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How To Be Prepared For Atrial Fibrillation Recurrence Even After Cardiac Ablation Procedure?
Posted on
Sat, 17 Dec 2016
Medically reviewed by
Ask A Doctor - 24x7 Medical Review Team
Sat, 17 Dec 2016
Answered on
Thu, 12 Jan 2017
Last reviewed on
Question : Dear Dr Iliri,
I am having some severe anxiety issues since my 2nd ablation. I keep fearing I am having PVCS and I won't have holter for 7 more weeks.
More than that, my fluid issues have intensified. It is exactly two years today since my first ablation and I have been remembering that time. My former cardiologist would have me come in twice a day to weigh me and he would make me drink a liter of water to see if I could void the water. He told me I had to lay down or I would not be able to process the water. I keep doing this again, drinking a liter and then trying to be still until I pass the water. Is this posture test crazy? Would anyone be able to avoid CHF by lying or sitting still? I have been doing this and afraid to be up and about. Does it truly not make a difference whether I am sitting or standing or walking when it comes to processing fluid? I won't retain more water from standing or walking?
I am trying to tell myself my post ablation echo means all is well but I am
Having so many flashbacks to my first recovery when I was told if I didn't have some EF recovery, I would need ICD and transplant. I feel like I am still that sick.
Thank you Dr Iliri. I am seeing my psychiatrist but he has not been helpful as he tells me simply to "stop having negarticr thoughts as if it could be that easy.
XXXX
I am having some severe anxiety issues since my 2nd ablation. I keep fearing I am having PVCS and I won't have holter for 7 more weeks.
More than that, my fluid issues have intensified. It is exactly two years today since my first ablation and I have been remembering that time. My former cardiologist would have me come in twice a day to weigh me and he would make me drink a liter of water to see if I could void the water. He told me I had to lay down or I would not be able to process the water. I keep doing this again, drinking a liter and then trying to be still until I pass the water. Is this posture test crazy? Would anyone be able to avoid CHF by lying or sitting still? I have been doing this and afraid to be up and about. Does it truly not make a difference whether I am sitting or standing or walking when it comes to processing fluid? I won't retain more water from standing or walking?
I am trying to tell myself my post ablation echo means all is well but I am
Having so many flashbacks to my first recovery when I was told if I didn't have some EF recovery, I would need ICD and transplant. I feel like I am still that sick.
Thank you Dr Iliri. I am seeing my psychiatrist but he has not been helpful as he tells me simply to "stop having negarticr thoughts as if it could be that easy.
XXXX
Brief Answer:
You are actually in clinically normal cardiac condition.
Detailed Answer:
Dear XXXX,
I know that it is a difficult period trying to convince yourself that everything is going to be OK after two years of a very serious health condition; several issues full of anxiety and fear of potential arrhythmia recurrence.
You already know my opinion that in your actual cardiac conditions, structurally normal cardiac status and trivial, rare PVCs nothing could trigger a cardiomyopathy relapse.
I remain at the conclusions that even without your last cardiac ablation, your heart would not be seriously threatened by the insignificant arrhythmia.
Regarding water and generally fluids retention, I could explain that there is not any rationale scientific proof that staying still and in a recumbent position cold protect from fluid retention in the situation when no evidence of decreased cardiac function (or any other organ dysfunctions) is present, such as in your case.
So, I would like to assure you that physical activity not only is innocent regarding any fluid retention triggering, but it is beneficial at improving your blood circulation, your psychological status and more appropriate circulatory volume distribution throughout the body tissues.
Meanwhile, tormenting your mind through those thoughts that have nothing to do with your satisfactory clinical conditions, would be nothing else but like watching a fiction movie.
Cardiac transplantation and ICD are quite irrational alternatives for actual health condition.
You shouldn’t even think about them.
The only advice I could give is to follow a normal daily activity without any physical restrictions as nothing dangerous seems on the horizon.
Hoping you will be more relaxed and enjoy the weekend,
Kind regards,
Dr. Iliri
You are actually in clinically normal cardiac condition.
Detailed Answer:
Dear XXXX,
I know that it is a difficult period trying to convince yourself that everything is going to be OK after two years of a very serious health condition; several issues full of anxiety and fear of potential arrhythmia recurrence.
You already know my opinion that in your actual cardiac conditions, structurally normal cardiac status and trivial, rare PVCs nothing could trigger a cardiomyopathy relapse.
I remain at the conclusions that even without your last cardiac ablation, your heart would not be seriously threatened by the insignificant arrhythmia.
Regarding water and generally fluids retention, I could explain that there is not any rationale scientific proof that staying still and in a recumbent position cold protect from fluid retention in the situation when no evidence of decreased cardiac function (or any other organ dysfunctions) is present, such as in your case.
So, I would like to assure you that physical activity not only is innocent regarding any fluid retention triggering, but it is beneficial at improving your blood circulation, your psychological status and more appropriate circulatory volume distribution throughout the body tissues.
Meanwhile, tormenting your mind through those thoughts that have nothing to do with your satisfactory clinical conditions, would be nothing else but like watching a fiction movie.
Cardiac transplantation and ICD are quite irrational alternatives for actual health condition.
You shouldn’t even think about them.
The only advice I could give is to follow a normal daily activity without any physical restrictions as nothing dangerous seems on the horizon.
Hoping you will be more relaxed and enjoy the weekend,
Kind regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dr Iliri,
Thank you. Was my doctor correct though that when I was sick two years ago that it was proper to stay still after drinking and eating to help pass fluid? My doctor now says he would never do that even for his sickest patient. But is this proper for people who do have cardiac issues? Would I have had helped myself in the past by sitting or lying down to pass fluid?
I am remembering two years ago when I was waiting to find out if I needed ICD. Surgery was scheduled but canceled when EF was normalized.
Trying to calm down but was frightened when I spent all day teaching a class on my feet and seemed that I barely had to urinate yesterday. No swelling I could see but it seemed like Urination was much less.
Is 1-2 lb weight gain nothing to worry about? My old dr said it was always going to be worsening heart failure.
Trying to calm down.
Thank you,
XXXX
Dr Iliri,
I guess I am asking if it is ever proper to prescribe lying down/sitting for people to avoid fluid retention. I haven't seen anyone who's been told to do that and yet my former doctor said it was only way I would survive until I got a new heart.
Surely my PVCS are better- I have not felt in my pulse and had no PVCS in hospital for over 12 hours but I am still so nervous.
So in a sick person, as I used to be, would it be expected/normal that they would have reduced urine from standing/walking or is that crazy even for those with reduced EF?
Thank you so much.
Thank you. Was my doctor correct though that when I was sick two years ago that it was proper to stay still after drinking and eating to help pass fluid? My doctor now says he would never do that even for his sickest patient. But is this proper for people who do have cardiac issues? Would I have had helped myself in the past by sitting or lying down to pass fluid?
I am remembering two years ago when I was waiting to find out if I needed ICD. Surgery was scheduled but canceled when EF was normalized.
Trying to calm down but was frightened when I spent all day teaching a class on my feet and seemed that I barely had to urinate yesterday. No swelling I could see but it seemed like Urination was much less.
Is 1-2 lb weight gain nothing to worry about? My old dr said it was always going to be worsening heart failure.
Trying to calm down.
Thank you,
XXXX
Dr Iliri,
I guess I am asking if it is ever proper to prescribe lying down/sitting for people to avoid fluid retention. I haven't seen anyone who's been told to do that and yet my former doctor said it was only way I would survive until I got a new heart.
Surely my PVCS are better- I have not felt in my pulse and had no PVCS in hospital for over 12 hours but I am still so nervous.
So in a sick person, as I used to be, would it be expected/normal that they would have reduced urine from standing/walking or is that crazy even for those with reduced EF?
Thank you so much.
Brief Answer:
I would recommend as follows:
Detailed Answer:
Dear XXXX,
When lying down, it is true that urine production is a little bit more pronounced than when staying in upright position.
This is in general, a normal physiological reaction.
I believe that your doctor two years ago has advised you to stay at rest, mostly in bed for the only purpose to limit first of all your physical activity, which could aggravate heart failure and arrhythmia and thus avoiding possible complications, helping the applied therapy to become more effective (including excessive fluid elimination).
This strategy would be appropriate when discussing about severely decompensated heart failure conditions.
But this recommendation could not hold true in the case of a normal heart, in the absence of heart failure symptomatology, which in fact is your actual clinical condition.
Coming to this point, I would recommend you to strongly disregard your doctor's previous advice of staying flat as much as possible, because it would be useless and nonsense in your actual situation and scientifically non-justified.
So, as I previously emphasized, you have nothing to fear about.
You are allowed and I also encourage you to engage in every physical activity that you want (stay upright, run, exercise, relax) as much as you can and you want.
Wishing a nice weekend,
Dr. Iliri
I would recommend as follows:
Detailed Answer:
Dear XXXX,
When lying down, it is true that urine production is a little bit more pronounced than when staying in upright position.
This is in general, a normal physiological reaction.
I believe that your doctor two years ago has advised you to stay at rest, mostly in bed for the only purpose to limit first of all your physical activity, which could aggravate heart failure and arrhythmia and thus avoiding possible complications, helping the applied therapy to become more effective (including excessive fluid elimination).
This strategy would be appropriate when discussing about severely decompensated heart failure conditions.
But this recommendation could not hold true in the case of a normal heart, in the absence of heart failure symptomatology, which in fact is your actual clinical condition.
Coming to this point, I would recommend you to strongly disregard your doctor's previous advice of staying flat as much as possible, because it would be useless and nonsense in your actual situation and scientifically non-justified.
So, as I previously emphasized, you have nothing to fear about.
You are allowed and I also encourage you to engage in every physical activity that you want (stay upright, run, exercise, relax) as much as you can and you want.
Wishing a nice weekend,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Dr Iliri,
So it is strictly my imagination that tells me that I am not in CHF because I am careful to set up the conditions to maximize fluid loss? After drinking I am not always able to sit but I try to and I panic when it is impossible, as it often is. So I do then notice less urine but never visible edema. I don't understand why my weight does fluctuate within 1-3 lbs when my food intake is always low (below 700 calories daily but I am not losing weight in last year) and I always fear it is my heart. Is my post-ablation echo proof positive that there is no deterioration of heart function or any damage that could have occurred during ablation?
Before my CHF/CM I have zero idea of how much/often I drank or urinated and I never liked to sit down or stay still. I hate to be still or inactive but my former dr said it was AFTER I believed I was cured and off of medication that "fluid will get me and that will be it." I know I have to forget things he says but he was very insistent that I would definitely never truly be cured and that if I was told so then I was "asking to die". He said transplant would always be my only hope of surviving beyond a few months. I dream of his words every night.
So my drinking a liter and sitting still would never help if I was actually experiencing a relapse? In my early days, I avoided fluid as much as possible, and drank only 1 liter per day but I started to drink more because I rarely had to urinate and I exercise.
So can I truly trust that my body can manage fluids?
And do you think no PVCS in hospital is good indication that my PVCs are gone? I know a few are likely, but in EP lap they were happening at rate of 10/minute which stopped when he ablated focus. I guess it was my anxiety which further increased PVCs in the hospital.
Thank you so much,
XXXX
Dr Iliri,
So there the difference in urine volume I sometimes I notice is normal and different from the fluid retention which occurs when fluid gets trapped in lower limbs and lungs? Again I don't notice edema or SOB but I am watching for it every minute.
Thank you.
So it is strictly my imagination that tells me that I am not in CHF because I am careful to set up the conditions to maximize fluid loss? After drinking I am not always able to sit but I try to and I panic when it is impossible, as it often is. So I do then notice less urine but never visible edema. I don't understand why my weight does fluctuate within 1-3 lbs when my food intake is always low (below 700 calories daily but I am not losing weight in last year) and I always fear it is my heart. Is my post-ablation echo proof positive that there is no deterioration of heart function or any damage that could have occurred during ablation?
Before my CHF/CM I have zero idea of how much/often I drank or urinated and I never liked to sit down or stay still. I hate to be still or inactive but my former dr said it was AFTER I believed I was cured and off of medication that "fluid will get me and that will be it." I know I have to forget things he says but he was very insistent that I would definitely never truly be cured and that if I was told so then I was "asking to die". He said transplant would always be my only hope of surviving beyond a few months. I dream of his words every night.
So my drinking a liter and sitting still would never help if I was actually experiencing a relapse? In my early days, I avoided fluid as much as possible, and drank only 1 liter per day but I started to drink more because I rarely had to urinate and I exercise.
So can I truly trust that my body can manage fluids?
And do you think no PVCS in hospital is good indication that my PVCs are gone? I know a few are likely, but in EP lap they were happening at rate of 10/minute which stopped when he ablated focus. I guess it was my anxiety which further increased PVCs in the hospital.
Thank you so much,
XXXX
Dr Iliri,
So there the difference in urine volume I sometimes I notice is normal and different from the fluid retention which occurs when fluid gets trapped in lower limbs and lungs? Again I don't notice edema or SOB but I am watching for it every minute.
Thank you.
Brief Answer:
I would explain as follows:
Detailed Answer:
Dear XXXX,
First I would like to say that I am glad that you are not experiencing any PVCs. This is a good sign indicating that everything seems to go as we hoped.
Regarding the changes in your body weight and urine volume through the day, they are quite normal. You should know that urine is not the only way that we eliminate fluids from our body. Other ways are respiration, stool, sweating, tears, etc..
So, as you have no signs of edema it means that there is no fluid retention.
You are allowed to take as much fluids as you like through the day and stay as you want (walk, lye down, sit, run, etc.).
Nothing bad is going to occur. So, there is no need to limit yourself to one liter water and sitting down position. These things are not important and are not going to make any changes to your body.
From the other hand your last performed cardiac ultrasound shows a normal heart function and structure. There is no sign of heart failure.
You should try to push away from your mind those bad memories from the past. That doctor has not shown to be very professional. And your medical history of improvement is another argument about this.
Hope you will find this answer helpful!
If you want to talk again about this, you know that I am always here for you!
Regards,
Dr. Iliri
I would explain as follows:
Detailed Answer:
Dear XXXX,
First I would like to say that I am glad that you are not experiencing any PVCs. This is a good sign indicating that everything seems to go as we hoped.
Regarding the changes in your body weight and urine volume through the day, they are quite normal. You should know that urine is not the only way that we eliminate fluids from our body. Other ways are respiration, stool, sweating, tears, etc..
So, as you have no signs of edema it means that there is no fluid retention.
You are allowed to take as much fluids as you like through the day and stay as you want (walk, lye down, sit, run, etc.).
Nothing bad is going to occur. So, there is no need to limit yourself to one liter water and sitting down position. These things are not important and are not going to make any changes to your body.
From the other hand your last performed cardiac ultrasound shows a normal heart function and structure. There is no sign of heart failure.
You should try to push away from your mind those bad memories from the past. That doctor has not shown to be very professional. And your medical history of improvement is another argument about this.
Hope you will find this answer helpful!
If you want to talk again about this, you know that I am always here for you!
Regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Dr Iliri,
Thank you so much. My former dr said sitting, standing, and walking were all bad for me, which left only lying down. He said it was for diuresis which is what would prevent me from dying. He was so focused on fluid that I became convinced that I needed to control fluid to stay alive.
Is sitting any better for diuresis than standing or walking? Is more water being used when standing/walking or is it being retained? As long as there isnt visible edema or serious weight gain, it isnt a problem? I know before my bout with cardiomyopathy, my weight could fluctuate a bit but I didnt worry. I have friends who say they fluctuate 10 lbs in a single day but when ill, I was told even a single lb was cause to worry. I dont know how to relax and stop weighing myself a dozen times a day.
I drink 3-4 liters, a day actually, as I panic without frequent urination. But I cannot relax until it seems its all been voided and when it seems its not as much as usual, I panic more. I am seeking psychiatric help with this but I cannot forget what my doctor said about fluid killing me.
Thank you so much, Dr Iliri, I am trying to relax.
XXXX
Thank you so much. My former dr said sitting, standing, and walking were all bad for me, which left only lying down. He said it was for diuresis which is what would prevent me from dying. He was so focused on fluid that I became convinced that I needed to control fluid to stay alive.
Is sitting any better for diuresis than standing or walking? Is more water being used when standing/walking or is it being retained? As long as there isnt visible edema or serious weight gain, it isnt a problem? I know before my bout with cardiomyopathy, my weight could fluctuate a bit but I didnt worry. I have friends who say they fluctuate 10 lbs in a single day but when ill, I was told even a single lb was cause to worry. I dont know how to relax and stop weighing myself a dozen times a day.
I drink 3-4 liters, a day actually, as I panic without frequent urination. But I cannot relax until it seems its all been voided and when it seems its not as much as usual, I panic more. I am seeking psychiatric help with this but I cannot forget what my doctor said about fluid killing me.
Thank you so much, Dr Iliri, I am trying to relax.
XXXX
Brief Answer:
There is nothing to worry about physical activity.
Detailed Answer:
Dear XXXX,
I understand how you feel but you are a healthy person now.
Your heart is perfectly normal now. Your last performed cardiac ultrasound was unremarkable. You have no signs of fluid retention.
The changes in your body weight are quite normal from the normal cycle of fluid exchanges in your body (input from drinking and eating ; output from urine, stool, sweat, respiration, etc..)
There is no need to limit your physical activity. It will not change anything in your fluid metabolism, because it will be perfectly normal, just like in other healthy persons.
You are allowed to perform as much physical activity as you wish!
Even when you were sick, the recommendations of your doctor during that situation have been a little exaggerated. Fluid retention is not totally dependent from physical activity.
Anyway, you should try to have faith in me and in your clinical situation. You can see yourself. You are a young and healthy women. You have a strong heart.
Everything will be OK!
It is all a matter of anxiety. Try to push those bad thoughts away from your mind! They are not real, just some irrational suppositions.
You should try to focus on your anxiety and your obsessions and try to look at them from outside. It will help you distinguish the reality.
I am always here if you want to discuss about that!
Wishing a happy Christmas time,
Dr. Iliri
There is nothing to worry about physical activity.
Detailed Answer:
Dear XXXX,
I understand how you feel but you are a healthy person now.
Your heart is perfectly normal now. Your last performed cardiac ultrasound was unremarkable. You have no signs of fluid retention.
The changes in your body weight are quite normal from the normal cycle of fluid exchanges in your body (input from drinking and eating ; output from urine, stool, sweat, respiration, etc..)
There is no need to limit your physical activity. It will not change anything in your fluid metabolism, because it will be perfectly normal, just like in other healthy persons.
You are allowed to perform as much physical activity as you wish!
Even when you were sick, the recommendations of your doctor during that situation have been a little exaggerated. Fluid retention is not totally dependent from physical activity.
Anyway, you should try to have faith in me and in your clinical situation. You can see yourself. You are a young and healthy women. You have a strong heart.
Everything will be OK!
It is all a matter of anxiety. Try to push those bad thoughts away from your mind! They are not real, just some irrational suppositions.
You should try to focus on your anxiety and your obsessions and try to look at them from outside. It will help you distinguish the reality.
I am always here if you want to discuss about that!
Wishing a happy Christmas time,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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