Post-Ablation Atrial Fibrillation: Heart Rate Variability

Post-ablation heart rate in atrial fibrillation?

Hello, Doctor.
I underwent catheter ablation for atrial fibrillation in early February this year.
On the 20th day after the procedure, I experienced brief episodes of irregular heartbeats lasting about 3 minutes each, with my heart rate fluctuating between 85 and 124 beats per minute after meals, but it returned to normal after 3 minutes.
Additionally, on the 37th day post-procedure, I noticed continuous fluctuations in my heart rate between 70 and 92 beats per minute for about 5 minutes upon waking up.
Currently, my heart rate is normal at other times, and I am taking Dronedarone.
Could you please advise if this is considered a recurrence of atrial fibrillation or a normal manifestation during the three-month blanking period post-ablation? Am I safe to engage in regular exercise? Thank you for your time.

Xiao Houzi, 50~59 year old female. Ask Date: 2020/04/16

Dr. He Dongjin reply Cardiology

Hello, a heart rate fluctuating between 70 and 92 beats per minute is generally considered normal.
However, fluctuations between 85 and 124 beats per minute may indicate an abnormal rhythm.
It's difficult to determine if this is a recurrence of atrial fibrillation.
It is likely not a concern, and you should be able to exercise normally without issues.
Don't worry, and take care.
Changhua Hospital is here for you.

Reply Date: 2020/04/16

More Info

After undergoing catheter ablation for atrial fibrillation (AF), it is common for patients to experience fluctuations in heart rate as the heart adjusts to the changes made during the procedure. Your observations of heart rate variability, particularly the episodes of increased heart rate (85-124 bpm) after meals and the fluctuations (70-92 bpm) upon waking, can be concerning but may not necessarily indicate a recurrence of atrial fibrillation.

Understanding Heart Rate Variability Post-Ablation
1. Normal Post-Ablation Response: After an ablation procedure, the heart may take time to stabilize. It is not unusual for patients to experience episodes of increased heart rate or irregularities in rhythm as the heart's electrical system heals. The fact that your heart rate returns to normal after a few minutes is a positive sign, indicating that your heart is capable of self-regulating.

2. Heart Rate Fluctuations: The heart rate variability you are experiencing, especially after eating or upon waking, can be attributed to several factors:
- Autonomic Nervous System Influence: The autonomic nervous system, which controls involuntary bodily functions, can cause fluctuations in heart rate based on activity levels, stress, and even digestion. After eating, the body diverts blood to the digestive system, which can temporarily increase heart rate.

- Postural Changes: When you stand up or change positions, your heart rate may fluctuate as your body adjusts to maintain blood flow and pressure.

3. Monitoring for AF Recurrence: While occasional fluctuations are common, it is essential to monitor for signs of atrial fibrillation recurrence, such as:
- Persistent palpitations or irregular heartbeats.

- Episodes lasting longer than a few minutes.

- Symptoms such as shortness of breath, dizziness, or chest pain.

4. Consulting Your Healthcare Provider: Given that you are experiencing these fluctuations, it is advisable to maintain regular follow-ups with your cardiologist. They may recommend additional monitoring, such as a Holter monitor, to assess your heart rhythm over a more extended period.

Exercise Considerations
Regarding your question about exercising, it is generally encouraged to engage in regular physical activity post-ablation, as it can help improve cardiovascular health and overall well-being. However, consider the following:
- Start Gradually: Begin with light to moderate exercise, such as walking or cycling, and gradually increase intensity as tolerated.

- Listen to Your Body: Pay attention to how your body responds during and after exercise. If you experience significant palpitations, dizziness, or other concerning symptoms, it may be wise to reduce intensity or consult your doctor.

- Avoid High-Intensity Activities Initially: Until you have a clearer understanding of your heart's response post-ablation, it may be prudent to avoid high-intensity workouts or activities that could provoke significant heart rate changes.

Conclusion
In summary, the heart rate fluctuations you are experiencing post-ablation may be a normal part of the healing process. However, it is essential to remain vigilant for any signs of AF recurrence and maintain open communication with your healthcare provider. Regular exercise is beneficial, but it should be approached cautiously as you monitor your heart's response. If you have any concerns or if symptoms persist, do not hesitate to seek medical advice.

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