My Second A-Fib Ablation Recovery (3-Month Blanking Period)

The three-month period following your ablation is called the “blanking period.” It is the time it takes for heart to fully recovery after the procedure. This is obviously an average time as some people will heal faster and some will heal slower, but generally speaking across the boards it takes three months for the heart to heal.

When I was discharged from the hospital after my second a-fib ablation, I was instructed to email my care team a copy of my ECG/EKG every week throughout my blanking period. The EKG is taken with my Kardia heart monitor. It’s pretty slick because all I have to do is fire up the Kardia app on my iPhone, hold on to the Kardia device, and within one minute I have an ECG in PDF format that I can quickly and easily email to my care team. The process is way easier than my last blanking period back in 2015.

My second ablation was on Thursday, January 19th. I will be updating this post weekly with updates on my recovery.

Week 1: January 26, 2023

Heart Rate: 91 bpm
Blood Pressure: 120/79
Blood Oxygen: 97%
Heart palpitations/a-fib: NONE; Normal Sinus Rhythm
Other symptoms/issues: NONE

Comments:
When I sent my first weekly ECG to my care team I commented that I felt great but was surprised my resting heart rate has been hovering around 90 bpm since Saturday, January 21st (2 days after my ablation) when it was just 72 bpm immediately after my ablation. One of the nurses replied back to me with this response:

“Inflammation and healing are affecting your normal rate pacing presently. Due to the proximity of your ablation to the normal nervous system pacing structures, Dr. Natale says it can take some time after an ablation to settle into your new normal. He often gives it 6 to 9 months.”

The “normal nervous system pacing structures” the nurse is referring to are the SA and AV nodes. The SA node is considered the pacemaker of the heart. It fires electrical signals that ultimately determine how often your atria (upper chambers of the heart) will contract, which is your resting heart rate. When each signal is sent the atria contracts. The signal then passes through the AV node to the ventricles (lower chambers of the heart) and then they contract. The path the electrical signal takes looks like this:
SA Node > Atria Contract > AV Node > Ventricles Contract
Anything that interferes with this electrical pathway can affect your resting heart rate.

My coronary sinus was ablated, which is right near that electrical pathway. As a result, the inflammation from the ablation in that area is affecting my resting heart rate. Dr. Natale is saying that it can take 6-9 months for that inflammation and subsequent interference to fully subside.

After my first ablation my resting heart rate was in the 80’s for well over a year. In the second year it eventually settled down to my new normal resting heart rate of 55 bpm. Prior to that ablation my resting heart rate was in the low to mid 40’s (I used to run a lot prior to that ablation).

Whether it takes 6 months or one year before my resting heart rate settles down to my new normal, I’m going to guess my new normal resting heart rate will be in the low to mid 60’s. If I’m right, that will be awesome because I’d prefer my resting heart rate to be above 60. I’ve had bradycardia my entire adult life without any issues, but the lower your heart rate, the more prone you are to arrhythmia.

Week 2: February 2, 2023

Heart Rate: 84 bpm
Blood Pressure: 116/81
Blood Oxygen: 97%
Heart palpitations/a-fib: NONE; Normal Sinus Rhythm
Other symptoms/issues: NONE

Comments:
I had another great week! My heart was in total sinus rhythm and I had ZERO heart issues. I felt 100% normal. I felt so good I decided to walk on the treadmill a couple of times. I would have walked outside but it’s been freezing cold here. Hopefully I’ll be able to get outside this coming week. Whether I walk on the treadmill or outside, or a combination of both, my goal will be to get a walk in every day this coming week.

My resting heart rate has already come down from last week. While I had an average resting heart rate in the low 90’s last week, this week it was in the low to mid 80’s!

1/31/23 – 30-minute walk on the treadmill
Treadmill speed: 3-3.2 mph*
Treadmill incline: 1%
Average heart rate during exercise: 102 bpm
Total Miles: 1.4
*Note I had to vary the treadmill speed to maintain a heart rate of 102 bpm.

2/2/23 – 30-minute walk on the treadmill
Treadmill speed range: 3-3.5 mph*
Treadmill incline: 1%
Average heart rate during exercise: 102 bpm
Total Miles: 1.57
*Note that I had to increase the top end of the treadmill speed range to maintain a heart rate of 102 bpm.

Week 3: February 9, 2023

Heart Rate: 93 bpm
Blood Pressure: 111/79
Blood Oxygen: 94%
Heart palpitations/a-fib: NONE; Normal Sinus Rhythm
Other symptoms/issues: NONE

Comments:
I had another great week but something happened last night when I went to bed that has me slightly concerned. I was lying in bed watching TV for a bit when suddenly I had one of those weird “a-fib mini runs” I’ve mentioned in some of my recent blog posts. I call them “a-fib mini runs” because they feel like the start of an a-fib episode but they terminate as quickly as they start. They last mere seconds and then go away. I’m only slightly concerned because I experienced those periodically throughout 2022, but then eventually went into persistent atrial flutter in late November.

The nurse I communicate with weekly during my 3-month blanking period warned me the day after my ablation that the L.A.A. is very stubborn and it’s not uncommon to go into a-fib or atrial flutter sometime during the blanking period. He specifically told me he wouldn’t be surprised to hear of “some activity” around the 6-8 week mark of the blanking period. I’m only three weeks into my blanking period so I’m slightly concerned that I may already be experiencing “some activity.” We’ll see how it all unfolds.

The only other thing that stands out for me this past week is my blood oxygen level at the time I recorded my weekly vitals for this update. My blood oxygen levels were 3% lower than usual (94% vs 97%). I tested it on a couple different devices at different times and they all came up somewhere between 93-95%. Of course being the paranoid person I am when it comes to health issues I went down a rabbit hole to figure out what was going on. I discovered that it’s normal for blood oxygen levels to fluctuate and that there isn’t anything to worry about as long as you don’t have any symptoms, and as long as your blood oxygen levels don’t go below 88%. I was just surprised my blood oxygen levels were “so much” lower than usual.

I have exercised every day since my last update on Thursday, February 2nd. I have either walked outside or on the treadmill for two miles every day, which takes about 35 minutes to complete at the pace I walk (between 3.5 – 4 mph). My average heart rate during each walk was around 104 bpm. That was the extent of my exercises. I am being far more aggressive with exercise during this blanking period than I was during the blanking period after my first ablation. My first ablation was far more extensive so there was a lot more heart inflammation going on than there is this time around. Back then I didn’t do any exercising until about the third month of the blanking period.

Week 4: February 18, 2023

Heart Rate: 85 bpm
Blood Pressure: 130/78
Blood Oxygen: 97%
Heart palpitations/a-fib: NONE; Normal Sinus Rhythm
Other symptoms/issues: NONE

Comments:
If you have an eye for detail you’ll notice this week’s update is a couple days late. I should have posted my weekly vitals on Thursday the 16th but time got away from me and I just forgot. It’s a good sign, though, because I’ve been doing so well since my ablation I’m already forgetting to take my weekly vitals. I hope my doctor isn’t too upset because I’m supposed to submit my EKG every seven days.

My vitals continue to be good overall, although my blood pressure was up slightly when I took it. My exercise routine remains the same. I continue to walk two miles every day. During those walks my heart rate is steady at around 104 bpm. That puts my exercise heart rate at about 60% of my maximum heart rate of 170 bpm, which is still considered low intensity exercising so it’s perfect for me right now. In a couple of weeks I’ll push that to around 109 bpm, or 64% of my maximum heart rate, to do more moderate-intensity exercising.

In case you’re wondering, I am not on any prescription drugs right now except Eliquis (5 mg, twice daily). I’ll be on Eliquis until I get my Watchman implant and it is fully sealed over, which won’t be until about mid-June if all goes well.

Week 5: February 23, 2023

Heart Rate: 87 bpm
Blood Pressure: 120/75
Blood Oxygen: 96%
Heart palpitations/a-fib: NONE; Normal Sinus Rhythm
Other symptoms/issues: NONE

Comments:
This past week has been great. I’ve been in normal sinus rhythm without any issues whatsoever. I’m also happy to see my blood pressure more in line with what it usually is. For some reason last week my blood pressure was a tad higher than usual.

In last week’s update I said I was going to wait a couple of weeks before increasing the intensity of my daily walks. I decided to go ahead and start increasing the intensity now. For the past five days I’ve been walking two miles every day on the treadmill with my heart rate averaging around 110 bpm during those walks. That officially put me into the “moderate-intensity exercise” category. I don’t think I’ll be increasing the intensity anytime soon. I’m perfectly fine with the a daily moderate-intensity walk!

Week 6: March 2, 2023

Heart Rate: 83 bpm
Blood Pressure: 122/73
Blood Oxygen: 97%
Heart palpitations/a-fib: NONE; Normal Sinus Rhythm
Other symptoms/issues: NONE

Comments:
I had another great week. I’m starting to sound like a broken record, but nothing has changed this past week compared to the previous week in terms of my overall heart health and exercise regimen. I remain in normal sinus rhythm and I continue to do moderate-intensity exercising everyday (two-mile walk on the treadmill daily).

Week 7: March 9, 2023

Heart Rate: 88 bpm
Blood Pressure: 118/72
Blood Oxygen: 97%
Heart palpitations/a-fib: NONE; Normal Sinus Rhythm
Other symptoms/issues: NONE

Comments:
Another great week without anything new to report. My exercise intensity remains the same – daily moderate-intensity exercising (walking 2 miles per day with a heart rate averaging around 110 bpm).

Week 8: March 17, 2023

Heart Rate: 82 bpm
Blood Pressure: 122/76
Blood Oxygen: 97%
Heart palpitations/a-fib: NONE; Normal Sinus Rhythm
Other symptoms/issues: NONE

Comments:
I missed my weekly update again by a day. I was supposed to take my vitals and then update this blog yesterday (March 16th). This is the second time I’ve done this now since my blanking period began. As I mentioned before, I suppose it’s a good sign I forget from time-to-time because that means things are going so well that I don’t even think to take my vitals. I have to keep reminding myself I’m still in the blanking period because I continue to do so well.

I had another solid week, but I have felt these weird “mini runs” of arrhythmia from time-to-time, similar to the ones I felt leading up to my atrial flutter break through back in November. It’s hard to describe what these mini runs feel like, but it’s just like you feel moments before you go into a-fib or atrial flutter. I’m sure most of you reading this understand the feeling I’m describing. It’s like you feel your heart pausing and then it’s followed by a very rapid succession of heart beats, or skipped heart beats. Fortunately, they never turned into anything as they disappeared as quickly as they appeared. I’m hoping it’s not a sign of something to come.

Other than that it’s been a good week. I continue with my daily moderate-intensity walks. Nothing has changed on the exercise front.

Week 9: March 25, 2023 ***2 Atrial Flutter Episodes***

Heart Rate:92 bpm
Blood Pressure: 119/64
Blood Oxygen: 96%
Heart palpitations/a-fib: TWO Atrial Flutter Episodes
Other symptoms/issues: NONE

Comments:
Yet again I forgot to take my vitals and update this blog on time! It’s Saturday as I write this update. This should have been done on Thursday the 23rd. Where do I start with this update? This ninth week of my blanking period has been a nightmare. To say I’m frustrated (and angry) is an understatement!

Things have been going so great up until now. I haven’t had a blip of a-fib or atrial flutter. Now it seems the wheels have fallen off as I’ve had not one, but two atrial flutter episodes this past week!

3/19/23 Atrial Flutter Episode Details
My Sunday morning was going great. I had finished my daily bible study and got up to have a quick late breakfast. I had a single serving of Cheerios with milk and one slice of peanut butter toast. My son was having a Jack’s frozen pizza so I snagged two small pieces of his pizza too. I quickly scarfed down my breakfast and the pizza in a couple of minutes. I’ve always been a fast eater. It’s a bad habit I formed many moons ago back when I was a teenager.

After quickly eating, I went back into my office and sat down to get some work done. Within minutes of sitting down I felt terribly faint. At one point my vision started to narrow and the room started to get dark. I was that close to fainting, but then suddenly the feeling went away and everything was fine but I felt really “off.”

Then BAM, I felt it. My heart was off to the races. I remembered the feeling all too well as it was the same exact feeling I had when I had my first atrial flutter break through back in November. I knew I was in atrial flutter but I was hoping it would terminate quickly. It didn’t.

I reached for my Kardia mobile device and just as I suspected, I was indeed in atrial flutter with a heart rate of 184 bpm.

I was in shock, but I couldn’t help remembering what the nurse told me the day I was discharged from the hospital after my January ablation. His exact words to me were, “Now the LAA can be stubborn. We often see activity and breakthroughs somewhere between that 8-10 week mark of the blanking period so don’t be surprised if that happens to you.” I didn’t give it much thought at the time because I was confident I would buck the trend. After all, I went 7 1/2 years without any activity after my first ablation. I wasn’t going to experience any breakthroughs. Well here I was in the ninth week of my blanking period in a full-fledged atrial flutter attack!

I wasn’t prepared for this. I was at a total loss what to do. To make matters worse, it was a Sunday so I couldn’t get a hold of anyone on my care team. I sent them an email anyway hoping they’d see it and reach out to me with some guidance.

In the meantime I walked around the house and tried to find things I could do to get my mind off of my heart. When I go into these episodes I do best if I stay active. Sitting still or lying down is the worst.

After an hour of nonstop flutter with a heart rate between 184-190 bpm, I resigned myself to the fact that I was going to have to go to the ER and have yet another cardioversion. I was more angry about that than the flutter episode. The idea of going to the ER on a Sunday afternoon, likely the busiest time of the week you can go to the ER, was not something I was looking forward to.

I figured I would take a shower and get some clean clothes on to prepare for the trip to the ER. As I often do in the shower, I prayed. I confidentially told God that He had to come through for me on this one. He had the power to end this, so He had to do it!

After my shower I continued to walk around the house to find things to do. At that point, two hours had gone by and I was still in atrial flutter. I decide to lie down on the bed to just collect my thoughts and mentally prepare for the trip to the ER.

As I was lying there for a few minutes thinking and contemplating everything, I suddenly felt normal. was it for real? Did I really convert to normal sinus rhythm? No way. It’s impossible. Going all the way back to my first a-fib diagnosis in 2006, I’ve NEVER converted to normal sinus rhythm on my own. My episodes have always required a cardioversion or drugs such as flecainide.

I pulled my Kardia monitor out of my pocket to take an EKG just to see what was going on. What I saw completely shocked me. Just like that I was in normal sinus rhythm. It was a miracle!

I can’t tell you how happy I was. I literally got down on my knees and cried in prayer to God thanking Him for coming through for me. I then got back up on the bed and rested for the next hour. I was physically and mentally spent.

A few minutes after I was lying there I got a call from my care team. I wasn’t expecting that. Before I could even speak a word she dove right into the protocol I was to follow to try to get out of my atrial flutter episode. When she finally paused, I was able to jump in and tell her it was unnecessary as I had just converted to normal sinus rhythm. She was happy for me and said obviously I didn’t need to take the drugs after all. She wished me well but said if I go back into atrial flutter to follow her protocol. I thanked her and hung up the phone.

To say that episode threw me for a loop was an understatement. I was hoping it was just one of those random blanking period episodes. It’s not terribly uncommon to experience breakthroughs during the blanking period.

3/24/23 Atrial Flutter Episode Details
Everything went fine for the rest of the week until late Friday night. It was 10:45 pm and I sat down to work on my puzzle. I was also munching on a late night snack and enjoying an ice cold beverage. I was totally relaxed and just enjoying my evening. Then at 11:15 pm I took a few bites of my snack and followed it up with a big gulp of my beverage and within seconds, BAM, another atrial flutter episode hit. My thoughts were, “Are you kidding me right now? Am I seriously in another damn atrial flutter episode? Why do I always have these stupid episodes during a holiday or on the weekend?”

At first I didn’t even take an EKG because I knew it was atrial flutter. I was beyond upset. I’m not proud to admit this, but I was so angry I punched the wooden filing cabinet sitting next to my puzzle desk. I wanted to rip my heart out of my chest and stomp on it.

Frustrated and angry, I took out my Kardia device to confirm what I already knew. I was in atrial flutter with a heart rate of 176 bpm.

Just as I did during the episode I had just a few days ago, I got up and walked around the house to find things to do. Let’s just say I got a lot of cleaning done.

This time around, however, I decided to implement some of the strategies I employed back when I was having all my atrial fibrillation episodes before having my first ablation in 2015. At around 11:40 pm I took 450 mg of Remag magnesium. Back in the day I would normally take up to 1,000 mg of Remag during my episodes but even those high doses never helped. I didn’t actually think 450 mg of mangesium would help but I figured I had nothing to lose. I was just desparate to try anything.

I continued to do stuff around the house and eventually started to get ready for bed. I brushed my teeth, took my contacts out, etc.

When I got to bed I realized I had some new sheets I purchased to put on the bed. I figured what the heck, I might as well do that now since I wasn’t going to sleep anyway. The mattress was very heavy and I had to put a lot of effort in lifting each corner of the mattress to put the fitted sheet on and to fully tuck it underneath the mattress. I’m a stickler when it comes to making a bed. I want the sheets tight and on “perfectly.” When I lifted the last corner of the mattress I was practically grunting to get it lifted high enough to put the sheet around it. The sudden exertion of lifting the mattress instantly converted me to normal sinus rhythm.

Once again I was shocked. Could I have possibly converted to normal sinus rhythm on my own twice in the same week? I didn’t believe it at first so I continued to finish making my bed. I finally sat down on the edge of the bed and took an EKG. My heart rate was way down to 109 bpm and my Kardia monitor was telling me I was in tachycardia.

It’s hard to know if I was really in normal sinus rhythm with a fast heart rate (tachycardia) or if I was still in atrial flutter. When I had my first atrial flutter breakthrough back in November, all of my Kardia readings said I was in tachycardia when I was in fact in atrial flutter.

Normal sinus rhtyhm or not, I felt great so I didn’t really care at that point. I finally got in bed and watched TV for a bit. Then at 1:45 am I took one final EKG and it was official, I was in normal sinus rhythm!

So ya, it was a hectic and frustrating week. I’m grateful I converted to normal sinus rhythm twice on my own, but with two breakthroughs in one week isn’t too promising. Clearly I will need a third touch up ablation.

I just hope they’ll be able to do both a touch up ablation and the Watchman implant during the same procedure on April 27th. More importantly, I hope I can remain in normal sinus rhythm until then. Say a prayer for me and wish me luck!

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