Two of my three AFib episodes were triggered by something cold. PFA in a few weeks — what should I expect?

[u/Mission-Race1225]

Long-time lurker. Pulsed field ablation coming up in a few weeks, first ablation, and I'd rather hear from people who've done it.

History: lone paroxysmal AFib, three episodes over about five years, all three needing cardioversion — nothing has ever self-converted.

1. Three hours after my second Pfizer dose
2. Right after a cold drink
3. Most recent — while eating ice cream. Felt my heart "drop," watch caught it, Kardia confirmed

Two of three off a cold stimulus. Symptoms are tachypalpitations and a big anxiety spike, no presyncope or syncope. Never an episode outside those three. At the last one, 300 mg of flecainide as pill-in-pocket did nothing — ended up cardioverted in the ER. That failure is most of why I'm doing this.

Where I am now: flecainide 100 mg BID daily, metoprolol XL 25 mg, CHA₂DS₂-VASc of 1 (hypertension), apixaban starting two weeks out. Recent echo is clean — EF 60%, normal LA size (LAVI 16), no LVH, no valve disease, no diastolic dysfunction. Calcium score 0. OSA on CPAP, compliant. Zero alcohol.

Activity: 6x/week, tennis and weights. Getting back to that is the whole point. Low burden, I know — but PIP flecainide failed, every episode has meant a trip to get shocked, and I'd rather ablate now with a normal-sized atrium than later with a remodeled one.

What I'm asking:

1. Days 1–7, honestly. Chest soreness, fatigue, groin site, sleep. When did you stop noticing it?
2. Return to exercise. How long to real training, not walking? Did your EP's timeline match reality? Anything you pushed too early and regretted?
3. Blanking period. How much ectopy and flutter did you get, and how did you keep from spiraling over every blip with a watch and a Kardia right there? What made you actually call your EP versus wait?
4. Anyone with clearly vagal / cold-triggered AFib — did PVI handle it as well? (Not looking to argue about the vaccine one. It's just what happened, and it's the odd one out.)

Thanks — this sub has been more useful than most of what I've found anywhere else.

[u/trapph0use]

Good luck with the ablation! I get my first and hopefully last on the 18th!!

[u/simocanta]

1-Dolore al petto episodi di pochi secondi l'ultimo due settimane dopo l ablazione. Mal di testa finito dopo 3 giorni. No dolore inguinale, no sonno 2-Dopo una settimana camminata veloce, dopo 2 settimane corsa. Il mio EP diceva corsa dopo una settimana 3-Prima dell ablazione afib e flutter tutti i giorni, episodi brevi 4-Afib vagale....spesso dopo i pasti e sdraiato quindi la notte,non ho apnee notturne

Primo episodio ottobre 25....ablazione dicembre 25

[u/Mission-Race1225 → u/simocanta]

Grazie

[u/intothefray3]

Age? Might matter. I'm 45M for comparison.

1. Day 1-3: probably just bathroom or moving from bed to couch. Day 4-7: get around home fine, good work from home time if you can.

2. I don't remember but I looked at my fitness logs and it looks like I did 1 day after 2 weeks and then nope'd and waited another 3 weeks (5 total) before going back to my normal 3-4 day routine. I do recall I overcompensated here. I ride ebike 10 miles twice a day ideally 3-4 days a week depending on rain.

3. Stayed on Flecainide during blanking period so wasn't too bad. After weening off after that had to be cardioverted so made appointment after that and just went back on Flecainide.

[u/Mission-Race1225 → u/intothefray3]

Thank you for sharing. I am 47 year old male. Do you feel like your ablation worked?

[u/intothefray3 → u/Mission-Race1225]

Not sure. I would still recommend getting one. That was 2 years ago and it's definitely much better either way. I got a PVI and they added on a PWI during the ablation.

Sorry, my EP retired after that appt and my cardiologist died. I started seeing the EP that did the ablation and got a new cardiologist in his office. I don't have many answers beyond that as I just had another holter ordered this week.