2nd Natale ablation - PACs

Had second ablation with Dr Natale on April 17, 2018. Had extensive work for AFIB and flutter in both left and right atria. Last ablation the Doc worked on "various fractionated potentials" around the coronary sinus area. He said this is a very delicate area and that he can't be as aggressive as he would like to be so if any arrhythmia resurfaces it would require a touch up. (My local EP who coordinates care with Dr Natale said he wouldn't even attempt to go into that area!) Came off meds about 2-3 weeks ago, except for eliquis. The good news is that I've had no significant episodes of either AFIB and flutter. (This is the first time in around 15 years that I've not had to take some type of arrhythmia medication!) However, I do have PACs at varying degrees and at varying times, ie at times I can be in perfect NSR and the next PACs. While I can handle the skipped beat and the extra beat there is one annoying beat I get that is very strong or much stronger then the others. At night it can wake me up and keep me up, so its starting to get debilitating. (I'm wondering if this is from the corornary sinus area.) Curry told me if the PACs get too bad I could take a half dose of atenolol. At this point I'm reluctant to get back into the meds. Also, i'd rather not start a supplement plan (although this maybe in my future). My thinking at this point is to gut this out such that if an arrhythmia is to return than its better for it to return sooner than later (and get a touch up ablation), then to start masking it with meds (atenolol low dose flec), or treating it with supplements. I know there has been much discussion on PACs, but does anyone have any experience where these PACs actually went away over time and how long did it take? Maybe my thinking is clouded!
Many thanks.
Joe

You’re just right outside the blanking period. I’d say stay the course for now. I don’t think supplements are a bad idea. If they calm the ectopics then great. If arrhythmia is destined to return then they won’t stand in its way, at least not for long.

thanks Wolfpack

Natale has KOed like 95% or more of the beast in you so as wolf said much experimenting with diff. supl. including many you have tried before that did not work are a good idea to finish off that PAC only fix....but i know what you mean PAC's if you get enough of them during the day or esp. at night and overnight to keep you awake are as bad if not worse than an ARR.....both have to go or it seems you have succeeded only around halfway.
1 only is not good enough.

Thanks Vanlith - I can see,smell, and taste the peak of Mt Everest. Will stay the course. Would not have gotten this far without Natale of course, Shannon and the insights of the many participants on this forum. Many thanks!

I have been in nsr since ablation and touch up in Bordeaux in January 2003. Since then I have always had many ectopics, up to 8000 on a 24 hour Holter. Prof. Haïssaguerre said they were a nuisance but not a problem, and that if they bothered me I could take a small dose of bisoprolol.

I don’t like taking medication but they were extremely uncomfortable. My solution was supplements - magnesium, potassium and taurine, which dampens them down so that I don’t notice them. This has worked for me for many years.

Gill

Magnesium and taurine supplements and potassium via my diet have tamed my ectopics significantly, to the point they aren’t a bother. I’m 13 months post Natale and 16 months from my first with a lesser EP. My resting HB is down significantly in the past few months as well.

Joe - Everyone is different in recovery time and also the amount of PAC activity post procedure. I've had three Natale ablations and had no notable PAC-type activity which may be because I always went back to my core electrolyte program and other support supplements as soon as I was discharged.

Since we all are different, there's no set standard but if your PACs are noticeable to the point where they dominate your thoughts, then it's certainly worth adding in some magnesium. Magnesium helps stabilize the PAC activity by prolonging the time between heart beats... or the refractory period because it's a requisite to be in place so potassium can work. If you don't get enough potassium from your dietary intake, then adding small amounts would be something to consider.
Stress depletes magnesium so if you stress alot about the PACs then consider small doses.

Best to you,
Jackie

Many thanks to all - Jackie will review your comments on the supplements and if I have any start up questions I will post. all the best

I have a similar issue. I had an ablation by Dr. Natale on Feb 22. Went off sotalol around June 22. Since then I have had ectopics almost daily, but what bothers me is some prolonged arrhythmia episodes. THey are basically afib episodes that don't last the 30 seconds to qualify as afib. Each time they went 15 to 20 seconds, long enough for me to think I slipped back into afib--really disconcerting. But each time it has corrected itself--SO FAR. I can live with ectopics, but I'm getting nervous that these things are going to pull me back into afib again. What's really frustrating is I just finished a 7-day monitor, and I didn't capture any of those episodes. Had one the week prior and one the week after. None while wearing the monitor.

An EP in London once told me that the ablation would not prevent AF from starting but would make it impossible for it to sustain itself. Could it be that the lines are just doing what they are meant to do?

I sometimes get a few minutes of what feels like AF but it stops quickly so I assume the ablation is still doing its job.

Gill (Female, pronounced 'Jill', 15 years of nsr since ablation in Bordeaux.)

Interesting. That would seem to be true at the moment. Other insights, anyone?

That's what my EP told me. I've still some unsustained afib between runs of PACs or SVT, and he's not bothered at all with that.
I've documented those episodes with a portable ECG. A couple of 30 sec recordings is usually enough to see what happens.
Wearing a 24hour holter is often a good way to remember the Murphy's Law.

I was having runs of pac’s and pvc’s for a little over a week leading up to last Friday. Last Friday was 21 days since my ablation with Dr Natale so I am stil on flecanide and metoprolol. I actually ended up in flutter last Wednesday and was carioverted Friday morning. Being only 21 days in I’m not surprised. And you just being past the blanking period, like others said, I would not be worried.