Did your ectopics die out after your ablation?

[Cliff_G]

So, shortening a long story, AFib from age 40, successful ablation (PVI + flutter + mitral line) at age 48, 15 good years then an aortic dissection at age 63, the long OHS surgery for which put me back in Fib. Sinus for 5-1/2 years on Amiodarone but it was slowly weakening me, plus bad ectos. After 6 months off it, sudden atrial flutter onset, 9 months after that an ablation 2 days ago, 70th birthday present! Unfortunately they could only address the flutter as the PVCs source is right where they can't get to due to my metal aortic valve 😞

My main problem always has been that if I'm in sinus, I get some or a lot of ectopics, so I was dismayed to have a bad night full of ectos right after this latest ablation. My EP said not to worry, they would settle, and last night was indeed better already. How much of that was the new scrip for Flecainide I don't know.

So my question is - I'd be interested to hear from people who've had post-ablation arrhythmias which have settled, how long it took, etc.

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For general interest here, my EP confirmed a couple of bits of new thinking around meds. One is that since the CAST trial, Flecainide has been off the menu for anyone who's had a heart attack. But that trial has been re-evaluated and they are more relaxed about this, provided an echo shows good heart function. The other option (if Flec doesn't do the full trick for me) is that Ranolazine is now being used for ventricular ectopics. I have seen several studies showing good outcomes, so very glad to hear it's now in use and available to me if needed. Hope this is of use to someone.

[CDreamer]

Short answer, yes but took 9-12 months to go completely and they were not persistent, just came on when I had moved in a certain way or pushed too hard with exercise.

[Cliff_G in reply to CDreamer]

Thanks CD. I've also found getting my potassium up has helped in the past. Bloods at hospital yesterday were 3.8, but I know if I'm up around 4.5 they are fewer.

[BobD Volunteer]

As for CD. Slow deepbreathng helped termiante mine after about five months.

[Cliff_G in reply to BobD]

Thanks Bob. Yes, that helps with a lot of stuff, I need to work it in to my normal lifr.

[CDreamer in reply to Cliff_G]

That's the hard bit I found, it's about maintaining a daily practice - regardless! THEN when the ectopics hit, finding a quiet space to calm yourself. I found that Tapping whilst LSD breathing worked best for me.

[Cliff_G in reply to CDreamer]

Yes, now I'm in mostly sinus + ectos, perhaps I stand a chance of getting back to my meditation practice, which would be a benefit all round anyway.

What's the Tapping you do?

[CDreamer in reply to Cliff_G]

It has many names & is modern take on ancient acupressure techniques. Gentle tapping with 3 fingers on the gamut point which is the ‘karate’ chop area of side of your hand. It calms ANS and is biological feedback to calm the whole system. Works for me.

[Cliff_G in reply to CDreamer]

Thanks, I'll dig into that & try it

[frazeej]

I got the same feedback about the outdated CAST study from my cardio guy, that Class1 antiarrhythmics such as flecainide and propafenone are no longer necessarily “black box” no-no’s for a heart with some structural damage. He also said that Tikosyn (Class 3 antiarrhythmic, recommended in cases with heart damage) has now been shown to have some “issues”.

JimF

[Cliff_G in reply to frazeej]

Thanks, interesting.

And (as one of many examples) that's why you can't rely on ChatGPT! I asked it about re-assessments of the CAST trial and it basically said it's still valid. Yet I dug up a paper that looked at the risk, stratifying patients into high medium and low risk, and it found that Flecainide actually improved outcomes in the medium and low risk groups. ChatGPT excels at regurgitating the "accepted wisdom" which with human intelligence you can often debunk.

I was on a trial for Dofetilide/Tikosyn at St George's a year before (2001) my ablation and it did nothing for me. Great concern over the QT prolongation and Torsades risk back then.

[Cookie24 in reply to frazeej]

What are issues with Tikosyn?

[frazeej in reply to Cookie24]

He didn’t think Tikosyn was exceptionally effective for PAF, and the risk of Torsades was a little higher than he liked. I don’t know if this was anecdotal information or from a study. He had in the past strongly encouraged me to switch from propafenone to Tikosyn because of my damaged heart. I had resisted because propafenone was working very well, and I didn’t want to be in the hospital for 3 days while they “titrated” the Tikosyn dose. Now he says the original CAST study is old, and propafenone for me is OK. My, my, funny how things change with time!

[etheral in reply to frazeej]

Been on Tikosyn 5 years with a markedly reduced EF. It has kept me in NSR with no CHF which occurred if I went into afib. No issues or side effects from Tikosyn

[Cookie24 in reply to frazeej]

Thank you. I also take Propafenone

[Sixtychick]

I had an ablation a year ago and had ectopics for about 8 or 9 months. They seem to have stopped more or less now.🤞🤞

[HC74_2]

No, my ablation was 10+ years ago, didn't have it for my ectopics it was for SVT and had ectopics back from a few days after. Heart has overall been better since, and the ectopics probably are less common. But I'm still getting them. What I've found since ablation is I get periods (months or years) where I barely notice them, then I go through a bad bout for a while. My GP is always happy to run tests during a bad bout and it usually does calm down again. Currently in a bad bout of them again. There's things I wish I'd done differently though. I started drinking alcohol infrequently post ablation, which research has linked to ectopics starting back up, and also got in a bad caffeine habit. I wish I'd left both alone to give me the best chance of them not returning, but maybe they would have, covid didn't seem to help matters.