markflint
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Posts posted by markflint
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3 hours ago, Daisy said:
However, if it were me and this didn't stop after the 3 month blanking period, I would not go back to the same EP for a second ablation.
I kind of thought the same thing as Daisy, but was going to wait before coming right out and saying your guy doesn't sound like he's a big dog when it comes to treating AFib. If I lived in Texas and needed another ablation I would go to Austin and have it done by Natale. I don't like the man, and he pushes the boundaries, which means he takes risks, but he's a savant with the probe.
Mark
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It's understandable to be upset, but those symptoms probably don't mean your ablation was a failure. You are in what is known as the blanking period, and your heart is well and truly pissed off about being messed with. During the blanking period scarring will form and close off the ability of misbehaving cells to cause AFib. The unknown is whether the EP got all of the miscreants.
In the meantime, if the AFib is intolerable, they may try a stronger antiarrhythmic med, such as amiodarone or Tikosyn (dofetilide). These drugs can have serious side effects, and tikosyn requires hospitalization for a few days to monitor to make sure it doesn't have the side effect of QT interval elongation, which can be serious.
I would only take drugs on that tier if the AFib was intolerable, or I were in AFib after the blanking period -- and I'd be scheduling a follow-up ablation ASAP to get me into NSR to minimize time on them.
Your EP should have given you information about the blanking period as part of your discharge, and you also should have been told to stay on the Eliquis. Not having you on anticoagulants is a pretty serious error.
Mark
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1 hour ago, FrankieWino said:
I am worried because I feel so bad that living with persistent flutter seems undoable at my age. Is there anyone with an experience like mine? And what to do?
At six weeks you are only halfway through the blanking period, so don't give up hope just yet. Your heart is not a happy camper, but that could still go away completely.
If it doesn't, you may need another ablation. That was my experience. I recommend waiting until the end of the blanking period, but have an appointment with your EP right then. If the flutter is still an issue ask him if he is able to ablate the Left Atrial Appendage, which is where he may need to go. Not a lot of EPs will do this, so if he can't, find one who can.
I did that in 2018 and it did the trick. I had another year of tachycardia, which gradually started getting better after six months. All of that, plus the pericardial effusion "oops" by the EP has been worth it for the quality of life I have enjoyed.
Mark
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3 hours ago, Martin Kotlar said:
Daisy, are you saying that I do not have to be experiencing A-Fib just prior to getting the ablation procedure?
Yes. They can induce AFib.
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9 minutes ago, Daisy said:
If you go to a really experienced EP with top-notch credentials, it shouldn’t be a problem.
This is the important part. Really important. Mandatory if you want the best chance for success. There are people here who have had multiple ablations that failed to get the job done. It may take more than one, and in my case, which was complicated, took three. Your EP should have thousands of ablations on the books, and share his success record -- which should be defined as NSR unaided by antiarrhythmic medications after the blanking period. I would be as diplomatic as possible, but do not worry about offending anybody when pushing for this. You have a right to put your future in the hands of someone you trust to get it right.
--Mark
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Hi Llevelyse
I'm afraid I can't be much help. CBD is unregulated, so it's a bit of a jungle out there. This site seems to be unbiased, but they do have a link to the only FDA approved CBD product, so might be steering you to that. Still, with that grain of salt in mind, I'd give it a look. https://www.straightfactscbd.com/
Based on a trusted friend's recommendation, I take mine in a product called Vitamin Coffee, which I get from Amazon. It's 15mg, a relatively small dosage, but I found, after about three months, that it was potentiating my Eliquis so I've skipped to every other day, and the gum bleeding I got two days in a row is gone. Cuts bleed about the same as ever, so that's close enough for me. Not sure how long it took for the anti-inflammatory effect to take hold. I just realized one day that I'd been feeling really good, like I was in my 40s again. Of course a lot of stuff still works like my actual age, especially after a few days of backpacking. On the other hand, I am backpacking, and mountain biking. and able to enjoy both rather than suffer the whole time.
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1 hour ago, shadowmnt said:
the EP I teleconsulted with also suggested I may want to try Tikosyn Anyone have any experience with this?
Tikosyn is not usually the first choice for anti-arrhythmia medication because of the potential serious side effects, and the need (and cost) for hospitalization. Usually they start with flecainide or multaq.
Common side effects listed are headache, dizziness, nausea, diarrhea, stomach pain, insomnia, back pain, skin rash and cold symptoms – stuffy nose, sneezing, sore throat. When I took it, I headaches and insomnia are the ones I remember having. And it didn’t restore me to sinus rhythm.
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Knowledge is power over fear. The more you know about it, the less it will prey on your mind. Yes, bad things can happen with an ablation, but bad things can happen when you drive down the road. Most of us don't spend a lot of time worrying about getting T-boned every time we drive through an intersection.
Be sure to ask if the EP doing the ablation uses collagen plugs. Those reduce the amount of time you are required to lie on your back. They didn't for my first ablation, and by the time the 8 hours was up (6 while conscious) I was a very unhappy camper. My mantra for things like this is "it's only pain," but toward the end the mantra wasn't much help. On the two subsequent ablations the 2 hours, although not a joy fest, were much more doable.
Dr. Natale's staff made it clear that I was to lift nothing heavier than 9 pounds for the first week. If you have an aversion to arterial bleeding you will want to follow weight restrictions religiously. OK, this is long, but I saved my discharge instructions (Lord knows why, but maybe for this), am pasting them below.
Remember that all the things they tell you to call about (except fluid retention) are extremely rare -- especially if your procedure is done by an EP who has lots of experience and a good track record. I think most people are put on diuretics initially. TIP: If you are flying home, skip the diuretics the morning of your flight. Or get an aisle seat, because you will be making multiple trips to the head. I learned this the hard way, had to excuse myself as I struggled from my window seat to the aisle for what seemed like 50 trips aft during my 2-hour flight.
What to Expect
During the initial 48 hours after an ablation, many patients experience:
Chest Discomfort. You may experience chest discomfort due to post procedure inflammation. You may take an anti- inflammatory medication (ibuprofen) as needed.
Mild Shortness of breath with activity
Soreness and bruising in the groin area
During the first 3 months after an ablation, many patients experience:
Heart Rate and Rhythm Changes. There may be a period of "heart beat irritability," which is normal and can occur up to the first 3 months following your ablation, including skipped heartbeats, racing hearts, and short periods of atrial fibrillation. Having an arrhythmia during the first 3 months after your procedure does not mean your ablation has not been successful.
When To Call
We would like you to call us if you experience any of the following:
Fluid Retention. It is common to experience fluid retention after your procedure. Your doctor may prescribe a Diuretic (fluid pill) to take for a few days after the procedure. Signs and symptoms of fluid retention are swelling of feet, ankles and abdomen; shortness of breath at rest or when lying flat; weight gain of more than 2 pounds in one day.
Difficulty swallowing
Any fever greater than 101 degrees Fahrenheit
Any vomiting of blood or coughing up blood
Sudden onset of swelling or pain to groin
Chest pain that is getting worse or does not subside after 5-7 days
ActivityYou may shower the day of discharge. We ask that you do not take a bath, swim or for 7-10 days until your incision sites are healed.
You may resume your normal exercise program one week after your ablation.
You should not lift more than 5-10 pounds for 7 days following your ablation.
You should have someone drive you home from the hospital. We ask that you not drive a car for 2 days following your procedure.
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4 hours ago, mailman52 said:
I don't remember the removal of the sheaths being a fun experience.
After my prostate cancer surgery in 2005 I had to stay on a catheter for a couple of weeks. The day before I went in to the doctor's office to remove it I called to ask if it would be painful, figuring I'd take a pain pill ahead of time if necessary. The nurse's answer was, "Not if you're nice to us." I came in with a plate of chocolate chip cookies.
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I would focus on what makes an ablation successful, and if you peruse the subject in this forum it all comes down to who does it. You don't have to have the best in the world, but you really want one of the best. Someone with lots of experience and a high success rate. Know that there are no guarantees, even with the best, but all you can do is get the best odds you can and hope for the outcome you want.
Also try to focus on the positive. Worry, aka borrowing trouble, can do no good and may make things worse.
When I first started down the AFib trail I was frightened and confused. I'd get these episodes where my heart rate and blood pressure would go up, then I'd get super anxious, which made them go even higher. Twice I took ambulance rides to the hospital. Both times it went back to normal within a half hour of arriving at the ER, but of course it was another 3 hours before they completed protocols and paperwork. Knowing that these episodes were transient and wouldn't kill me allowed me to relax, which reduced the duration and frequency, and then they stopped altogether. Still had AFib, of course, but was able to focus on learning about AFib and what my options were. It took 7 years from the onset, but I'm finally at a place where I have my life and the activities I love back. I still have some issues, but it's looking like we can address those as well.
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10 minutes ago, peteycap said:
Also, some define success as decreased afib burden and/or fewer/no symptoms.
Or, as the plumber would say, you will need to put your finger on the hole now and then...
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As has been said above, cardioversion is a short term fix, and AFib tends to get progressively worse. The longer you wait the more work whoever does the ablation will have to do. You had three and they failed, which, as steffke said, speaks more to the competence of the person operating the probe than the validity of having an ablation. I'd look for someone who has plenty of experience and a good success rate -- defined as being in NSR without the aid of anti-arrhythmia medication. (Some EPs list ablations as successful when the patient is in NSR and using anti-arrhythmia medication, which is like a plumber saying he repaired your leaky pipe but you have to keep a finger on the hole.
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1 hour ago, Carey said:
There are a number of people here who've had ablations with Natale and only a single visit to Austin, including me.
I am one of the people who required a second trip. Given how great I now feel -- walking, running and riding my bike and having more energy and feeling better than I have in probably 10 years, I'd make four trips if that's what it took.
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13 hours ago, Carey said:
Thank you.
We established his age recently in a thread I can't find at the moment, but as I recall we figured he's 58
He's pretty robust. I would have guessed him at 50 or even late forties.
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45 minutes ago, Deirdre Dame said:
And-----you know I have scheduled AND cancelled 3 times before. Not this time!
Not sure how it works but I had my insurance provider request Dr Natale And that's who I got. As far as the rest of it there's an old quote that I like that goes, "Sometimes you have to make the leap and build your wings on the way down.
The staff and setting -- heck, Austin itself -- are tough to beat.
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I will be forever grateful to this forum for all of the advice, encouragement and wisdom you have shared with me.
Finding Dr Natale was the icing on the cake.
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3 hours ago, Carey said:
Doing it all in a single trip is something they don't do as often as they used to due to scheduling difficulties.
If it's going to be a hardship and you don't mind a delay you might ask about the possibility of a one-trip arrangement. They did one for me; told me it might be March or April, then called and offered me Feb. 21 for the appointment and the next day for the procedure. So even if they tell you it's going to be a few months there's always the possibility of a cancellation creating an opening.
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3 hours ago, peteycap said:
Good thing she wasn't thinking "one and done!"
She kind of was but I was persistent, eventually got her to give it another try. After 38 years I think it worked.
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Looking awfully good to me! I'm in line, but it may be April now. Guess more and more people are waking up to the need to go to the best. But the best is worth waiting for. Heck, I got engaged to my wife, broke up, went to Vietnam and it was 12 years after the original engagement that we got married, and she'd married and divorced in the meantime. That was worth the wait, too.
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Got a voice mail from Norma in Dr. Natale's office today. She's the one-trip coordinator, so apparently the program is still in effect. Our plan is still to take the train, roomette on the way there, family room on the way back. Probably won't look for a cancellation opportunity because the family rooms on the train need to be booked way early.
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What is the one-trip arrangement, and what would not having it mean?
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21 hours ago, hegel said:
Mark, do you hear the lonely howling of the wild chihuahuas at evening coming home?
Those may not be Chihuahuas. The howling is indistinguishable from that of a chupacabra, and you do not want to run into one of those after dark. Or so I am told.
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Thanks. I figured a 90-day wait would be likely, and this isn't much more than that, especially when you consider the vortex that occurs next week, sucking us into the maelstrom and spitting us out the first week of January. I don't even want to get my hopes up about a backpacking trip back down into the Grand Canyon. In the meantime the QOL hasn't been too bad. The AF has morphed into evenings every 2-3 days, and a higher heart rate -- which is why I decided to go with 25mg metoprolol twice a day.
So for the last few weeks I've been putting in long (for me) days operating a trail building dozer (Sweco 480) in the foothills of the Rincon Mountains in the Chihuahuan desert. Glad to be able to do it, and without rolling it down an embankment.
The only problem is it seems the dofetilide interrupts my sleep. I'm awake after 5-6 hours, usually unable to fall back to sleep. Anybody else have that with this drug?
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It's in the works. Only down side is Dr. Natale is one busy guy, so my appointment is not until March. On the wait list for a cancellation but even if it's March I'd rather wait than get it from a hack who has lots of time on his hands. Although it's possible Carey charmed the office staff when he was there; maybe I'll call and use his name to see if that opens doors...
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Paroxysmal atrial fibrillation
in 2023 Atrial Fibrillation Patient Conference Attendee Forum
Posted
I may remember this wrong, but around a month before I got mine somebody else on this forum got a pericardial effusion during a Natale ablation. He only ablated areas showing up generating arrhythmias for me, too, but that meant going into the LAA, and that's a place most EPs don't dare to go. My EP, who was fine with me seeing Natalie and considers him one of the best, did comment that he, in his words, "ablated the sh** out of you." He wasn't saying that was a bad thing, just a big thing.