Ablation, atrial flutter, and exercise

The last thing I requested before my atrial flutter ablation general anaesthetic  6 weeks ago was,"Please, don't fiddle with my pacemaker settings, leave them as you find them". Did they? No. 

I have had a month of tachycardias and shortness of breath on even light exercise such as a flight of stairs. Fed up, I contacted my pacemaker clinic and they had me back.  The test of two flight of stairs nearly had me with the crash team. I really could not breath at the top much to the shock of a passing health care worker.  Back to my old settings and another two flights of stairs - no problem. 

Now I am still in atrial flutter. I am told that it could take another month to settle ( according to the hospital  hand out and literature).  I am writing this because yesterday I tried to use a spade to dig a little grass away from my front drive kerb and ended up acutely short of breath. Lying on the grass, gasping, the passers-by asked, "Are you all right?". Ha, ha, how can you answer when you can't breathe?  Fully recovered, I realise that the problem must be venous return - any holding of the breath whilst straining ( such as digging) increases intrathoracic pressure and worsens the venous return to my fluttering atria.and subsequent poor cardiac output.  I am presently reduced to swimming a mile with 8 gasps for air at the end of each length. 

I expect patience is a virture. I may ask for my minute ventilation rate response to be turned back on, as it did help the swimming. I see my cardiologist in a month or so.  I just hope the atrial flutter settles. This is my fourth ablation. I am left wondering how many ablations  you can have?  I expect sooner or later luck may run out. Things could be worse and things could be better.  There is always chocolate. Back to the Easter egg.

Happy Easter.


Rest Up!

by Penguin - 2024-03-31 15:31:16

I'm in no position to give you advice Selwyn! However, perhaps the advice that you would give to a patient in your own situation may be worth a moment's thought?

Would you suggest that you should ditch the swimming, gardening etc and wait for the flutter to settle or would you suggest that you should keep doing as much as you can? 

My advice would be the Easter Egg. 

As for setting changes -  don't get me started.

You don't sound in great shape right now Selwyn.  Look after yourself please. xx


Please pace yourself!

by Gemita - 2024-03-31 16:15:07

Dear Selwyn, this is not the news I was hoping for but let us hope it may still be a normal part of healing and that things will steadily improve for you.  Healing after an ablation can be so variable and I don’t think at this early stage we can say with certainty what the future holds.  I do hope it won’t mean another attempt will be necessary, although I think your team did mention this could be a possibility with your atypical Flutter which is quite difficult to control.

In your shoes after going so far and if one more attempt should ever become necessary to hit this on the head, then I would probably go for it but no more.  To try to cure a tachyarrhythmia like atypical Flutter or Atrial Fibrillation has to be better than controlling it with an AV Node ablation but if cure is not possible and this is wearing you down, how would you feel about becoming pacemaker dependent with an AV Node ablation?  Would that ever be an option for you?  You would lose the atrial kick, but with atrial flutter present, you have already lost that atrial push.

Well no-one can accuse you of not testing your heart fully following the Flutter ablation, but I too am wondering whether pushing yourself during these early months might work against you although I know you would see it as a failure not to do so.  Just don't expect too much at this early stage.  Ablation healing can take months.   Pace yourself consistently, slowly.   I would also advise you keep the consumption of chocolate Easter eggs to the minimum!  Chocolate is a trigger for me.

I hope your Flutter burns itself out and that the ablation will still be successful.  Stay safe wherever you are 

Sometimes the patient knows best

by Good Dog - 2024-04-01 07:25:59

With regard to your PM settings; I truly sympathize with you! Often and especially with a long-time PM patient, nobody knows what is best for the patient better than the patient! If they would only listen. 

When I was on the table for my last procedure the Medtronic Rep asked the doc if I had an underlying rhythm. I spoke-up and said; yes, I have a good 35 bpm junctional escape rhythm. I told them that I do fine with that low rate and to just give it a few seconds to kick-in when you drop the PM rate (I'm sure they didn't need my 2 cents, but I gave it anyway).So they did and the Doc said; "there it is; well, who would know their body better than the patient! 

My point is; that I am sorry that they did not listen to you! I am sure that it is pretty likely that you have  forgotten more than most of us ever knew. So I am confident you will help to insure that they get you back into fighting shape ASAP! I wish you the very best!



How frustrating

by Tracey_E - 2024-04-01 11:08:34

Patience is a virtue, but it's a lot more challenging when they didn't do what they were supposed to! I hope you are feeling better soon. 

Being a patient patient and careful with the chocolate

by Selwyn - 2024-04-01 17:49:34

Patience is indeed a virture. Thanks for all the advice and best wishes guys.

I thiink the exercise thing is to do what you are comfortable with. The problem is knowing what will cause acute breathlessness.  I never thought that using a spade could be so upsetting. There is a lesson for all of us that are in atrial flutter and I presume those with atrial fibrillation. I find lifting and carrying weight the same. I think this is something to do with venous return. I would be really interested to hear of other people's experience with regard to this as it is something that I was not aware of previously. 

You are right : ALWAYS LISTER TO THE PATIENT.  If only doctors actually did that. We all get treated as if we are educationally retarded, and I include myself in that. Particularly if you have long term health problems you are likely to know more about your condition than the average GP, and also for a lot of junior consultants that have done the studying but not the listening. 

My sympathy, Gemita, about chocolate. A trip around Bournville Cadbury's once gave me a headache.  However, I do note chocolate contains caffeine, dark chocolate has the most. The higher the amount of cocoa solids in chocolate, the greater its caffeine content. According to Amano, a pound of 90 percent dark chocolate contains about 816 milligrams of caffeine. While most people may not eat that much in one sitting, even 1 ounce contains about 102 milligrams of caffeine, or about the same as drinking an 8 ounce cup of brewed coffee. One study published in the August 2004 issue of "BioMed Central Cardiovascular Disorders" noted that eating chocolate triggered palpitations in patients with known episodes of the disorder. 

I wonder if white chocolate is the answer?

Thank you all for your best wishes.


Same here on bending over, carrying weights

by Gemita - 2024-04-01 19:56:05


I remember an old post of yours on this very subject and I have posted too about shortness of breath, worsening arrhythmias on bending over.  I recall you mentioned something about venous return to the heart is diminished due to the bend.  The heart rate then slows and the normal physiological response would be to increase the heart rate as soon as possible to compensate but with a pacemaker this doesn’t happen quickly enough.  Not sure what the answer is.  And of course any excess weight we carry around the middle or after a heavy meal, would make the situation worse.

I have exactly the same problem carrying weights even fairly light weight shopping can sometimes trigger worsening tachycardia and SOB, as can working in the garden with loppers, stretching up, or bending over using a heavy edging tool.  If I remain bending over for too long, I can come over faint and breathless as tachycardia starts for no apparent reason.   My husband has just had two episodes of near faints over the past two days while bending over.  Who would have thought a simple action like bending or carrying lightweight shopping could cause such difficulty?  I wonder which pacemaker setting could help prevent this or at least help?

I didn’t realise how much caffeine there is in a bar of dark chocolate.  White chocolate is too sweet and full of sugar, so it is definitely not the answer for me

White Chocolate is a misnomer

by Good Dog - 2024-04-01 20:43:56

White chocolate.................is not chocolate.....................

Gardening Conditions

by Penguin - 2024-04-02 05:58:36

I don't know how the North of the UK have fared over Easter, but further South we've had loads of rain and my soil is claggy, super heavy and difficult to lift with a spade.  I haven't been close to collapse, but have had to ease up and have felt exhausted and light headed at times gardening - particularly digging out and moving heavy soil using a wheelbarrow to move soil around. I'm having to do very small manageable amounts a bit at a time and lighter trowel work - kneeling is easier. 

I've decided to adopt the RHS suggestion of 'no dig' gardening where I can - better for the soil and easier for me!  Let the worms do it for you. 

You know you're wired when...

You always have something close to your heart.

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