PM After Cardiac Ablation

Bob - it will get better

by Gemita - 2021-03-01 16:09:06

It is really hard to know whether the ablation caused the bradycardia.  You may have been heading that way even without the ablation.  Like AF, bradycardia is also an electrical disturbance that might already have been present waiting to be triggered and maybe the trigger was the ablation, but maybe not.  AF could certainly be a trigger and taking out one arrhythmia can sometimes reveal another (bradycardia).  This happens a lot according to my EP.  It doesn’t necessarily mean that the ablation caused the bradycardia. 

In my case I have AF which has become more frequent.  I chose not to have an ablation a few years ago, but may still get one.  My AF over the years has caused both fast and slow rhythm disturbances (tachy/brady syndrome) and I required a pacemaker for the bradycardia part, the pausing and the syncope in 2018.  I am not disappointed.

If you still feel symptomatic like you felt in AF, I wonder if the AF is still occurring?  You are still in the blanking period (3-6 months) and it is possible AF may still be present.  Remember too that an ablation can be very traumatic for the body and your heart is still healing.  So much can be expected during this period, even a worsening of many symptoms and of the arrhythmia itself.

You ask whether the ablation could have caused additional damage to the heart?  Well the procedure itself Bob can sometimes cause damage to cardiac nerves and blood vessels and other structures in the area.  It is not completely risk free but I believe you are still healing and because you needed additional intervention (a pacemaker) so soon after your ablation, you are expecting rather a lot from yourself.

I am uncertain whether you are worried about becoming hypertensive and diabetic, or whether you have these conditions Bob?  Lifestyle changes can be beneficial for both conditions but they will need treating if they are out of control.  Trauma, like an ablation, pacemaker implant, an infection, any illness, may adversely affect blood glucose levels.  This has been my husband’s experience and confirmed by his Diabetes team.  The same may also be said for blood pressure that may increase in the presence of a traumatic event, infection, illness, inflammatory condition and so on.  I think you need to appreciate just what a trauma you have been through and all your symptoms could well be the result of your body trying to come to terms with what has happened.  I believe you will get better but it may take a little longer Bob.

It is completely understandable but try not to fight yourself anymore, try not to go over in your mind whether you made the right decision about the ablation, it is done and we cannot go back ...but we can go forward.  And forward from where I am sitting sounds likes a better place once you are healed.  You will have your pacemaker to protect you from bradycardia, your ablation after the healing period should give you good results and freedom from any residual AF.  Your nausea and other symptoms should resolve and with pacemaker adjustments you will be a new person.  Does that sound more reassuring?  I think it is worth aiming for, don’t you?

Action Plan:  Give yourself time to properly heal.  Listen to your body and rest if you need to.  Get your blood pressure/blood glucose checked and take medication or other treatment if you need to.  Ask your doctor for additional blood checks if you continue to feel poorly or have sharp chest pain (referred to in previous posts I believe)?  They may want to look for inflammation or an infection.  

Finally, good luck and enjoy the journey ahead

Gemita is correct!

by Julros - 2021-03-01 16:27:46

Bob, your frustration and doubts about the ablation and pacemaker are understandable. You have undergone both physical and emotional trauma. You may be greiving at this point, which is normal, perhaps bargaining about the "what-ifs." I am going to guess many of us have felt that way. The good news is, you will feel better. As your heart muscle heals and your provider adjusts your settings, you will like have more energy and edurance.

For myself, I had an ablation for aflutter, but my heart rate was already 40. Knowing that the bradycardia might persist, I consented to a pacemaker beforehand. I had a great deal of pain and was so angry that I felt unheard and brushed off. It has taken some time and adjustments , but I feel much better than before the ablation. My A1C has been slowly creeping up for years, so  I made the decision to change my diet and increase activity. I have lost weight and reduced my lisinopril dose to almost nothing. 

Long story short, it will get better. Make sure your heart team knows your concerns. CrustyG has many posts about what sorts of settings you might ask for to maximise exercising. 

Ablation, Bradycardia, and pacemaker.

by AgentX86 - 2021-03-01 23:39:58

Sure, a botched ablation can certainly cause Bradycardia.  Damage to the sinus node is one of the (small) risks of ablation surgery.  I don't know if that was the cause but it is a possibility. 

Ablations cause "damage" to the heart.  That's the whole point of them - to create scar tissue that insulates the source of the aberrant electrical signals from the rest of the heart.  If the EP ablates the SI node, Bradycardia or complete loss of the SI node (or AV node) is rare but possible.  A PM should completely fix the problem.

Diabetes would be a very unlikely result.  There my be a connection between high blood pressure and sboof sugar but that's just a guess and the cause/effect may be reversed.

I'd say that a 63yo man with a 4yo child is enough reason for hypertension, though I wouldn't expect Bradycardia!  ;-)

A " Botched" ablation ??

by IAN MC - 2021-03-02 07:18:29

The word " botched" implies that your ablation may have been carried out badly or carelessly . In defence of your E.P. this is probably a long way from the truth. 

Cardiac ablation, like any surgical procedure carries a risk of complication When I had a flutter ablation , it was spelled out to me that the procedure carried a  0.3  % risk of leading to the need for a pacemaker.  I had to sign a consent form acknowledging that fact.

When you think about it , your EP had to selectively burn some tissue inside your heart  ( which is about the size of your clenched fist ) while it  was thrashing around !!     It always amazes me that the complication rates after ablations are not much higher !

Like Gemita, my EP told me beforehand that ablations often reveal other pre-existing arrrrythmias and bradycardias.

But you are where you are and I hope that you, and your doctors, resolve your low energy levels .Interestingly, I recently had the same problem and found that , in my case, blood pressure drugs were the cause. 

Best of luck 

Ian

Botched

by AgentX86 - 2021-03-02 16:45:27

Yes, botched.  Ablating the SI, or A/V node is a "botched" procedure, IMO.  Intentional or careless?  Unlikely (but possible) but it's more than just an honest mistruin, mismanage; muff, butcher, flub.ake.

Synonyms: ruin, mismanage; muff, butcher, flub.

It's amazing to me too but that's what they're paid to do and it's done routinely.  I'm amazed at a beating heart CABG, too, but it's relatively rare because it can so easily be "botched".

Thanks to the People who commented!

by BobN - 2021-03-05 17:31:06

Hi,

I want to thank all of you who commented on my earlier post regarding my rant of a botched ablation!  Gemita, you really put some effort into your response to me and I just read it today, so sorry it has taken so long to respond to your wonderful response!  You helped me immensely and I now feel my outlook is much better!  I have had one adjustment and it seemed to make things worse for the first two days but now I am doing better. I am constantly assessing how I feel and trying to understand why I feel the way I do sometimes.  Before my ablation I was involved in weight training and loved to workout.  Since the ablation I haven't attempted it because I wasn't allowed to for a month. After the month I felt faint and weak and shortly after I received the PM.  Now it has been 6 weeks since I received my PM and I want to start to work out but I noticed that my heart rate goes up to fast.  If I turn over in bed my heart rate increases as if I just finished a set of 12 reps of weights, well, maybe not that bad but normally I don't feel my heart from such a minor movement. Anyway, I am rambling I think, but I wanted to say thank you to you and all the other PM people who commented and offered advice, it really helped!

Bob N.