Hi,
Thanks for writing in.
I am a qualified and certified cardiologist. I have done dealt with dozens of patients who needed ablation and have done sufficient number of ablations to understand your concerns. I read your mail with diligence.
One thing is apparent that you have to the ablation procedure behind you and move on. In your case radio frequency ablation was done for probably done for Paroxysmal Supra Ventricular Tachycardia (PSVT) That by definition means that heart rate episodically, went above 140. In any case upper limit of your heart rate which we want to achieve at stress test is 165 (220- Age in Years. Therefore, with physical stress of climbing stairs making your heart rate to 136-138 is perfectly normal. It stays for a while is also alright. Similarly, I do not think you have low blood pressure. Therefore, unless you have sudden onset of palpitation, like a bolt from blue and heart rate shoots up and till you are given a drug it remains there, so is no immediate cause for concern. Thus, the comment that electrophysiologist does not have time for you is not fair. Unfortunately, when one is preoccupied with problems which are present, in your patients you tend to give less time to those who have been treated. That is not to say that if you are getting giddiness, blackouts or episodes of palpitation (none of which you have) should be ignored by the doctor. I am trying to understand why should not a doctor spend some time with you. That is because what you have described is perfectly within normal limits, therefore, priorities of a doctor apparently precludes him/her to place you lower in his/list of things to do! Good Luck.
If you have any further question, I will be happy to answer as soon as possible.
With Best Wishes.

(Dr Anil Grover)
Cardiologist

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Thanks for writing back. Please do not worry about fees. For if you hear what I get in answering your question you will be find it amusing for it is less than one third of what you co pay (with insurance company) to see a specialist in your country. Nonetheless, it is a pleasure to try to answer your question. I have reproduced your letter here.
I quote first part you wrote
"First, I should say that my ablation was ultimately for atrial tachycardia and it was originally thought to be SVT. After 4 places were abated, the decision was made that they were searching in the wrong chamber. After two tries in the other Atrium, they found a place next to the mitral valve that finally stopped the induced tachycardia after 5 hours. There is unfortunately very little specialized medical care where I live. The ablations have only available here for the past year or so and that is only with a doctor who drives 6 hours to see patients here to do the procedures. I do have light-headedness, occasional shortness of breath, the feeling of missed beats and extra beats that are evident on the ECGs and that basic exhaustion that has never been there before 2 years ago after I had pneumonia. I do occasionally have the old familiar feeling of my hands going to sleep when I'm feeling the light headedness. This is not nearly as bad as prior to the ablation, which had me buzzing at 180-220 multiple times each day and I had gotten very used to that feeling:

Answer to this part: I am sure they have done ablation of the focus which was in the atria; any way if the recoard says if it was done for braod QRS tachycardia originating from LA it means the same if it was Left Ventricular focus then with your present symptoms cardiologist who has done the procedure (or any member doctor of the team) should re evaluate you. You may need Holter.
Second part you wrote and I quote
" I want to confirm that you are saying that 80/45-95/60 is a normal BP. When it is at the lowest, I do see a correlation between the BP and my lethargy and exhaustion."

In absence of any symptoms attributable to low blood pressure then I stand by what I said before. You have performed stress test so you do have any objective evidence of low BP being pathological in you. However, if you are sure that symptoms are directly linked to "Low BP" I suggest that you discuss with your doctor you may be having some autonomic nervous system problem. You may need HUTT (head up tilt test).

Third part you wrote and I quote
"Also to clarify. How long after exercise should it take for a heart rate to return to normal? and How long when you begin exercising should your heart rate respond and begin to raise? Having the answers to these two questions will help me understand what I'm seeing on my monitor and will put my mind at rest about the pain and fluttering I feel during those minutes. Because I taught myself to ignore all of the chest pounding and arm and face numbness from before the surgery, it's important now for me to understand what feelings to ignore."

Answer
How long it takes to get back to normal rate depends on conditioning of an individual. Some take few seconds (especially athletes) other take few minutes. In your Case it does appear that is not a major issue. Well, the chest pounding, if it is akin what it was before ablation that would necessitate seeing your cardiologist!

How long does it usually take for a person to really recover from the ablation procedure? I thought I would feel better very soon after. But, I suppose because the process took longer than expected and I had some bleeding and a temperature of 102 afterwards, I may be on the longer healing side, though I usually heal very quickly.
Fourth part you wrote and I quote
"I am not concerned about dropping over dead from what I am experiencing. But, I'd like to know if you can share with me a list of vitamin/mineral supplements which cause a problem with heart rate problems. Also, in your opinion, is it totally necessary to have the patient fully aware of the procedure during an ablation?"

Yes, patient should be totally aware of procedure done on ones' body. There are no vitamins or minerals which cause rate problems (coffee increases heart rate but that is not a mineral). I will here tell you with trepidation that you worry too much.
Fifth part you wrote and I quote
"I have no complaints about my doctor or her care of me and so appreciate that you don't jump on that critical wagon that so many doctors do. I think she knows what she's doing. But, if I have to go through this again, I'd rather not be awake and aware if that might be possible some other place. I'm sorry if it sounded that my doctor didn't have time for me. The fact is, that she said that something else might be going on but she didn't know what it was or where to send me and I'm trying to put that to rest. "

My answer is though each one of us is trained to tackle questions by patient but you can take away basic personality of the person. Therefore, you develop rapport with some and not with others.
Sixth Part you wrote:
At no time when I've gone to the doctors have they made suggestions to avoid this returning or to improve my heart health. No mention of exercise or vitamins or eating suggestions, other than my last conversation with my EP doctor when she suggested that I do the daily exercise because the tachycardia that being picked up on the monitor in November was sinus in origin and should respond to that. I'm trying to tell with my own monitoring what may be left of those findings. What I would love to find is a provider who looks at the entire picture and can make healthy suggestions that can be followed up after I follow those recommendations a year later. I don't know if you are in the US. If you know of such a place, please let me know. I sincerely thank you for your time."

My answer is here the doctor has fallen short of what was genuinely expected by a patient. No Madam I do not live in US, I thank you the kind words you have for me. If you have any more questions please write, I should be able to answer those. Good Luck.
Best Wishes

Dr Anil Grover

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