I wonder if anyone can advise me on the following - a bit of background - I have had AFib for the last few years - the vast majority of episodes required electric cardioversion to get back to NSR - I have had 11 of those. I have had four ablations - #1 lasted eight months. #2 was eleven months later and lasted five months; #3 was eight months later and lasted three months. I was reluctant to have a fourth and so just spent 19 months on amiodarone, but the EP insisted I was too young to stay on it long term and persuaded me to try yet another ablation. At least I got a gap of 33 months this time thanks to amiodarone!
Anyway, Pulsed Field ablation 26 days ago. Been having episodes of fast heart rate - often goes up to 90-100 at rest (my usual resting heart rate was mid-50s) lasts a few minutes to a few hours. I have also had a couple of longer episodes with HR between 120-150. All self-corrected after maximum of 6 hours. Arrhythmia nurses told me to sit these episodes out unless I felt too ill and obviously I am still in the infamous blanking period.
So, my question is (finally getting to the point!) just how long do I sit these episodes out? I have now had a HR of 90 - 135 for the last 11 hours. I'm a bit breathless and a bit light-headed when I move around, but ok other than that. I have no PIP and am only taking anti-coagulants for the heart. Am I damaging my heart?
Also what medications are recommended if this continues - I'm a zombie on the lowest dose of beta-blockers and cannot take verapamil. I previously took flecainide for a number of years until it stopped working before switching to dronedarone (didn't work for me) and then amiodarone.
Thank you in advance, Jaja
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Jajarunner
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I have seen a paper somewhere which says that though there can be a blanking period, it's best not to just wait and see and hope, but that if there's anything that can be done during the blanking period then that helps the heart heal. This makes sense as if there are wayward rhythms then the tissue is not getting the chance to reverse remodel. I've had perhaps an example experience. Another ablation (my third in 22 years) fixed my fast atrial rhythms immediately but left me with 22,000 PVCs per day (25% burden). My EP said it was possible to increase my post-op Flecainide from 100 to 200 mg/day, and this has very quickly settled my heart, 4,500 PVCs/day 2 weeks ago, 2,200 this week just gone. And it does feel to me like the whole thing is settling down.
It may be worth trying Flecainide again, as mine used not to work well before my ablations, but is clearly working now.
p.s. I was discharged on Flecainide after my first two ablations, too. I was just into continuous AF ("permanent") at the time, so that's a difficult ablation, so I think it was a good decision by my EP then. I had a good 15 years fib-free until my aortic dissection
Whilst raised heart rate is normal after an ablation anything much above 110 is less than ideal and would fall outside the "normal " range . A range around 135/140 can often be atrial tachycardia, again not uncommon after ablations, so I would suggest discusssing the possibility of a DCCV (Cardioversion) if it persists.
Bless you, that sounds rough. You are still well insude the blanking period. Try to rest as much as possible, keep well hydrated, but I would say if it persists, and it's over 100 all the time then perhaps visit AnE may be an idea?xxxx
I’m sorry you’re having this post ablation trouble- I do hope it’s just temporary and will resolve within the blanking period. But I agree, you must want to get some advice on how long to sit out the tachycardia. I presume your arrhythmia nurses aren’t available to ask over the weekend? It’s a shame they didn’t say if there was a heart rate or length of time that would need attention rather than sitting it out. Mind you, I’ve asked that direct question regarding when I’m in fast AF (consistently over 140bpm) and I have had very different answers, ranging from leave it ‘no more than 1-2 hours’ to ‘at least day or two’ so long as feeling ok! So I always end up staying home and hoping it will self convert.
I’m sorry I don’t know if having just had an ablation would mean you should be seen sooner or not… I do hope you can get some helpful advice from somewhere - and best of all that you are already (or soon) back in NSR. 🙏🏻 Jx
I'm now in A&E. On the drive here HR corrected itself so we turned back only for it to go berserk again 🙄. About 140 now 😱. Thank you for your kind response
Have they tried the calcium channel blocker. Diltiazem" for rate control?
It works well for many of us, including myself, and unlike beta blockers, it does not have such a profound effect on the resting heart rate so it's tolerated a lot better.
As far as cardioversion is concerned, it is not typically used for atrial tachycardia, but more for arrhythmias, like atrial fibrillation or atrial flutter. I'm assuming these episodes are not a fib since you didn't mention it.?
I can't take verapamil which I think is also a CCB. I'm now at A&E with HR of 140. Feel terrible but it's going to be a long wait.....Thank you for your help
Sorry about what you're going through but I think you're in the right place to help sort things out. You should not be at home riding out such a high heart rate regardless of what the nurse says. Just because you cannot tolerate veraptamil, doesn't mean you cannot diltiazem. Maybe ask them the hospital?
My experience is very humble compared to yours - so far I have only had one ablation. However I experienced what you are going through within the blanking period with my HR getting up to 150 bpm.
Amiodarone for six weeks sorted it working immediately. Rather drastic I know but my cardiologist preferred to use use the heavy artillery as my EF had drastically dropped and during my echography she simply stated : " Your heart is very tired" . I was Afib free for nearly 2 years. I have started having short infrequent episodes again and take Sotolol as a PIP.
Thank you. The whole point of the ablation was to get me OFF of amiodarone, but I hadn't thought of it as a short term measure for myself. I'm in an A&E ward now but will ask in the morning. HR higher than ever, stuck at 122 now. Turns out I'm anaemic too , think it may be all the blood lost to cause extensive deep bruising after the ablation....
Oh I'm sorry to hear that. If you responded well to Amiodarone before it might work as a short term solution this time? I really thought I was worse off than before and started to regret the ablation but the Amiodarone knocked the different arrhythmias on the head and I think gave the heart time to heal in my case .
I have had three ablations and the last two left me with some lingering Inappropriate Sinus Tachycardia. Unmedicated, mine tends to go upwards of 90-110 resting and up to 120-140 when acrive. Last time I had to take meds for about six months, and I am expecting that this time as well. My EP prefers Corlanor (Ivabradine) as it doesn't cause all the yucky side effects. I cannot take Calcium Channel Blockers either and the Beta Blockers make me feel gross, but the Ivabradine has been stellar. Keep us posted.
I've just been through a bad patch with sinus tachycardia since the middle of August. Only self converted 27 hours after doubling my dose of Sotolol to 320mg daily 10 days ago. But how long to sit these episodes out is a question that has caused me some significant anxiety.
After an echocardiogram whilst in tachycardia showed very worrying poor results, because of that, going forward, I now wouldn't hesitate to seek medical intervention after 48 hours or before if you experience any pain.
I hope you get sorted and I would take some comfort that you have the advice of an experienced arrhythmia team.
I have been advised by GPs and consultants that if the heart rate is over 100 (one of them said 90) and it lasts for more than 30 mins I should call for an ambulance. Certainly, if there is any breathlessness you are supposed to do that immediately.
However, if the situation is post-ablation then it is (or may be) quite different. I would ring the hospital (or 111) to give them detailed information on what is happening and obtain advice on what to do. They might ask you to see an out-of-hours GP to check that all is well.
Thank you for your helpful reply. I think the sitting it out instruction was because it wasn't super high and resolved in a few hours. Yesterday was a horror show. I did come to A&E and ended having an emergency DCCV as my BP fell to 53/33! Apparently even the Crash Team were panicking!! 😱😱😱 Thank goodness I came in....
Not saying I'm feeling out of it after yesterday's excitement but I just saw this on the daily email and thought 'ooh, sounds just like me '. Duh! It IS me 🤣🤣🤣
I don’t think you can possibly be damaging anything. If you are well in yourself (i.e. feel safe since you’ve had it before) and your BP is not too low, then I suspect sitting at home is safer than sitting in A&E.
As we are all different, when I have a sustained elevated heart rate for even a relatively short period of time, a few days, it induces a tachycardia cardiomyopathy in me reducing my ejection fraction to 25 - 30%. No heart can tolerate a high heart rate very long without sustaining some damage. The good news is that it is usually reversible once the heart rate normalizes. I have had 6 ablations with varying degrees of success. Most recently I had one done on October 25 and things seem to be ok so far but I did experience some early episodes of increased heart rate, 125-150, but for me metoprolol worked slowing my heart rate down. If you are as symptomatic as your say you are then something needs to be done to help your through these periods. Seems odd to let you suffer through these periods of high heart rate.
I think the initial ones were just a few hours before converting, I probably should have got them to put a clearer timescale on it. Thank goodness I did go to A&E in the end as I went into shock with a BP of 53/33 and had to have an emergency cardioversion at the bedside of the A&E ward 😱😱😱. Thank you for your thoughtful reply 🙏
Oh my goodness, jaja, thank goodness you went to A&E when you did … phew. I do hope you’re recovering well now after all the drama and emergency dccv 😖 xx
After reading all of this post,l would just like to wish you well. What a nightmare for you and thank goodness you went to AE. I have low blood pressure, so know how frightening that can be. I have just had a change of meds. and mine went too low so l had a couple of cups of strong coffee as a last resort. Caffeine helps bring it back up. Hope you soon get some peace from all of this and that, in the end, it has all been worthwhile. Take it easy for a while yet, it’s not a race, and all will be well. Speedy recovery.
oh, goodness, what a scary ordeal. Glad you went to the hospital and they’re getting it sorted. So frustrating to have had 4 ablations and still feel so awful. The dr didn’t have you on anything meds to control the rate after the last ablation? Hope they give you something to control that high rate during your healing.
I have tachycardia too. But after 3 afib and flutter ablations, those extra pesky tachycardia triggers never revealed themselves. An unsedated EP study finally mapped then, but couldn’t ablate without damage to nerves. Waiting to see if a pulsed field ablations will help. In the meantime, the only thing that helps me is to lay flat on the floor and overfill my lungs, squeeze my belly and cough (vagal maneuvers), I’m only telling you this to give you a laugh at all the ridiculous places I’ve had to lie down. Ladies dressing room at M&S, our car outside Morrisons, the floor of multiple airports around the world, on multiple flights when lucky enough to be in a lay flat seat, and the worst.. a totally gross loo stall at a pub. 😂
Sure hope you’re feeling better now and that the drs have a plan for you! ❤️
Thank you for your nice reply.No, I had to stop amiodarone before the ablation so they didn't put me back.on it. But now being filled up with IV amiodarone. I think they'll maybe keep me on it and let the ablation heal and then wean me off again.
Pub toilet floors never a good choice unless REALLY drunk 🤣🤣🤣
lol! Yes, I hope never to be that drunk. 😂 My dr mentioned amiodarone some years ago, followed by “you’re much too young to take it”, 60ish at the time, that made me feel great. But when he mentioned it again last year, I suddenly felt old! 🙄 xx
Oh, poor you, you’ve certainly been through the mill with this episode. 💔 I can imagine how wiped out you feel. And even though it’s good you’re being taken good care of in the hospital, there’s no place like your own comfy bed at home. Hope you’re home soon!
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