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

Sent the ZIO patch back the other day. Now to wait and hear of the results and the next step.
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Edited 1 time(s). Last edit at 02/10/2019 08:09AM by rocketritch.

Woke up out of rhythm this morning. Have been under allot of stress since last Friday.



I got out of bed shortly after taking this ecg and hit the deck. I didn't go out completely I just sort of crumbled.

I took my normal meds afterwards, elequis and upping my metoprolol to 50mg. I took a flecanide about a half hour ago and I've since converted back to sinus rhythm. I sent an ecg to my afib nurse and will be contacting Dr Natale's office later.



Edited 5 time(s). Last edit at 02/15/2019 01:26PM by rocketritch.

Had contact with my afib nurse. They downloaded the info from my 7 day monitor and it showed several short runs of what I had today. Dr Natale will be in the office next week and will go over everything then. Until then business as usual.

Good afternoon Rich - I am so sorry to hear about this. I am sure that it is disheartening, to say the least. How long were you out of NSR? It sounds like the flecainide quickly converted you. We all wish that our hearts did not have a mind of their own but a new normal may be that the PIP quickly gets us back into NSR. I am hoping that it is just a small blip on the road to a long full life with your heart behaving!! I have been following you since I came on this forum almost a year ago. I had my first ablation at TCAI a year ago and my second in May. The last episode, other than PACs and PVCs was in September of 2018. I wore the Zio a few weeks ago and am scheduled for a TEE the end of the month. I do believe it is all a process with setbacks, here and there. Live your life to the fullest extent possible. If the beast comes back, then you deal with it. But, today, now, you are in NSR. I know that is easier said than done. Please keep us posted as to what Natale and your healthcare providers say. Hang in there. We are all pulling for you!

Thanks MS. I'm not the least bit disheartened and carrying on with life normal as I've been in this game a long time. I again spoke with my afib nurse and she said I had 17 short episodes recorded on the ZIO the longest of which was 17 beats. Nothing sustained. The only sustained event is the one that I recorded on my Kardia device which isn't really any help when it comes to diagnosing.

The current plan is to wait 3 months then do another ZIO patch. If all is ok between now and then and nothing shows up on the patch they will schedule me for a TEE. to check LAA function. In the interim,what will be truly helpful, if this trend persists, is if I can capture an event on a 12 lead ecg which may be tricky. I have contacted a local urgicare place to see if they have one and they do. However, the process to getting one done when I am out of rhythm is going to take time and my fear is I will convert before they get to record then I'm out $$$ with nothing to show for it. I still need to contact my local Fire Dept to see if they have one. I also need to contact the local ambulance service. I used one of those many years ago to capture an event.

I have also had a couple phone chats with shannon over the past week so lots of of good advice there and ideas as well.

Not much new to report here. Haven't had any more sustained arrhythmia's. I have had a few eptopics and such but that is it. I did about 80 miles on the bike last week over 3 days and continue to go to the gym 3 days a week. I also got some work done on the convertible as well. Life is good.

was at the gym this afternoon and went out of rhythm again. Gathered up my son and headed to the local ambulance service. They have 2 centers in town and I just happened on the one that only schedules transportation. After spending a few minutes trying to tell them that I didn't need an ER just a 12 lead EKG they said I should try their other office.

So back to the truck and across town the their other facility. I walk in and they are having a paramedic class. One of the instructors came out into the hall and I again start explaining my needs. Their first response was to ask if I wanted to go to the hospital. After a few minutes of explaining that all I needed was a 12 lead EKG before I convert back to NSR. That I did not need a hospital that was going to charge me $1000, maybe or maybe not get to me before I converted, then try to admit me the finally got the comfort level that I was aware of what I was doing.

They took me over to the Paramedic side of the building and they briefly explained my situation and what I needed and the manager grabbed their Portable EKG and lead me to their lounge. They hooked me up and got a recording. I thanked them and made my way back to the truck and converted back to NSR without meds, so I was out of rhytm for about 30 minutes same as last time There was allot of other conversation and banter in between, mostly them trying to tell me I should go to ER. They were also confused why the doctor would not want me to go to the ER

Here is what I got.







Edited 3 time(s). Last edit at 04/01/2019 08:05PM by rocketritch.

Heard back from my Afib nurse. She is handing this of to Dr. Natale's Nurse practitioner and I should be hearing from her soon. My guess is I wont be returning to Austin for a TEE anytime soon. More than likely I will be returning for a touch-up which is fine by me.

Dr Natale's scheduler sent me a date for May 23. I talked it over with his NP and we came to the conclusion that I would pass on that and shoot for something further down the road.

I've had 2 break through's since last September which isn't that much. I've also done a couple hundred miles on the bike with no issues thus far. I haven't really been pushing myself but having been off of the bike for so long I'm a bit out of shape. So even JRA (Just riding around) pushes my heart rate up especially on the hills. I've seen max hrm's thus far @154 bpm with good steady recovery times.

The second break through was proceeded by a short run of PAC's. Teh first I am unaware as it woke me from a deep sleep. I'm wondering if the break through's had more to do with mineral imbalance. When I'm riding I'm more regimented in keeping up with my Mg & K.

Had another break through event on Sunday. I took a call out at work so didn't get any sleep. At the 18 hour mark I went out of rhythm. I ended up taking a Flecanide as I was concerned that since I had so little sleep, and had 4 more hours to go, I may not convert as quickly. I was out of rhythm for 1 hour. So that makes 3 events this year, Feb 15, April 1 and April 14. Two of them happened wile relaxed and the other at the gym. Non of these happened under any conditions I am used to. My events were always just after or during sustained cardio exercise

I talked to Dr. Natale's scheduler the other day. He hasn't released any dates for June or July yet so now it is just a waiting game. I continue to exercise without issue to this point. Did 34 miles of dual surface cycling yesterday without any issues.It feels so good to be back to doing normal things again. even with the current arrhythmia issues lingering in the background. One tihng for sure whatever work Dr. Natale did is doing its job and now its is just a matter of completing the isolation of the LAA.

Not much happening these days. Been working on the convertible and riding my bike. Did just over 80 miles over the past 2 days with zero issues. Even did a 2 mile walk with the family later both days. It appears, at least at this point. If I am going to have an event its going to happen when I'm just sitting around doing nothing. Even the event I had at the gym that day I wasn't pushing myself.

I'm starting to wonder if I am rushing into the touch up ablation now. I know that the afib will most likely continue to progress and know that nipping it in the bud right now is the best plan of attack. But I also wonder if the couple events I had stem more from a lack of minerals. When I am riding I know I use up allot of minerals so I am careful to maintain my hydration and mineral intake. When I'm not riding I can tend to get a little lax in mineral maintenance.

[www.strava.com]
[www.strava.com]

I guess I spoke too soon. Had a break through event tonight. Was in the basement truing up a wheel and replacing a broken spoke. Walked up the steps and across the kitchen then boom.

Not sure of the arrhythmia. Rate of 160 bpm. Looked normal for the most part though except for some pac's and pvc's. I converted back to NSR in a little under 15 minutes. I did take a flecanide but that wasn't nearly long enough to take affect.

This does play into my thoughts that it could be deminished minerals. I hydrated good the past couple days and was taking my K and Mg but probably not enough. Two forty mile days in a rowand one being near 80 deg. I definitely taxed the system.

It's either that or I'm going to go out of rhythm around every 10-14 days or so since that is he pattern for the month of April so far. Ugh.

Rocketritch - sorry to hear about this. Do you think there has been some reconnectivity or are there arrhythmias coming from your LAA? If you go for another ablation, are you thinking about closing the LAA and a watchman? Good news is that you are converting in minutes vs days. I am sure you are weighing all your option. I was just in Austin on Monday for a TEE ( I had one earlier by my local cardiologist but he did not get the information and measurements needed to make a decision to stop Xarelto). Good news for me is that I was able to stop Xarelto. Hang in there. TCAI and Natale’s team is the best. You are in good hands.

LAA was where my organic episode originated during my ablation last July. Dr Natle did so some work there but when we talked afterwards he didn't rull out having to go back and do more work.

Had my longest breakthrough event this evening after returning home from work. Just hanging out in the kitchen helping my wife make macaroni salad when I went out of rhythm. The rate reached a little over two hundred for a portion of the event.
I took 200 mg of flecainide and 75 mg metoprolol and converted 3 hours later
There's been a fair amount of stress around here lately so I'm sure that was a contributor to the event.
I also had a colonoscopy this week so the stress coupled with the prep and dehydration associated with that surely played a major factor



Edited 1 time(s). Last edit at 05/04/2019 10:47PM by rocketritch.

Scheduled a followup ablation with Dr Natale for this July 18.

Sounds like a good move. Thanks for the update!

--Lance

This 10 day cycle of arrhythmia is making me nuts. Went out again this morning at the gym.

I think my breathing was off when I was doing my last excercise which is when it started. Episode lasted 1 hour.

Well yesterday was a sad day. I had to say goodbye to my local EP of 10 years. Not by either of our doing but due to insurance.

You see locally we have one of the best hospital networks there is with University Of Pittsburgh Medical Center (UPMC). We also have another great system) which is Allegheny Health Network (Highmark).

Unfortunately for patients in this area these two conglomerates can't get along. So if you don't carry their specific insurance they won't accept you as a patient. So people all over the area are saying goodbye to their caregivers that they have grown to trust over the years.

The date is set for July 18th and airline tickets purchased. Need to make reservations this week. Think I am going to give the Days Inn across from St. Davids a try this time.

My wife and son will be joining me this go around so hope to see some sites this time around. Will get there early Tuesday morning. Consult and whatever testing needs to be done on Wednesday. Ablation on Thursday then released on Friday. Based on previous ablations I hope to be able to get around some on Saturday. Would like to go see the Alamo. Flight back to Pittsburgh Sunday afternoon.

Not much happening lately. I have been feeling a little off since yesterday evening. Had a good 30 mile outing on the bike Friday after being off of it for almost a month due to monsoon season, work and life in general. My effort was more than usual, according to my fancy bike computer anyway. I was a bit hypoxic at the end of the ride but nothing more than that. Then last night I had some severe stomach cramping after dinner but that was it. I was feeling better later in the evening until I had a couple tablespoons of honey. Then I really felt bad. Kind of a combination of a sugar high and nausea. So I cut the evening short and headed off to bed.

Still not right today either but better. I have felt a couple eptopic beats over the past 24 hours as well.

Nothing new to report. My ❤️ has been behaving itself as of late which is a good thing.

Spoke to soon. Was awoken last night by palpitations which lead to being out of rhythm.
I had spent the day working in the hot sun then topped the day off with a trip to the local Chinese buffet. I also have neglected my magnesium and potassium supliments the past several days.
Dehydration, high ammount of MSG and lack of supliments. A perfect storm.

Really wiped out today. I'm not sure if it's due to the flecainide I took to convert or having been out of rhythm.
I've never had I'll effects from flecainide in the past but then again when I was in it it was for extended periods of time. Also when I was just using it as a PIP I was in much better cardiovascular shape than I am currently.
Really looking forward to seeing Dr Natale in July to get this eliminated.

I’m so glad that you are soon going back to TCAI and having a third ablation from Dr. Natale. One more month!!! Best wishes and please keep us posted as to your ablation and recovery.

Thanks for the well wishes MS. I'm so thankful for Dr Natale and the members of this board.
Looking back to this same time last year I am so much better off there is no comparison.

Nothing of significance heart-wise lately. I did have a short run of eptopics last week that I thought was going to lead to afib but they stopped.
Only a couple weeks and I'll be back in Austin.

Had another run of eptopics last night that lead to afib. Thought it might be flutter at first but the Kardia caught possible afib on the third reading with a rate of 178.

Took a couple flecanide and went to bed. Woke up in 52 bpm NSR this morning but completely wiped out as usual. July 18 cant get here fast enough.



Edited 1 time(s). Last edit at 07/02/2019 08:44AM by rocketritch.

Hang in there. This will all be a distant memory. Enjoy Austin and, as you know, you are in great hands - both Natalie and St. David’s staff. Keep us posted.

This time next week I will be back in Austin.
I will arrive early Tuesday. Will meet wit Dr. Natale Wednesday and Have surgery Thursday. I'm excited to get there and get it done.My wife as usual is still a little apprehensive but excited for me as well knowing how miserable the afib makes me feel. It has also kept me from doing many of the things I enjoy.
Since my last episode a few weeks ago I decided to hang the bicycle up for the time being. To this point I have had zero issues on the bike but that doesn't mean that I wont. It does appear though that I can expect to have some sort of event in the days following a ride. The events also seam to be more pronounced than they were earlier this year. And afterwards I am completely wiped out for at least a day.

Met with Dr Natale this morning. Spending the day roaming around the city. Lots of great sites and the people are fabulous.

All the best to you on Thursday. Keep us posted!

--Lance

Quote
ln108
All the best to you on Thursday. Keep us posted!

Thanks Lance,

I was #1 this morning. Saw Dr. Natale stepping into a patients room as they were wheeling me to the EP Lab.

He just popped in to say hello on his way out this evening. He was very pleased with how things went and I didn't want to hold him up with a bunch of questions after such a long day as he will be back in the morning. I know his focal point was the LAA as thet is what we discussed yesterday.

I'll post more tommorow.

Rich



Edited 1 time(s). Last edit at 07/19/2019 02:15PM by rocketritch.

Back at the hotel after a fairly restful night.

Yesterday was a long day. Checked into St David's @ 0530. Was in the EP Lab @0600. As always the EP crew was upbeat and fun right up until the point I was out and woke to pleasent nurse in recovery. I really thought I would be able to get to sleep early last night but as usual that wasn't the case. I finally requested a sleep aid and was out shortly after.

My wait for a room was going to be a while so once I was fully awake she ordered me lunch and brought my family back to visit while I was waiting.
I can't say enough about the atmosphere at both TC&A or St. David's as the staffing is fabulous.

Dr Natale was very pleased with how things turned out. He confirmed all pulmonary veins were isolated from previous procedures. And successful isolation of posterior wall of the left atrium using roof and inferior posterior lines. He also ablated along the left atrial septum, floor of the left atrium, left atrial lateral wall and interior roof of the left atrium. He also isolated the coronary sinus and left atrial appendage.

For those that have been following along since last year you will remember that Dr Natale did work on my coronary sinus and LAA at that time as well. I also had an organic afib episode that originated in my LAA while he was working his craft on my coronary sinus. This was after he had already done some work on the LAA.

As you who are veterans to this process here will already know how difficult the LAA is to ablated due to its consistency and proximity to other vital organs. This limits the the time that he can spend there. So even though he had twice visited my LAA there was still a little work to be done.

Also, most bennifit greatly from a single LAA procedure which may or may not completely isolate the LAA. The plus side to that is that not only does this eliminated Afib in some patients. It also increases the possibility that the LAA will still function properly eliminating the need for long term anticoagulants.

He did have some issues ablating my LAA as he normally uses a 15 mm lasso but it could not be engaged because the entrance to my laa is too small. So he just used the regular catheter and went into the left atrial appendage and isolated it that way by moving the the catheter around the interior.

When we talked this morning we went over everything that he did as well as possibilities for the future. Chances are at this point I will either be on long-term anticoagulants or we need to have the laa isolated with either of watchmen or a lariot sutcher approach. His concern at this point with a watchman would be sizing as there only two sizes and the fact that my laa entry is so small could be an issue. But that's all down the road.

He sent me home only on 25 mg metoprolol and 5mg Elequis twice a day. He does not want me taking the Flecainide unless I need it.



Edited 2 time(s). Last edit at 08/17/2019 10:46AM by rocketritch.

Been back from Austin a few days now just relaxing. Have had one short run of ectopic since. Got it recorded on my Kardia. Looked mostly normal to me except it wasn’t a solid recording. Second recording right after was normal with 72bpm.

Feeling really good since my latest visit to Austin. Only a few eptopics along the way.
Biggest issue now is getting back to work. Have my papers but have to go through an outside source to get back to work. We don't have STD and I wasn't off long enough to file a claim if we did.
Worst case is I get extra time off paid.

Sounds great Rich! Glad to hear it’s smooth sailing in these early days post ABL.

Cheers!
Shannon



Edited 1 time(s). Last edit at 08/05/2019 10:43PM by Shannon.

Thanks Shannon. Haven't had a chance to order the hummingbird feed you suggested. We had some gardensong clear feed mix I've been using. They really like it.

It's been a month since my latest ablation with Dr. Natale. All is well so far. I have been having a couple PAC's and PVC's but nothing lastng more than a couple beat's. They only occur when I lay down or after I've been sitting for a while.

Not much new to report. Have had a few eptopics over the past couple weeks but that's it

It's now been 3 months since my ablation with Dr Natale. Celebrated today with a 30 bike ride and a couple hours ride in the convertible with my wife after I got home.

43 miles on the bike today. My legs are tired but my heart was in it.

Tried to keep my rate below 140. Had an avg rate of 129 with a Max of 155 during the 3 hour outing. I didn't hit the 155 mark until near the end of the ride. There's a pretty long climbed at about the 38 mile mark.

Overall a good day

Just got the results back from my in home sleep study. I have mild sleep apnea-hypopnea syndrome. But since I have a history of affib I qualify for c-pap and more than happy to comply. The doctor placed the order so I should have a machine by next week I suppose. My AHI is 6.7/hr and my saturation dropped below 90% for 3.3% of the night.

Been a while since I have given an update.

Everything has been good heart wise. I feel the occasional eptopic but that's it. I have been going to the gym regularly but have been having a hard time getting back to cycling. Not sure why but that's where I'm at.

I am getting some decent cardio at the gym when lifting. I am avoiding doing any real heavy weight and just doing high rep sets and combining 2-3 exercises per muscle group together. I'm hoping my interest in cycling comes back. We'll see once the weather breaks and I have opportunityto get out on a regular basis.

Good news, Ritch. Long may your heart be at peace!

--Lance

Had a great first ride if the season today. 30 miles on the road. Life is good.

Finished my week with ZIO patch now waiting on results.

Been feeling really good. Got a couple rides in on the bike this week. 60 miles between both days.

Spoke with someone from Dr. Natale's office today concerning my ZIO patch results. Only thing that showed up were several short 4 beat runs of SVT's.

I'm very happy with those results as short runs like that are common even in those without arrhythmias. We will schedule a visit down the road to have a TEE done to check my LAA velocity. I also need to do a better job of keeping up with my suplimenatation of Mg and K.

Haven't posted in a while since things have been normal. Unfortunately that came to an end the a week ago.
I was out of rythem for about 1/2 hour. Not sure what it was since my Kardia was out of commission due to it finding it's way into the washing machine.
I ordered a new Kardia Xl the next day and it arrived early this week. Just in time to capture my next event. I'm pretty sure it's AFib bit I'm not a pro at reading strips. I took flecanide to convert but converted moments after taking it so I self converted.
Not sure what triggered this as I have not been doing much besides work since the Covid-19 sent our lives into chaos. I've been going to the gym and some long needed yard work. But that's the extent of what I've been doing. I've only been on the bike a handful of times this year and now I'm not sure what to do.
I'll be calling Dr. Natale's office on Monday to see if they have any thoughts.
On a side note. Back when I first experienced AFib I was heavy into weight lifting. This was prior to my overindulgence in cycling.





Edited 2 time(s). Last edit at 06/14/2020 03:21PM by rocketritch.

Sorry to hear about this, Rocketritch. Good to call Dr. Natale's office. I'm sure they'll help you get a handle on what's going on.

All best!