Managing Atrial Fibrillation: Irregular Heartbeats After Ablation

After undergoing four catheter ablations, the heart rate still occasionally fluctuates between being fast and irregular?

Hello Dr.
He,
I have been experiencing atrial fibrillation due to arrhythmia and have undergone multiple catheter ablation procedures at the hospital.
However, since the last procedure 17 days ago, my heart rate continues to fluctuate, sometimes speeding up, and I experience mild chest pain when it slows down.
When my heart rate is elevated (120-145 bpm), I don’t feel uncomfortable.
I am currently taking one tablet of Dronedarone (200 mg), and sometimes I need to add one tablet of Bisoprolol (30 mg) to lower my heart rate to between 70-55 bpm.
However, after my heart rate decreases, it sometimes beats irregularly for a few beats and then pauses, which feels very chaotic.
Once the medication wears off, my heart rate increases again.
Could you please explain the reason for this? What kind of treatment should I seek? Are there other medications or methods available to help control my heart rate? I would prefer to avoid further ablation procedures.

Mr. Xin, 60~69 year old female. Ask Date: 2021/01/28

Dr. He Dongjin reply Cardiology

Hello, I apologize for the limited information I can provide.
I recommend returning for a follow-up and discussing thoroughly with your attending physician to seek a mutually acceptable treatment plan.
Wishing you peace and good health.
Changhua Hospital cares about you.

Reply Date: 2021/01/28

More Info

Managing atrial fibrillation (AF) after catheter ablation can be a complex process, especially when patients experience irregular heartbeats and discomfort post-procedure. Your situation, where you continue to experience episodes of rapid heart rate (tachycardia) and mild chest pain, is not uncommon among patients who have undergone ablation for AF.
Atrial fibrillation is characterized by disorganized electrical activity in the atria, leading to an irregular and often rapid heart rate. Ablation aims to eliminate the sources of this abnormal electrical activity, but it does not guarantee that AF will not recur. In fact, it is not unusual for patients to experience a period of "atrial remodeling" after the procedure, where the heart's electrical system is still adjusting. This can result in episodes of tachycardia, irregular heartbeats, and even palpitations.

The symptoms you describe, such as a heart rate of 120-145 beats per minute and the need for additional medication to manage these episodes, suggest that your heart may still be in a state of instability post-ablation. The fact that you experience mild chest pain when your heart rate slows down could indicate that your heart is struggling to maintain a normal rhythm or that there is some underlying ischemia (reduced blood flow to the heart muscle), which can occur in the context of AF and rapid heart rates.

Here are some considerations and potential management strategies:
1. Medication Adjustment: It seems you are currently on Dronedarone (臟得樂) and occasionally use Bisoprolol (合必爽) to manage your heart rate. It may be beneficial to discuss with your cardiologist the possibility of adjusting the dosages or trying different medications. Beta-blockers, calcium channel blockers, or antiarrhythmic drugs can help control heart rate and rhythm.
2. Monitoring and Follow-Up: Regular follow-up appointments with your cardiologist are essential. They may recommend continuous monitoring (such as a Holter monitor) to capture your heart's rhythm over a longer period. This can provide valuable data to help tailor your treatment plan.

3. Lifestyle Modifications: Certain lifestyle changes can help manage AF symptoms. These include maintaining a healthy weight, engaging in regular physical activity, avoiding excessive alcohol and caffeine, managing stress, and ensuring adequate sleep.
4. Consideration of Further Ablation: If your symptoms persist and significantly impact your quality of life, further ablation may be considered. This decision should be made in consultation with your electrophysiologist, who can evaluate the potential benefits and risks based on your specific situation.

5. Patient Education: Understanding your condition and the potential triggers for your AF episodes can empower you to manage your symptoms better. Keeping a diary of your symptoms, heart rates, and any potential triggers can be helpful for discussions with your healthcare team.

6. Alternative Therapies: Some patients explore complementary therapies, such as acupuncture or mindfulness practices, to help manage stress and potentially reduce AF episodes. However, these should be discussed with your healthcare provider to ensure they fit within your overall treatment plan.

In summary, your experience of irregular heartbeats and discomfort after ablation is not uncommon, and it may take time for your heart to stabilize. Close communication with your healthcare team, medication adjustments, lifestyle changes, and possibly further interventions can help manage your symptoms effectively. Always consult your cardiologist before making any changes to your treatment plan.

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