Post Ablation Hypertension

[RevDoc]

I'm a male, age 88 who had persistent AF of unknown cause for 3 years, at the time on Dyazide and 10 mg Bystolic for mild essential hypertension. I had a successful RF ablation in May 2023, after which Dyazide was replaced by 20 mg Lasix, and the Bystolic was increased to 30 mg. Immediately after the ablation, my HR decreased from 90 to 55 and my BP decreased from 135/80 to 110/60. In September 2023, my BP started to increase. Soon, an echocardiogram showed diastolic dysfunction and pulmonary artery hypertension. My BP has continued to climb and has been unresponsive to Bystolic 30 mg, Cozaar (losartan) 50 mg, and Inspra (eplerenone) 25 mg. My HR is still 55, but my BP is now 160-170+/56-65, with symptoms of fatigue, mild headache, and mild lower leg edema. My cardiologist and internist seem bewildered as to what to do with this mounting problem. Thoughts?

[Ppiman]

This is bad luck and must be worrying. There are some papers online which look at PH following ablation. From a quick look, it seems to affect around 1% of patients and might occur because the ablation has worsened or uncovered other issues. It might also be that your ablation is taking a long time to settle and that things will slowly improve?

Your doctors might be bewildered but they surely will be seeking further guidance from less bewildered colleagues. Reading the papers, an aim of treatment seems to be to protect the kidneys so that might be a question you could ask?

Steve

[JOY2THEWORLD49]

Hi

Stroke - yes with AF. 4 days later thyroid cancer (removed 4 mths with 12 r lymph nodes (2 affected).

I have 2 meds which control my H/R and BP.

CCB Diltiazem 120mg AM control of H/R Rest Day. After a year now 60s

BB Bisoprolol 2.5mg PM control of BP

I haven't heard about your meds.

CCB Calcium Channel Blocker

BB Beta Blocker

110-130 / 69. 60s Day H/R avg. and 47 Night H/R avg (always regardless of meds.

cheri JOY. 74. (NZ)

[Buffafly]

Do you check your own BP or do your doctors do it? I always have very high BP when tested in hospital but very low at home. If you haven’t got a home BP monitor you might want to get one if you can resist being obsessive with it. Though it sounds as though there is a physical cause diagnosed unfortunately.

[cuore]

Is your potassium level low? Have you been tested for primary aldosteronism ?