems with medication.

He had had daily episodes of AF since and 4 weeks ago his acid reflux gerd came back along with a persistent cough. And breathing difficulties. GP gave him PPI’s and told him to use his blue inhaler to help him breath.

Ended up going to A&E on 28th July due to breathing difficulties, had lots of blood tests ecg ( was in AF) and a chest X-ray and was given a 5 day course of steroids which helped for a week but the coughing and breathing is now worse and he is having to use his inhaler every 4 hours but this is giving him a higher heart rate,

he rang the cardiac clinic on Thursday and spoke to a nurse who was going to speak to his EP and call back but hasn’t yet!

Does anyone have any advice I have been using google and come across pulmonary vein stenosis, he is worrying that he has heart failure although I am sure the blood tests and chest X-ray would have shown something.

It has been a long and worrying 2 months really hoping for some improvement.

[mjames1]

Very sorry what's going on. Have they ruled out post procedural pericarditis? I had that after my ablation with symptoms of pain on inhalation, very similar to upper respiratory reflux/gerd. You might also ask your doctor to switch to a stronger PPI like Dexilant, or increase the dose of the current PPI to see if that might help.

Hopefully, they will find the cause and appropriate treatment. With time, many of these post procedural issues seem to go away, however important to keep on top of your ep like you're doing so your husband will get the attention and treatment he needs.

Jim

[Oak321 in reply to mjames1]

Thanks for the reply I have just googled pericarditis and he doesn’t have the symptoms. He has been given 40mg pantoprazole (increased from 20mg)

We will ring the cardiac team again on Monday to chase up.

Julie

[mjames1 in reply to Oak321]

Hopefully, the higher dose will help. I have gone as high as 40mg twice a day, PPI equivalent.

In case they didn't mention it, PPI's like pantoprazole are significantly more effective when taken on an empty/fasting stomach, one hour before a meal for maximum absorption. On a single dose, that would usually be before breakfast.

Jim

[Oak321]

yes he takes it in the morning, he was on them for 5 years then had a nissen fundiplication to tie his sphincter but that only lasted 3 years before the gerd came back. Only had gerd occasionally over the last2 years but the ablation seems to have brought it back.

[MummyLuv]

this happened to me too, it was quite frightening I can imagine you and your husband are worried. I got to the stage that I could not speak a word without struggling for breath and the coughing was awful. I was seen by my EP and referred for a CT scan to check for pulmonary vein stenosis. It wasn’t that fortunately. It did turn out to be bad ablation positioning that was right against my phrenic nerve causing my difficulty in breathing as it’s the main nerve between the lungs and the diaphragm. My advice to you would be to chase the EP who did the ablation, you need to make sure if it is either of these things they are treated as early as possible. Good luck!

[Oak321 in reply to MummyLuv]

Thanks for your reply I will make sure we get to speak to him on Monday. CanI ask how yours was corrected please.

[MummyLuv in reply to Oak321]

If it was pulmonary vein stenosis it would have been a stent, my phrenic nerve was never identified by my local hospital and was only identified when I had my mini maze. I still now suffer from low oxygen but my breathing is not laboured and I don’t cough,

[MarkS]

If he had a cryoablation, then there can be problems from phrenic nerve injury/palsy. This is caused by the cryo balloon going too far into the pulmonary vein, typically if the PV is quite large and the operator is inexperienced. This does usually clear up within 40 days or so. It can be tested for so I suggest you discuss this with the EP on Monday.