12 month blanking period. Long post

[MisterMagoo]

It's just about 12 months since my ablation and it's been a crazy ride but I'm now a month without any detected afib and 2 weeks fully off Flecainide.I'm not counting my chickens yet but here's my story to hopefully give hope to people on this forum. Happy to answer any questions people may have on the back of this.

The first few weeks after ablation were characterised by a gradual shift from afib to ectopic .

After a couple of months things settled down to getting short afib episodes once or twice a week whilst on a reduced dose of Flecainide from 200mg to 100mg per day. I considered this to be a success.

Then in January things went haywire, resting heart rate upto 70 bpm from 55, regular afib and flutter. After some settling down, HR about 65, I started cycling again but this precipitated afib and, on one particular hill, a HR of 250 which resolved immediately on stopping. This alarming rate was reproduced a couple of times

After taking it easy again, my afib and HR settled down again and I was back to weekly afib. I then reduced my Flecainide to 50mg before bed. Things remained stable and the 250 bpm episodes disappeared.

Forward to late April and afib disappeared prompting an experiment with stopping Flecainide. This was unsuccessful. Mid May and afib absent again so at the end of the month I had another go at dropping the Flecainide.

So here we are mid June. No afib, ectopics or flutter. Resting HR 55. Feeling fit as a butcher's dog.

I have read on this forum that ablation can take 12 months to fully have it effects become apparent and this appears to be the case for me. 🤞

[BobD Volunteer]

What I have always said that many people are still improving at nine months or a year so thanks for you views. Strange then that Barts are suggested that blanking period be reduced to two months!

[mjames1 in reply to BobD]

BobD: Strange then that Barts are suggested that blanking period be reduced to two months!

This (see link below) will help explain why. However, that doesn't mean that just because you have an event after 2 months, your ablation is a failure.

But it does mean that more attention should be paid to episodes after 2 months (some say after 1 month) as some interventions at an earlier point might help save the ablation longer term.

elsevier.com/about/press-re...

Jim

[BobD Volunteer in reply to mjames1]

As I discussed re RBH.

What is interesting is "what is the blanking period.?" Many people religiously think that after three months things should be all done and dusted. Is this the blanking period? We know from patient's stories that this is nonsense. Barts seem to be saying that intervention within the first two to three months is important to preseve NSR where possible. RBH (in my own experience at least) have always taken this view and have strived to return NSR where possible either through drugs or electrical cardioversion. I admit to being amazed when people are offered second ablations within a few months where again my own experience is that a much longer time is needed for the heart to recover before beeing poked about again. I had at least a year between all my ablations and as many people have, noted improvements up to nine months or even a year.

So should we have two marker posts during recovery, one for fast response to return NSR if AF has returned and one for a more wait and see approach? This is especially important where ectopics are concerned as many people seem more troubled by them than AF yet they do usually fade given time and a calm approach.

It all comes back to patient expectation. When I had my first ablation in 2005 I was sold the idea that next day I would be tripping the light fantastic out of the hospital a cured man. (Maybe I sold that to myself) . The reality was crushing but time, patience and persistence from my EP eventually gave me that satisfaction.

[Buzby62 in reply to BobD]

I had an episode at day 6 and called the arrhythmia nurses, I was told it was the right thing to do and they indicated that they didn’t want me in AF over 72 hours without some sort of intervention. I’m amazed when I read that people are left for weeks or months without intervention and some feel it’s too soon to contact them. It’s never too soon, that’s why we are given all the contact details pre-ablation. Luckily I reverted to NSR by the next morning so no intervention was needed.

I had another episode after overdoing things cleaning and decorating at 10 weeks (in between 2 and 3 months) and I feel I pushed too much while still in the recovery period and was/am still improving for many months after.

For me the 3 month blanking period seems about right but as is said here regularly we’re all different so don’t be too fixed on that time.

I know I’ve replied to BobD but it’s a general reply to all reading.

Best wishes

[mjames1 in reply to Buzby62]

Buzby62: (My doctor) didn’t want me in AF over 72 hours without some sort of intervention. I’m amazed when I read that people are left for weeks or months without intervention and some feel it’s too soon to contact them.

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Yes!

Jim

[mjames1 in reply to BobD]

I think the two points can coexist.

Yes, episodes during the first 3-6 months (possibly longer) do not necessarily spell doom for ablation success. I had a single afib episode six months post my ablation and haven't had another episode in the 9 months following, so I consider the ablation a success.

But on the other hand, it can be counter productive to be too dismissive of early episodes as "it's ok, just blanking", when sometimes an early intervention, for example cardioversion or increasing anti-arrhythmic meds might be in order. By shortening the blanking period (based on studies showing early occurrences are related to ablation failure), they are merely saying that any episode after 1 or 2 months have to be taken seriously rather than letting an episode slide until the 3 month mark. I know my ep never wanted me in afib for more than 3 days, at any time.

Jim

[JoDogBlue in reply to mjames1]

It's been 10 weeks since my ablation. I went into symptomatic permanent AF just two days afterwards and got straight onto the arrhythmia nurse who said I'd be put on the list for a cardioversion. That would have been at the end of July, four months post ablation but I managed to get a cancellation at short notice (cardioversion two weeks ago; 8 weeks post ablation). I'm still in NSR.My EP had told me I was on the correct treatment plan and early cardioversion wouldn't improve the long term outcome. I think making myself heard at least got me on the radar when a cancellation came up.

In my experience so far at least you have to be your own advocate, don't just wait to improve in those early weeks if you're struggling. Ask questions and make a noise if you have to.

[Buzby62 in reply to JoDogBlue]

“you have to be your own advocate, don't just wait to improve in those early weeks if you're struggling. Ask questions and make a noise if you have to”

Exactly!

[jeanjeannie50]

Great news to hear how well you're progressing. Long may that continue.

Jean

[Desanthony]

glad to hear you are getting on well now. Take care.

[Nan1]

Morning, from someone who is struggling with ectopics after an Ablation four months ago it’s really encouraging to read your post. So glad things have worked out for you. Keep well

[50568789]

Well, I've just got through my first 48 hours, without a peep from the heart, wouldn't know it had been touched, but am fully aware the time ahead is unpredictable. I suspect a "successful " outcome is largely dependent on me being sensible (there's a challenge).

[Mugsy15]

I was still noticing gradual improvements at least 18 months after my Ablation.

Still get occasional runs of ectopics if I'm slightly dehydrated or have worked hard for a long period, but they don't worry me at all.

[listerines]

Excellent news and very glad that you are feeling benefits from the ablation many months out from the procedure. Wondering, have you been able to get back to a normal exercise/ biking routine or have you reduced the intensity of your exercise routines to better manger afib episodes. Wishing you nothing but heart stability

[MisterMagoo in reply to listerines]

Thanks for the good wishes, Listerines.

I'm back "normal" but think I really need to pull back a bit as I've been getting carried away. Last week I couldn't resist pushing myself towards the end of bike rides and swimming sessions to achieve my old times - just because I could. I've really had to have a word with myself. I mean, who the hell am I trying to impress? Absolutely nobody else gives a damn how fast can swim 1500 meters or ride 30 miles.

So this week my mantra is going to be long and steady, something I need to permanently adjust to.

[listerines]

I know from experience that this can be hard to adjust to as, as like you I did like to push myself . I believe though that with afib/ ectopics and other matters of the heart a manageable and less intensive approach is probably best in the long term. I do so appreciate being able to exercise that over time the desire to constantly push myself has waned and am now more in the moment with exercise if you will. I am sure you will find your happy medium. Wishing you the best.