My Ablation With Dr Natale (07/20/2018) with current updates

This thread will cover my ablations with Dr Natale and I will do my best to keep it current along the way. Enjoy.

They say that time flies and it surely does.

Failed ablation in January, Medications I had been using for years stopped working. Cardioversion in April. Then starting new medications (Ticosyn) shortly after that worked spartically. Now in just a few days I will be having an ablation with Dr. Natale.

My last dose of Ticosyn was Friday evening and I started to taper off the Metoprolol. I will continue to tale Elequis straight through. I didn't have to stop the Ticosyn until Sunday but I spoke to my nurse and asked if it would be OK to stop a day or two early as I wanted to be certain that as much of it was out of my system as possible before the ablation. She said that would be fine so I did. I'm also down to a single dose of metoprolol.

Now the weird thing is that I have had nothing but issues since starting the Ticosyn. It didn't keep in me rhythm all the time. Sometimes I would stay in NSR for several days and other times several hours. Even up until last week I was in and out of rhythm a few times. But since I stopped on Friday I have only had a few stray odd heartbeats.Now I am not complaining as I figured I would be out of rhythm and miserable until Friday.

Don't get me wrong. I am more than happy to not be miserable but it does strike me as odd. Especially with all the issues I have had up until this point. Anyway, I am leaving for the airport soon and have an appointment for a CTA and I will finally get to meet the nurses and Dr Natale tomorrow in Austin. Needless to say I am excited.

I also want to thank everyone here for their kindness and support along the way. I also want to recognize Shannon and his passion for this site and for helping people.



Edited 4 time(s). Last edit at 07/19/2019 07:45PM by rocketritch.

Austin and Natale sounds like a helluva plan to me!!

You're in great hands this coming Friday (-:

Best,

Mike F.

You're in great hands, the best. Safe travels. Here's to the very best of outcomes. Shannon and Dr. Natale and TCAI/St. David's are the cream of the crop.

You mind is your heart to some degree so now that your relaxed and so full of anticipation of getting this done with THE master tech. himself........prob. your cortisol levels are perfect and your brain is being flooded with good chemicals.
Its like the natural reaction when 1 gets to an emergency room visit when your name is called or hearing the door bell ring and know its the doctor on your doorstep and you feel that finally help is on the way and a great relief comes over you.
I hope i feel just like you Ritch in few months when i go see Da Vinci also......dates and so on for me will be finalized in a few weeks.
How about that Shannon. I am wondering how a person in our state or even 1 with just a pinch of afib/flutter/tach could not go to see Dr. Natale after listening to Shannon. What a wealth of knol. of afib, Dr. Natale and the whole industry as a whole. He was nice enough talk to me for about 90 min. and as i said in another thread i was on the edge of my seat the whole way and cannot remember feeling better after a phone call maybe in my whole life. Him the people at St. David hosp. in austin have made this exper. so wonderful and everyone seems so caring i cannot wait to get show on the road like you.
I come from Canada....aka assembly line health care so its an incred. exper. to be treated this way.
Keep us updated on everything that happens...I for one cannot get enough so many updates would great.
All the best Ritch.



Edited 1 time(s). Last edit at 07/18/2018 09:28AM by vanlith.

Good luck to you!

You will be in good hands with Dr. Natale. I have had 2 Ablations with Dr. Natale. St. David’s is the best. My Nurse Case Manager Curry is a Gem. Its all good from here my friend.
Shannon is a wonderful person who was so helpful to me plus so many on this forum. I was a lost “ puppy” in late 2011 when I found this forum. I thank God daily for leading me here.
Happy NSR days are Soon my friend.

I hope you have great success. Keep us posted...

All the best to you. As others have said, you're in the very best hands.

--Lance

Can I say it one more time? You're in the best of hands. Good luck and let us know how it went as soon as you're able.

Arrived here in Austin last evening. Went to get a bite to eat and spoke with Shannon.

Not long after that I went out of rhythm. Eating had become an issue at one point when I was on the Ticosyn. So I was not shocked when it happened.
Stayed out of rhythm most of the night. So much for all the hydrating I did yesterday 😁.

Anyway, I'll be catching an UBER here in a little while as my CTA is scheduled for 10am and they want me there by 9am. So I'm hoping to be there by 8am.

Never used UBER before so hopefully that will go smoothly.

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rocketritch

Never used UBER before so hopefully that will go smoothly.

My experience in a busy area like Austin, has been excellent. Hopefully all goes well this & your ablation!

Joining in late to wish you the very best. I have no doubt all will go well for you and you'll soon be posing about your
fantastic Austin experience.

Jackie

Hey Rocketritch,

I've also got an ablation with Natale tomorrow. We'll probably be neighbors.

Hope your procedure goes smoothly and your recovery is quick!

-Tony

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ragatx
Hey Rocketritch,

I've also got an ablation with Natale tomorrow. We'll probably be neighbors.

Hope your procedure goes smoothly and your recovery is quick!

-Tony

I just saw your post and was thinking the same thing.

Good luck to you as well. No need to worry. I've had 2 ablations over the years, not with Natale though. I'm a slow learner.

Your are in the absolute best hands to start out with.

Maybe we'll cross paths.

Had my CTA and consultation with Dr. Natale today.

I have never had a CTA before. Very interesting process. And the feeling you get when they inject the contrast dye is IMHO very pleasant.

As to Dr. Natale, I was very impressed.
Very pleasant and he is so relaxed and very interactive. Very warm personality. Great first impression.

The staff I have had interaction with. Both at TCA and St. David’s has been stellar.



Edited 2 time(s). Last edit at 07/19/2018 10:09PM by rocketritch.

Good luck neighbor!

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rocketritch

I have never had a CTA before. Very interesting process. And the feeling you get when they inject the contrast dye is IMHO very pleasant.

It's certainly an....odd feeling. Getting you all the feels right there in your business area. I'd had this done before, but for some reason the one at TCAI made me nauseous for a short period after. They told me ahead of time that may happen.

Again, best to both of you.

Quote
ragatx
Good luck neighbor!

Same to you.

Up and about.

LAA, Coronary Sinus and Posterior wall. I think. Was up and about but still kind of out of it when Dr Natale came in.

Will get better clarification tomorrow.

He was impressed with my 220 bpm 💓-rate.

220 bpm..that must have been when he put the 20 or 30 ug's of isoproterenol in you to find any lingering afib/svt/flutter culprits after he thought he got em all or maybe after just the PV's and post. wall. What's your rate now...must be around 80-100 bpm my guess...btw you must be lying on the gurney with a phone in your hand right...if so that's what i call dedicated to giving his fellow affibers almost real time info. That's a lot of ablating....if that's what Natale did cause he normally just does the PV's and post. wall for rotors ect. in your basic case and then moves on if nes. to the coronary sinus next then LAA and vein of marshall in % of possible 2nd and 3rd or more culprits. Well look at it this way he pretty much covered your whole heart grid by grid so i cannot see any chance of anymore afib flare up spots hiding there. Well the LAA work if he did indeed iso that will require you to take a blood thinner now but that's a very small price to pay for letting Da Vinci paint that beautiful picture on your heart toward nsr bliss...keep us posted....its too bad you could not have givin us the play by play in real time during the branding iron session itself.....o well this was close as i have ever seen. When i get this done in dec. i will ask Dr. Natale to wake me up mid procedure so i can update you guys and see what he says.
GL..keep up us posted during supper, showers, bathroom breaks ect. how you feel and bpm.



Edited 1 time(s). Last edit at 07/20/2018 08:04PM by vanlith.

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vanlith
0 bpm..that must have been when he put the 20 or 30 ug's of isoproterenol in you to find any lingering afib/svt/flutter culprits after he thought he got em all or maybe after just the PV's and post. wall. What's your rate now...must be around 80-100 bpm my guess...btw you must be lying on the gurney with a phone in your hand right...if so that's what i call dedicated to giving his fellow affibers almost real time info. That's a lot of ablating....if that's what Natale did cause he normally just does the PV's and post. wall for rotors ect. in your basic case and then moves on if nes. to the coronary sinus next then LAA and vein of marshall in % of possible 2nd and 3rd or more culprits. Well look at it this way he pretty much covered your whole heart grid by grid so i cannot see any chance of anymore afib flare up spots hiding there. Well the LAA work if he did indeed iso that will require you to take a blood thinner now but that's a very small price to pay for letting Da Vinci paint that beautiful picture on your heart toward nsr bliss...keep us posted....its too bad you could not have givin us the play by play in real time during the branding iron session itself.....o well this was close as i have ever seen. When i get this done in dec. i will ask Dr. Natale to wake me up mid procedure so i can update you guys and see what he says.
GL..keep up us posted during supper, showers, bathroom breaks ect. how you feel and bpm.

You only edited that one time?^^^^^^ Now I’m impressed 😂

Heart rates been between 83-94. Did see it go to 101 just before supper. Sorry I did see your post before I could have Skyped it over dinner. The catfish was splendid BTW.

Anyway, I feel really good right now and the fog has cleared. He said that PVI scarring from previous ablations was good. I’ll need to clarify if he actually did anything there (He did do some PVI work. He expanded the scar tissue on all 5. He also did some work in my right atrium. Not sure if he did this before he punctured through or as he was coming out). I have had flutter addressed before as well. But otherwise it appears he didn’t just take the .10 tour. He did say that everything looked good amd worse case I may need a touch up of the LAA down the road. The 240 heart rate was organic. It lit off as he was starting to work on the coronary sinus.

So far as the heart 240 rate I’ve seen that before. Very first time was back when my Cardiologist sent me for a stress test in the very early days so I was still in my mid to late 20’s. They put me on a treadmill (I had requested a bike) and stared pacing me. They kept increasing the speed and asking me if I felt alright I said yes and started a conversation with the tech. He was having non of that so he kept bumping it up and I kept talking. At one point after he and another technician started to look at me as if I had spiders crawling out of my ears they concluded the test. Said that was the first time they ever ran that machine that fast.

They then took me to a room, had me lay down and watch my rate drop. A Dr came in and talked to me and looked at my strip. He looked st me again then turned to the nurse and said leave me hooked up for a while longer. This whole time I had been watching the screen as my was dropping. 140,130....... 100,90,80.......BOOM........ 240. Alarms and mayhem from my nurse ensued. She looked at the monitor then at me back at the monitor then she was off like a shot as I tried to say something to her. All I could hear was here yelling Dr. DR getting further and further away. I just laid there shaking my head smiling to myself as she had left me alone.

Finally I saw her running back up the hall towards me with the Dr trailing way behind. When he finally arrived he looked at the monitor, at this point I was below 200, then he looked at the strip, then he looked at her for a moment. He then looked back at me and said “come see me, go ahead and unhook him”, then left. She then unhooked me as I was back in sinus and led me to the discharge area. I never did see that doctor again as I had already been through several cardiologists to this point and had one I liked. So I never did get to find out what he was thinking. He may have been an EP for all I know.

I’ll update tomorrow after speaking with Dr Natale.



Edited 2 time(s). Last edit at 07/21/2018 06:15PM by rocketritch.

That runaway rate was prob. linked to the problem you just had addressed.

Just talked to Dr Natale. He seemed very pleased and wants to see me in 6 months. Since I am on the younger side I asked him about the watchman device. He said that we could talk about that when I come back.

The high rate he spoke of was organic and was 240 bpm not 220 as I posted before. He said it happened as he was starting to ablcate the coronary sinus. Also said he rarely sees that high of a rate. They had stared me on Ticosyn here but he and I had discussed going back to flecanide. He left that decision up to me so I will have to give it some consideration. The Ticosyn wasn’t keeping me in rhythm but the flecanide had stopped working. Also my back pain has gradually subsided since stopping the Ticosyn last Friday so I’m in a quandary as to which to choose.

I’ll be getting out of here today sometime and hope to be able to catch a flight home a day early (Monday), and join my family at the beach for a couple days. We will see.

Well lets hope you have to go on zero rate drugs from here on in or this whole thing would have only been of limited success.
IMOP PIP only is the way to go through the blanking period if at all cause if it comes back normally as we know in the blanking period its not as intense and shorter than before....much shorter normally, unless it was a failure like mine, so maybe just ride it out if it comes back like many just do with no drugs other than blood thinners of course.
If you do decide to go PIP...well flec. seems out for you try propafenone during the blanking period....its a miracle drug for me in the PIP mode and i cannot imagine my life without it as a bridge between this horrible afib (about 6 ep. a month) to a final hopeful fix with the good doctor later this year. Discuss it with your doctor or just ask him for it like i did after a hosp. visit 3 years ago when 3 zaps of cardioversion did nothing for me and then 2x150mg propafenone converted me in just under an hour after 50 hours of hell. At that point i made an app. with my GP and asked/told him this is my bridge drug and he was ok with it then wrote me my 1st of many persc. of it and life has been so much better with 1 hour or less ARR's these days compared to 50 hours or less in the past...day and night, but hopefully this is mute point cause there is no reason you cannot be NSR from here on PERIOD.......esp. considering WHO was just in there working on you.

It's my understanding, and please correct me if Iam wrong, the antirhythmic drugs are used to keep the heart in rhythm as much as possible during the blanking period. And if an eppisode does occur tte shorter the better. I thought this was even more important for more complex/long standing arrhythmias.

The reason for this I thought is to prevent the heart from creating new pathways. Again this is only my understanding I'm no expert.



Edited 1 time(s). Last edit at 07/21/2018 02:42PM by rocketritch.

Your correct ritch about trying to keep your heart in NSR no matter what it takes absol. but in your new condition its like a trial and error situation your in cause you currently and for the next few months are not sure what to expect from your heart as compared to a few days and weeks ago when you knew what to expect.
This is what i would do if i were you.....NOTHING.....at least until you get another ARR.....now lets hope you don't but if you get 1 or even 2 more anytime soon again.....nothing.....observe it time it see how long it is and then with that info decide if you want to use drugs....cause it may only last a few hours or less and the 2nd if it comes may be even less severe esp. if the 2 come spaced out a few weeks....the big point i am making is don't take your heart too seriously in the next 2 months don't overreact unless your heart really starts going wacky in the next few weeks with long ARR. run ons and freq. with little diff. from before then its prob. time for that PIP drug bridge until you see Natale again but until you see yourself deteriorate to that level just sit back and observe only.+++++++never lose sight that NATALE just worked on you..... the BEST EVER......the stuff that i have read about his work...... unless your a real complex case is your at very MIN. for short term meaning months and possibly a few years are going to be perfect....its maybe 3 years or more years down the road that i have observed that a few cases have gone somewhat sideways and only then have a few come back for touch ups.
Natale puts his rep. on the line in every 1 of his patients and that means YOU......he won't let you down......now no more negative thoughts (and that includes me).....just enjoy the sweet beat.....i envy you.

Feeling really good today. The chest pressure this morning is pretty much gone. I'm sure as I move around today it will build some.

I've lost just about all the fluid weight as well which I'm sure is contributing to my feeling better.

Was able to move my flight up to tomorrow so I'll be back home Monday instead of Tuesday.

This whole experience here in Austin has been great.

I also was looking at some things and back in 2009 on the same day of my CTA scan this week I got the time and date for my very first ablation which took place 1 week from today which would have been July 29, 2009.



Edited 1 time(s). Last edit at 07/22/2018 09:06AM by rocketritch.

Quiet day today. Laid around all day and had a nap. Chest pressure was basically gone today and my blood pressure feels like it's back to normal. All those extra fluids you get during the ablation really increase your volumes. Gained a little over 3.5 lbs. This is the first time I have ever been given diuretics beyond the interveinous one they give in the hospital. Those really make a difference in relieving the chest pressure.

Had a couple runs of PVC/PAC's this afternoon. Nothing that lasted more than 30 seconds or so. Nothing out of the norm following an ablation and nothing since then.

Was able to get my flight changed so I'll be heading home tomorrow.

Travel day today. Up early for a light breakfast then laid around the hotel until it was time to leave for the airport.

Flew out of Austin around noon. Back in Pittsburgh around 7pm.

Heart was quiet today. Chest started feeling a little sore later in the trip. Used airport assistance all day and took it as easy as I could.

Chest feels fine now.

Do you notice any increase in your HR rich?

Today is the first I have measured it since leaving the hospital. Sitting here in my man chair its 61 bpm.

Had a really good nights sleep last night. Started back on potassium amd magnesium last night.

Currently taking Ticosyn, metoprolol and elequis. I’m going to talk to Joaquie today and get a script for flecanide. I feel more comfortable with that



Edited 1 time(s). Last edit at 07/24/2018 10:05AM by rocketritch.

Since he worked on your LAA in some way are you on blood thinners forever now because of that and most importantly when are going cold turkey on these many drugs your mentioning other than ELQ. cause is that not what you went through all this for in the 1st place and of course to get back in NSR.....i am guessing during and late in the blanking period you will be withdrawing from them.



Edited 1 time(s). Last edit at 07/24/2018 12:03PM by vanlith.

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vanlith
Since he worked on your LAA in some way are you on blood thinners forever now because of that and most importantly when are going cold turkey on these many drugs your mentioning other than ELQ. cause is that not what you went through all this for in the 1st place.....i am guessing during and late in the blanking period you will be withdrawing from them.

Will remain on drugs for at least a month. Thinking about switching from Ticosyn back to flecanide though. He had no real preference.

Since the LAA work anticoagulants will be part of my life for now. They will test function of the LAA when I go back in January. However,even if functionality is fine they probably will not have me discontinue the elequis especially since the LAA starts to become a risk factor under normal conditions at my age. We had a brief discussion about the Watchman device and will discuss it further when I go back in January. There are two issue with the Watchman.

First and foremost is insurance. They don’t want to cover patients in my category, younger and physically active (ie. high risk for bleeding), for some reason. Secondary to that is the possibility of him maybe having to revisit the LAA for more work. He didn’t mention that but I’m just speculating as he is unable to be as aggressive in that area due to structure and proximity to the coronary vein. I would guess that if a Watchman Device was implanted now it would limit him in that area.

Another thought on the anticoagulants is that to address the afib the LAA needed work. To not address that would have left me in a position where I would have had to remain on them anyway. So worse case I end up selling my dirt bikes and stop mountain biking. I’ve pretty much given up on mountain biking anyway as I can’t afford broken bones at my age. I much prefer road riding anyway. And I’ll take the money from the dirt bikes and buy a convertible.



Edited 1 time(s). Last edit at 07/25/2018 08:42AM by rocketritch.

A question re going out of town to Austin etc to get an ablation. Do you need to have a local EP to work with you before and after?

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Brian_og
A question re going out of town to Austin etc to get an ablation. Do you need to have a local EP to work with you before and after?

From here on out Dr. Natale will be my arrhythmia EP. In other words nobody else would do anything inside my heart but him. He also wants me back in January for my follow up TEE. This is when they will look at the function of the LAA and make determinations/recommendations on anticoagulants or further steps such as the Watchman Device.

I will continue to work with my current local EP for basic follow up checks and so forth. He had already offered to do that for me along with any help he could be to get me in to see Dr. Natale.

Like I said before, your Dr should be vested in your health regardless of weather or not they are capable of helping you or if they need to assist you in finding someone who can.

Hi Brian - Yes, you should have an EP who can help you if you should need cardioversion. When Dr. Natale was here at the Cleveland Clinic, that was great. When he went to Texas, there were a couple of associate EPs here who were more than willing to help when I began having recurrent events 11 years later. However, knowing I would most likely need a another ablation for a-flutter when that surfaced, I knew I'd be going to Austin for the second ablation.

Then, while traveling home from Austin to Cleveland after the second procedure, I went into a-flutter again in the Nashville airport (connection) so immediately upon arrival at home, I called the local EP to get on the schedule for ECV. it was a great comfort to know I had a reliable contact I could call when I got home so I would urge you to set up something similar just in case you'd need it. Chances are, you won't need it but better that way than feeling desperate.

Best to you,
Jackie

Thank you. I guess the next question is if I ever feel that I needed an ablation and want someone like Natale to do it, how do I find an EP that ok with taking care of before and after? Or would working with a good cardiologist work?

Kinda like walking into someone's office and saying "can you help me? But I don't want you working on me" 😊

It's possible that depending on where you are located that Dr Natale may have a contact near you.

Your cardiologist may be able to refer you to someone as well knowing the situation up front.

Also, just because they won't be Ablating you does not me that they can't help you. There is testing and even rutine Dr visits that are all part of it.

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Brian_og
Thank you. I guess the next question is if I ever feel that I needed an ablation and want someone like Natale to do it, how do I find an EP that ok with taking care of before and after? Or would working with a good cardiologist work?

If their ego can't handle you using Natale for an ablation and asking them to be your local clinical EP then walk away. No EP worth their salt would have a problem with that. No, don't substitute a regular cardiologist. My EP was actually relieved I went to Natale and fully supported my decision even though he had been my EP for two years, had done two prior ablations, and was highly regarded. I admired the hell out of him for that attitude and consequently I still do routine followups with him and seek his advice on things such as the Watchman procedure I'm going to do next week.

Carry is absolutely right. My EP of 9 years. That performed 2 ablations and ii fairly whell reguarded himself was also more than willing help.

He is the one that told me that it was his goal to see me well. Weather it was he who was able to help me or in finding someone who could

It’s been a nice quiet couple of days. Heart is still purring along@ 65 bpm. Messed around in the garden yesterday. Went and retrieved my 4 footed companions from the kennel today.

Just got home from a friends house for dinner and ready for a quiet evening on the deck.

Still experiencing some fatigue if I am up and about for too long. Nothing out of the ordinary though.

Do you have a pocket heart monitor rich?
When i go in dec. for mine they offered me either a pocket carry one or an implantable one that last for 3 years but i think i will decline both because i am so aware of my beats to the point even in my sleep i wake up when i get some pac's let alone an ARR. so i don't need any monitors to let me know how i am doing...sounds like you rich...you feel everything too it seems.

No pocket monitor. They did send home a HEARTRAK device to send weekly recordings which may be what you mean. I’m going to order a Kardia though. I do have a WAHOO heart rate strap that is Bluetooth and can link to my phone but that’s really only good for tracking current heart rate.

As far as being in tune with my heart, I am too a fault. And have been that way since the very early days. I really try not to be though as I have found that focus can cause issues. I remember in my younger days while out on training rides with friends. The mere mention of how my heart was doing could trigger an event.

I was discussing this with my friend and his wife last night. The hardest part right now, and I remember going through this following my other 2 ablations, is ignoring my heart. You really become focused during this stage, almost obsessive and that’s not good because it makes it nearly impossible to relax. And being in tune with how you feel only exacerbates the situation. Especially if your heart rate climbs to a high NSR rate under normal circumstances.

This happened to me several months following my first ablation back in 2009. I’m an avid archery hunter. Not as possessed as I was back then now though. Anyway, I was just nearing the end of the blanking period and had been feeling really good. The only event I had had to that point was when I had a afib event in the hospital following my ablation, before they started me on the arrhythmic drugs . I had been on stand for about an hour and a good mature 8 point was approaching my stand. The adrenaline kicked in and so did my heart. Completely threw me for a loop. Bow down, and fingers to my neck to feel my pulse. It was completely normal, only elevated due to the adrenaline rush. Needless to say I was relieved and chuckled to myself as the buck walked away.

HeartRak...did they suggest or tell you to have that....how many hours in a 168 hour week does it send back info?

HEARTRAK. It doesn’t do loop recording. I just hold it to my chest and hold the record button once a week or when I have an event.

I’ll start using the Kardia when I get that.

1 week since my ablation. Feeling really good.

Family got home this evening and I ran out to my mennonite friends house for some home made ice cream. Had a scoop of blueberry and brought a quart of peach home for everyone else.

He makes some serious ice cream from an old family recipe. He also doesn't use any chemicals for cleaning his equipment. Only soap and water and always passes his inspections.



Edited 1 time(s). Last edit at 07/28/2018 09:54AM by rocketritch.

Thats great rich.....do you have any shortness of breath and i don't mean just doing normal things i mean have you walked up a few flights of stairs or walked at a good pace for a couple min. ect....when do you plan to start pushing things a bit?

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vanlith
Thats great rich.....do you have any shortness of breath and i don't mean just doing normal things i mean have you walked up a few flights of stairs or walked at a good pace for a couple min. ect....when do you plan to start pushing things a bit?

I do have shortness of breath and fatigue if I am up and aout for too long. The nerve pain is returning as well so I am going to switch back to the Flecanide. I was feeling really good that week I was off of the Ticosyn. The nerve pain dissipated over the span of the week I was off of it. I'll have to be off of the Ticosyn for three days before starting the Flecanide.

I'll probably wait three months before getting back on the speed machine (pinarello). I do plan to spend some time on the rails to trails with the family on the bikes I purchased for my son and I earlier this year in the interim. Bought a pair of gravel bikes. We had planned to ride the Allegheny passage and C & O Canal Trail from Pittsburgh to DC this summer. That's on next year's itinerary now. I was also looking at our Kayaks the other day and will probably hit the river on those next Saturday.

My son also mentioned yesterday that he wants to get back to the gym. So that is on the schedule as well. Slow and easy wins the race they say, Never been a believer personally but willing to give it a shot.

Learned a new term the other day while doing some research on exercising and how much might be too much. PAFIYAMA, Paroxysmal Atrial Fibrillation In Young And Middle-Aged Athletes. Whie I am down I am going to try to come up with a regiment that is palatable to both my psyche and my heart.

Its been a few days since I posted. Figured the monotony of NSR was getting boring. But we all know that the time post ablation can be anything but boring sometimes.

The weekend started out the same nice calm NSR. DId some shopping in the afternoon followed by church. Then home to for a quiet evening. Sunday morning I awoke to find myself out of rhythm. This was the day I planned to start weaning myself off of the Ticosyn because the nerve pain has been creeping back. So I decided to wait until I had the opportunity to speak with my Afib nurse at TCA. Meanwhile I took some recordings throughout the day with the HEARTRAK (Kardia on its way).

I spoke with the nurse yesterday and what showed up on the strips did not concern them. Some affib and more elevated but normal rhythm which is totally normal for this stage (10 days). So she advised that I go ahead and stop the Ticosyn, which I did yesterday morning, so that I can go back to the Flecanide. She also said that I may have to up my dose of Metoprolol in the interim if I go out of rhythm again just to keep my rate down.

The other odd thing that happened was Monday morning very early. I had woken up around 3am still out of rhythm. I got out of bed to get a drink and came back to bed, At some point shortly after I converted back to what felt like sinus rhythm. However, my heart rate was very low. 37 bpm. It stayed this way for a while then jumped back to around 70. Then after a while back to 37. Now I was using a pulse oximeter to record these rates so the accuracy and interpretation of what was actually going on is up for debate.though the rate was steady with no fluctuation at both rates. I did run back out to the kitchen to grab the recorder to try and capture the event but what I was feeling and what was recorded were two different things. This continued for the entire morning; until my heart decided to just go completely haywire for the remainder of the afternoon into the evening. I converted back to NSR early evening and have remained there ever since.

This is the first time I have ever experienced such a low hear rate. My normal resting heart rate now is 62 bpm. And has been as low as 52 bpm when I was more active. One thing I think that may have contributed to this was that I had taken 75mg of Metoprolol the previous evening to try to keep my heart rate down as the 50mg I had taken in the morning was not enough. This is only speculation though. I had been taking 75 mg of Metoprolol with the Ticosyn prior to my ablation for the same reasons when the Ticosyn was not sustaining NSR without any issues.

Ya i think your right it's that heavy dose of met. that did but it should not jump around like you described thats weird......in the past i took bisoprolol a few times and it put my already pretty low fit heart that i have into a tailspin for beats meaning 40-45 which was crazy but unlike you it stayed there for about 12-16 hours then slowly returned.
It's only been 11 day's so try not to take anything too seriously....early to mid. sept. is the time to start doing that i say.