Atrial Fibrillation - ablation and recovery

A few months ago I wrote a post about being diagnosed with Afib, and how it was affecting me. For context I am (very) nearly fifty, I started cycling regularly in 2016. I have done three of the seven day haute route events, I am not fast but I am persistent.

I had a crash last may on a fast descent, broke three ribs and bruised my heart (myocardial contusion). They noticed atrial fibrillation in the hospital - not caused by the crash, just something which develops over time. Afib is where the electrical signal sent by our natural pace maker gets drowned out by other electrical signals via a break down in electrical resistance inside the heart. They can treat it with drugs - mostly beta blockers (which gave me a resting heart rate of 48 bpm!) but left me feeling very fatigued. So I was offered an ablation, they feed a catheter in via your groin, enter into the heart and then burn the inside of the atria wherever they find electrical condution. Most often around the veins which carry blood to/from the lungs. My procedure took about an hour - typically it is 1-2 hours. I was in afib when they started, and I went into normal rhythm when they did my left pulmonary veins. 

After the operation I spent 24 hours in a high dependency ward - like half intensive care. You have to stay pretty still, the worst part for me was a sense of bloating in my stomach. Apparently this is because some of the ablation happens quite close to the stomach. It passed naturally within a few hours. I had to take anti coagulants to stop any blood clots forming in my heart which could break off and cause a stroke. I took these blood thinners for 2 months - which was a pain as I could not ride outside for that time. Where I live has some quite remote areas, and a fall would mean a big risk of major blood loss. I was thinking about cheating, but then I cut my hand doing some DIY- the kind of small nick you put your finger on for a few seconds and it stops normally. It took me three hours of pressure and elevation to stop the bleeding - so it would be serious if you lost skin somewhere away from rapid medical assistance.

The first month after the ablation I was advised to keep my exercise to walking. We have recently adopted a rescue dog, so she was the happy beneficiary of this. I did have a lot of random heart rhythm issues during this first month - I was told in advance to expect this as your heart is quite swollen after the ablation. The second month I started to do light sessions on the indoor trainer, 30 to 45 mins recovery building up to 20 minute sweet spot intervals every couple of days. 

After two months I wore an ECG for 24 hours to record my heartbeat. then went through that with a cardiologist who gave me the green light to stop the drugs, and ride again - no sign of afib. I will admit my first ride was probably a bit OTT, we have a beautiful climb near me which is about 1000m vertical in 12km of forest road - no cars. I made it, but very slowly, and my legs were pretty tired the following day. Now I am back to a more sensible training schedule.

An interesting aside - I was warned by the surgeon to expect a drop off in VO2 max after the procedure, the scarring around the pulmonary veins reduces the maximum blood flow. He said it will recover over time. I have not noticed much to be honest, it feels more like a general loss of fitness/muscle tone.

So in summary - the operation not too unpleasant, two month recovery period - was boring and frustrating. Apparently, about 80% of people like me are symptom-free after two years from a first ablation, sometimes they need to do a second procedure if they don't find all the problem locations in the first go.