Could an ablation contribute to the development of Diastolic Dysfuntion?

Good morning ~ I'm a former Afibber who has had two ablations - the first for Afib and the second for Flutter - both done by Dr. Andrea Natale in 2013 and 2014 respectively. I no longer have Afib, thank God, but now seem to have another problem,which I am wondering if there's any connection.

I have been dealing with shortness of breath for a little over a year. It started soon after I got over the flu and walking pneumonia. I was very nauseas for a couple of weeks, I believe, and when that finally subsided, it seems that soon afterwards I was noticing difficult in catching my breath. I should add that I have also been burping a LOT during this whole time as well.

I had an Echo last year at the cardiologist and it appeared I have mild pulmonary hypertension - but my breathing symptoms seemed more than they should be for that diagnosis - per my cardiologist and the pulmonologist. I visited the Gastro Dr. who attributed my problem to "stress"....I was thinking that maybe the burping was due to some GERD and that could cause some breathing problems...but that dead ended.

Back to the Cardiologist...I had another Echo about 2 weeks ago and then saw my Cardio on Friday. She was perplexed as she said my report showed my pulmonary #s were down slightly, but she wasn't sure why I was having this problem with my breathing. I left her office thinking I need to find an alternative doctor because no one knows what's going on. Soon after I got home I got a call from my Cardio..apparently she had not seen the most recent Echo..(?) and as she suspected, I have a 'stiff heart" or Diastolic Dysfunction....and am supposedly at stage 3...doesn't sound good. I have had a knot in my stomach all weekend as this was Friday eve and I won't be able to ask my questions of her until hopefully Tuesday..she's not easy to reach.

After my ablation, I remember one of my reports saying that I might have 'atrial stunning"..which I think meant my heart wasn't pumping as well as it should...and the reason I'm on a blood thinner now..Eliquis...I am wondering if this set the stage for the problem I have now or if anyone knows anything about this condition. I am looking for encouragement....this is scary.

I also Googled this and found info on Dr. Stephen Sinatra and Diastolic Dysfunction - and he apparently uses CoQ10, L-carnitine, Magnesium and D-ribose to help his patients who have this - and claims great results. While I could try this, I have no idea how much to take and if these are all safe to take when I'm on a beta blocker, diuretic and Eliquis.....

I know this is a lot to digest...any ideas, advice, encouragement you have to offer is great appreciated.

Thank you ~ Barb

Hello Barb - I'm certainly sorry to see your post. If it does turn out to be Diastolic Dysfunction and you decide to try Dr. Sinatra's regimen, I'm sharing this with you because I'm using those nutrients to help maintain heart muscle health as a result of the LAA isolation procedure, although I'm not on any other meds except half-dose Eliquis. However, I still want to try to keep the 'pumping capacity' optimized. You'll probably recall that Dr. Sinatra's heart healthy nutrients form the basis of my report, aka The Strategy.... and that's what I continue using three years after the isolation procedure.

I'm not suggesting that you follow my protocols, but just letting you know that I'm doing well but as we all know this can vary by individual.

Among other useful nutritional supplements that I use regularly, I include
-Magnesium glycinate - 600 - 800 mg daily. ...plus or minus depending on bowel tolerance.
-L-carnitine - Carnitine tartrate powder...700 mg twice a day.
-D-ribose - powder... 5 grams morning and evening
CoQ10 - 200 mg capsule morning and late afternoon ...if I'm tired, I add in another 200 mg.

I also use Taurine to help balance and stabilize electrolytes and for at least a couple dozen other healthy assists including Omega 3 fish oil, curcumin, adrenal support, thyroid support, Vitamin D and lots of vitamin C plus always drink water made with the WW or magnesium bicarbonate concentrate for alkalinity.

The Strategy details are here:
[www.afibbers.org]

Best to you,
Jackie

The Atrial stunning is only temporary, lasting only minutes to a month at most. Otherwise, LA function is lowered after an Ablation because of the burns, and I would be interested in Shannon's response to recovery of LA after a Natale Ablation, but overall, LA function is usually restored to a large extent in less than 3 months. This sounds like the bad stories from patients getting 3,4 or 5 Ablations from a less than stellar Ablationist, and they lose Atrial contractiblity, so much that it poses a threat to clots forming even when in NSR. Having said that, this Stiff Heart syndrome is something else than the normal Post Ablation LA recovery.



Edited 4 time(s). Last edit at 05/28/2017 04:51PM by The Anti-Fib.

HI Jackie - thanks for your suggestions. Do you feel that the D-ribose and L-carnitine need to be in powder form? I prefer pills or capsules if it doesn't matter. And how much Taurine do you take?

I have to watch my Omega-3's as I already take some in various supplements I take..for lowering cholesterol and overall heart health - being on Eliquis too.

I am praying that these nutrients, perhaps an exercise regimen (as exercise is mentioned as one of the things that can make a difference), a sleep apnea test (a big contributor to DD), and watching my BP will all help. It's a scary thing and I really don't know what to think right now...I have a bunch of questions ready to ask my doctor when I call tomorrow.

Have a good night ~ Barb

Barb - I'll be happy to help with the dosing on the Sinatra nutrients... but first, you must be sure to rule out the Diastolic Dysfunction.

To answer your question, the capsule forms are fine. I just choose not to swallow so many capsules and mix the powders into one liquid. Just a matter of choice.

Let's plan to correspond more on this once you have total clarification on your diagnosis.

Best to you,
Jackie

HI Jackie - I've had a busy week and am still in the middle of it with a few deadlines. I'll email you on this some more in another day or two, OK?

Thanks for your help ~ Barb

Hi Barb,

As we have discussed several times on the phone this week, it is possible that you do have a degree of diastolic dysfunction and can rest assured that whatever degree of diastolic dysfunction you might now have is not related to your two prior AFIB ablations ... i.e. your index ablation with Dr Natale in September of 2013 and your follow-up more limited touch-up ablation with him in June 2014 exactly 3 years ago, in which he buttoned down your LAA/CS isolations from the first procedure.

And as your cardiologist also indicated to you over the phone this week, it is quite possible that the initial impression of a 'Stage III Dystolic Dysfunction' (DD) could well be over-estimated. Not only can something as simple as hydration status at the time of the diagnostic scan impact the grading assessment for DD, but in particular, it is highly likely that in your case the fact of your extended LA/LAA ablation may well have caused an inadvertent over-estimation of the degree of severity of any DD you might now have.

The reason for this possible, if not likely, overestimation of your DD in your case is because one of the several measured criteria from Echo scans (TTE or TEE) that are used to assess and assign a degree of severity to DD is to measure the 'Doppler A-wave into the mitral valve inflow', but in the case of DD evaluation they are looking at this A-wave number into the mitral inflow as it represents 'Left Ventricular stiffness along with the associated 'LV wall thickening' that are characteristic of DD. However, the exact same measurement of 'Doppler A-wave consistency into the mitral inflow' is ALSO a key measure when evaluating mechanical function of the LA/LAA after and extended LA/LAA ablation. However, the meaning of any reduced A-wave into mitral valve inflow from an LA/LAA ablation are entirely different than the reason and meaning of the same metric of the 'A-wave into mitral inflow' being measured when assessing Diastolic dysfunction.

For example, six months after an LAA isolation the 'A-wave into the mitral valve inflow' is just one of three measurements one must pass with flying colors to possibly be able too stop all oral anticoagulants and essentially be done with the AFIB saga, assuming all three measures are solid.

But when assessing diastolic dysfunction ... which has nothing at all to do with AFIB ablation ... the same 'A-wave into mitral inflow' measure is looking for Left ventricular stiffening as seen when the LV wall becomes thickened from all the more proximal contributors to developing DD to begin with.

Therefore, it is easy to see how, if a cardiologist or Echo radiologist reading such a report is not aware that a patient with DD they are evaluating has also had an extended LA/LAA ablation, they could mistake the lower 'A-wave into mitral inflow' number caused by the LA/LAA ablation as reflecting a worse degree of DD than it really does!

The consequence of a low 'A-wave into mitral inflow' reading from an extended LA/LAA isolation ablation is needing to stay on OAC drugs and/or go for an LAA closure procedure. Whereas when a person has a similar level of low 'A-wave into mitral inflow' readings in the absence of having had an extended LA/LAA ablation, the low A-wave number will surely reflect only the degree of severity of the DD condition that ... once again ... is not effected by having had a prior LA/LAA ablation.

Diastolic dysfunction is an increasingly common finding over the last 15 plus years with improvements in echocardiography, and reflects a different type of heart failure that is more often found in women as they age, and also in those with long term poorly controlled hypertension, obesity, aortic stenosis, coronary artery disease, restrictive cardiomyopathy, diabetes and once again for emphasis in particular in aging women. AFIB ablation is part of the recommended treatment those who have AFIB and any degree of DD.

Basically, the 'Systolic' phase of the heart cycle is when the ventricles contract to pump the blood out to the rest of the body that has flooded into the right and left ventricles during the ventricular relaxation phase known as 'Diastole' or diastolic phase. In diastolic dysfunction, the ventricles do not relax enough during diastole and thus the ventricles cannot open wide enough and accept the full volume of blood they should pump during the systolic contraction phase. As a result, over time the ventricular muscle walls become thickened and even more stiff leading to even less relaxation and more blood volume that should be pumped in each cardiac cycle starts to 'back up' into other organs like the nearby lungs, for example. Thus often leading to edema or fluid build up that can result in variable degrees of SOB (shortness of breath) as Barb has complained about especially during exertion the past year ever since she had a bad flu virus that led to a diagnosis of 'walking pneumonia' just over a year ago.

None of the 5 Echo scans (3 TEEs and 2 TTEs) that Barb has had since her index ablation at St Luke's in NYC by Dr Natale suggested anything like diastolic dysfunction, including her last two TTE tests ordered by her local cardiologist. In fact, the worst documented suggestion on her last few scans was of a mild degree of pulmonary hypertension. And her LVEF of 65% as well as the function of all four chambers and all 4 valves are all top notch ..especially for a 64 year old person! Also, the fact that she had no such symptoms at all of SOB for approximately two years after her second and last ablation for touching-up only her CS and LAA isolations, also underscored that her ablations would have had no real impact on her SOB that only began so long after this last ablation.

In any event, Barb does have some SOB and there is real hope that with some treatment (diuretics are the first line) gaining good control over her many years of hypertension, improved fitness and her continued very good results at weight loss will really help her symptoms going forward. And with her Cardiologist help and follow up, it is my hope that she will be able to manage this condition and keep it to a more minor issue in her life.

It is estimated that approximately half of all ER visits for acute heart failure are actually for diastolic heart failure which is a later even more serious manifestation of diastolic dysfunction. And a lot of people with diastolic dysfunction are completely unaware they even have it during early to middle stages of the condition.

For those who wish to learn more about diastolic dysfunction that effects both men and women, but with a greater likelihood to impact older sedentary women and those with long term hypertension, I've added three article links below.

Note, too, that one of the key treatments suggested for both diastolic dysfunction and the more progressive stage of full blown diastolic heart failure is to aggressively treat any AFIB! Which Barb has already done and is now enjoying exactly three years of freedom from all arrhythmia thanks to her two part expert ablation process with Dr. Natale.

Below are the articles for learning more, and we all can wish Barb the best in minimizing any future impact of this condition with the help of her cardiologist and her investigative nature to adopt smart life style risk reduction for any risk factors shown in these articles that can really help her ... as well as any of our readers ... so that we might be able to also intervene early should such symptoms show up in any of our lives as well! And at least, by addressing our AFIB aggressively we are all helping to reduce our long term risks of all forms of heart failure.

Diastolic Dysfunction - Ariticle 1 of 3

Symptoms and Diagnosis of Diastolic dysfunction and Diastolic heart failure - Article 2 of 3

Treatment of Diastolic Dysfunction and Diastolic Heart Failure - Article 3 of 3

Be well, Shannon