I had a cryo ablation at the JR on Friday. I was expecting to be feeling better today but my pulse is all over the place, anywhere between 80 and 140, and irregular. I feel like I'm back in full-on AF.. breathless, tired and light headed. I left a message describing my symptoms with the arrhythmia nurses but they haven't got back to me so I'm assuming they're not worried, but I am.
This may all be perfectly normal but is there a point at which I should have an ECG? Is there anything I can do or avoid doing to increase the chance of going back into sinus rhythm, or is it a waiting game?
Comments gratefully received as ever.
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JoDogBlue
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It’s Pulmonary Vein Isolation (PVI) cryoablation I think you’ve had not AV node ablation. AV node ablation would only be done with a pacemaker (pace and ablate), that’s why BobD asked that.
I wonder what you are using to measure your heart rate while you are in AF. While in AF you should take the average only as instantaneous measurements from devices will be jumping all over the place and can cause you more anxiety when you see it, I’ve been there. If you have more 80s than 140s then your average may be around the 100.
After my last ablation I found that the Valsalva manoeuvre would put me back into normal sinus rhythm. Breathe in, hold your breath and bear down tensing your body for as long as you can. Look it up on YouTube if you want.
Yes, I would keeping ringing whoever did it. You need to be evaluated and given a plan what to do in what scenario. Afib and other arrythmia's are not uncommon after an afib ablation, but just like before the ablation, they have to be dealt with intelligently with rate and/or anti-arrhythmic drugs or cardioversion. It would be big bonus if you had an ekg to show them. Might be a good idea to get a Kardia 6L. For better or worse, ep's take ekg's more seriously than patient's complaints.
I totally agree with Jim. Your symptoms demand that you be in touch with your EP people. The same thing happened to me after ablation #2: arrhythmia and HR in 160’s. A cardioversion didn’t work (the first time ever), but amiodarone did and I’m still in SR 2 months later. Post-ablation ups and downs are not uncommon, but as Jim says, they need to be paid attention to and dealt with—which means getting your EP carers involved. Keep at it until you get a real person who can advise you on your options and best course of action. Best of luck to you. You’re not in an easy place right now, but you’ll find your way out—with the help of your providers I’d guess.
Thanks, I'm going to call the EPs secretary in the morning and ask to speak to him for advice unless the nurses get in touch first (I've left two messages and two emails now). In the meantime anything other than lying or sitting down is an effort. Don't know where I'd be if it wasn't for the advice on here!
I’ve been exactly where you are. The fatigue was overwhelming. And lightheadedness. And worry. These worries belong on the shoulders of your EP team. Their job doesn’t end when the ablation is over—though sometimes they act as if it were. They are the ones to calm your fears and provide a way forward. Stay proactive—even more so now that two messages and two emails remain unanswered. I assume they know that blips after an ablation are common and believe that there is no urgency to your situation, but if that is the case they need to tell you that! Keep after them. How frustrating. The same thing has happened to me. I felt ignored, sort of abandoned. But I kept squeaking my wheel, up the ladder of the cardiology department, until I got my needs met. That’s exactly what one doesn’t need to be doing post-ablation. Anyway, get your needs met. That’s their job.
Thanks again for your comments. I've left a message with the EPs secretary asking if I can speak to him for advice tomorrow. I'm quite good at pushing, just not feeling like I have all the required energy!
Thanks . They did give me a number but it records messages and responds based on ' clinical need'. As yet they haven't phoned back. I'm taking it that they aren't worried but thought thay might have called to say so. I'm going to see what today brings.
Good plan!I'd also add...keeping them updated can't hurt. So, if it continues, even though they haven't got back to you, an update might be useful for them. It's additional information for them to assess that clinical need. They might not be worried. And you need not be worried but they might consider a cardioversion to restore rhythm. This is one of the reasons they like to know what's going on. Well, that was my experience with my 3 ablations.
You could also update your GP. If you feel that is helpful.
Keep us posted if you're so inclined.
And keep resting! That's probably the best thing you can do . It sounds passive but it's being proactive.
After my first ablation, like you, I thought it had made things worse and can remember getting quite upset but it did settle down eventually. Give it time. Also my resting heart rate was quite high too which lasted for many months but this too sorted itself out eventually and didn't need any further intervention apart from a six monthly follow up. Take it easy, rest up. I was told that I could go back to work in a week - what a joke!
I would just like to add that I was in contact with the hospital post ablation and their advice was that it was expected and would settle down, which it did. Quality of life restored mostly for the next 10 years.
My ablation was two weeks ago and I am getting a higher resting heart rate. What used to be normal for me was around 64 BPM is now average 76bpm, even when I wake in the night. This makes me anxious which makes it worse! It scares me. Hope it settles. Your words give me hope
That's a difficult one to remember but I know it was in excess of 6 months as I mentioned it at my follow up where the answer was it was quite usual so I didn't worry about it and got on with my life.
Hi Not sure if this helps but I had a cryo ablation at Stoke in March 2022. The first couple of days were fine but then symptoms that sound similar to yours. Erratic heartbeats sometimes in the 80's and then 150's. For the next two weeks I ended up in A & E five times spending more time in hospital than at home. They tried increasing bisoprolol and then sotalol in ever increasing amounts. On the last discharge the cardiologist said I expect to see you back again but it did settle down and apart from a week with non-stop ectopics AF has behaved itself. I'm still on sotalol albeit at a much lower level and I do get breathless going uphill or upstairs quickly but I can comfortably knock out 20,000 steps on the level so I'm very grateful for the treatment. Hopefully you will find yours will also settle down after a period of rest and recovery too.
Thanks for your reply. I ended up phoning 111 last night and was told a clinician would call back in 20 minutes. Eight hours later, at 3 in the morning, they did and said I should get to A and E within an hour! I didn't go as yet and not sure I will until I've tried the arrhythmia nurses again. Think I just need reassurance and the folks on here are giving me that.
Some very good advice above and good you have rung the arrhythmia nurses but I wouldn’t rely on their rapid response as they are often swamped.
You ask a pertinent question - how long to wait with erratic HR? If you are not in AF then it is a matter of time. If you haven’t the ability to take your own ECG and don’t know if it’s AF or what is going on then I would ring and keep ringing the arrythmia clinic as if you are in AF for more than 48 hours I think most EP’s would consider prompt treatment to help re-establish NSR. Alternative is ask your GP if they can take ECG to send to your EP for analysis and advice.
Are you on any meds?
Only other comments - expectations can lead to disappointments and recovery from ablation procedures are so individual that sometimes it is only time, especially through the blanking period.
Did you read the Recovering from Ablation Leaflet that Bob gave you the link to?
I had the same happen to me, pulsed field ablation in January this year, three days later afib started at 1:00am during sleep,I contacted my consultant's PA who got my consultant to phone me that day, I was self pay for the procedure so that probably led to a prompt response, he wasn't in favour of a cardioversion but advised me to increase my meds and we would review a week later.
I was still in afib on the first day of increased meds - 84 - 90 RHR which rose to 100-127 on the second day. I woke up in sinus rhythm on the third day of increased meds with a RHR of low 50's again.
A week later the consultant advised me to stay on the increased meds until four weeks after the ablation when I could return to the initial plan of 50mg Flecainide + 1.25mg Bisoprolol am only, 1wk post ablation.
It's now ten weeks after my ablation and everything's fine.
Thanks for your response. I'm on 60mg Edoxaban and 5mg Bisoprolol in the morning. On the day of the procedure the consultant advised reducing the Bisoprolol to 2.5mg but I haven't done that and will see what advice I get next.
Bisoprolol will limit the heart rate but generally not affect the arrythmia, the Flecainide, for most people, will stop the arrythmia and put you back into sinus rythm, allowing best post ablation recovery with normal heart beat. It's worked in my case, at least so far anyway
Thanks for your comments. I haven't had an anti arrhythmia drug in the mix since I came off amiodarone in October. I'd been in normal rhythm (though anticipating going back into AF) as the effect wore off. I'm going to try the EPs secretary tomorrow to see if I can speak to him or get some advice relayed as I've still not heard from the nurses. I feel OK as long as I do nothing!
Further to my posts - I do have ectopic heart beats, which my consultant was unconcerned about, visible on my daily home ecg's done as a record of my progress during the recovery and something I can communicate with my consultant at the follow-ups if necessary, my next one is at six months,I am asymptomatic from the ectopics as I also was from afib, possibly helped by my fitness where for 6 - 7 days/wk I do a mixture of swim/row/cycle & weights which I gradually resumed two weeks post ablation with no ill effects.
I did some research before my ablation to find who were the top afib cardiologists/physiologists in London and chose one who has a lot of experience and also involved in research into afib and new techniques, so hopefully I'm in good hands.
Hi, I would be ringing them again if I was you and if no response ring the EP secretary to chase them up, I’ve done that. You should really have an ECG to evaluate. I was also given a letter to use if needed for my GP surgery to perform an ECG in your position.
I wouldn’t assume they’ve assessed your call unless they’ve given some sort of response.
It’s the last thing you want to do is chase things up when you feel like that but it’s what we have to do unfortunately.
Hope you get attention soon.
PS, you can also try calling the ward you were in as they have close contact with EP nurses.
Not sure if this will be reassuring to you or not but I’m now 9 weeks since my ablation and regular spells of either ectopics or AF. I’m still hopeful things will settle down. You are in the really early stages so I’m sure things will calm down.
Thanks for your comments. After being in normal rhythm for a long time it came as a shock to back in AF so soon after the ablation. Perhaps I'd forgotten what it's like but AF feels much more debilitating than I remember. I guess in part that might be because of the new trauma on the heart from the procedure. I'm basically doing nothing but rest for now.
Rest up. I did nothing much for the first week and short walks the second. What I found was that on a few occasions the tiredness just hit me and I was good for nothing.
I've heard from one of the JR arrhythmia nurses. They've come up with a plan... ECG and if in AF back on amiodarone (very reluctantly on my part) or several weeks wait for a cardioversion, possibly increased bisoprolol too. Will see what the ECG brings, I'm getting that done tomorrow. Although irregular my pulse seems less erratic and I have some energy back so headed in the right direction.
Thank you to everyone for your comments, they really helped reassure me.
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