6 days post ablation

Hi,

I had my Natale ablation 6 days ago. It is a pretty easy procedure to undergo. The after effects of anesthesia were uncomfortable & took a while to abate. My energy comes & goes in spurts. Have taken walks, cleaned house, etc.

However, 2 conditions exist. I have had GI effects of bowel problems (like one would get if they take too much magnesium). Sometimes it is almost diarrhea. I think I have had this since Tuesday (today is Thursday) & my ablation was last Friday. My other problem is a wheezy feeling in my chest upon a bit deeper than normal inspiration causing an immediate cough reflex, though the cough is totally nonproductive, dry & non-relieving. I think ever since I went on sotalol back in February, I had a slight cough similar to this, but very minor. Now, it is irritating, fairly constant & a bit worrisome.

I continue to take Xarelto 20 mg at night with dinner, and sotalol 80 mg q.12 h. I was not told when the antiarrhythmic would be stopped. I am assuming there is a period of afib-free transmissions before they stop that, perhaps after the 8-wk blanking period. Also, if I remember correctly those collagen plugs in the groin region will dissolve anywhere from 3-6 months out, correct? They are tender & firm knots.

That is my experience so far. Many thanks to all the afibbers who have been a tremendous help & without whom I would never have gone for an ablation with such confidence. I knew next to nothing about afib before finding this group through a recommendation on a thyroid support group. I have been without a thyroid for 14 years and found my way to Internet support groups because of that. They are invaluable. This group is superb & I have never experienced such hands-on support - as in the time I was sent by dr to ER & was able to text Carey while in the ER to find out what was going on & what to expect & what not to allow, etc. And, Shannon with his intelligent guidance to & through the ablation experience. Such generosity in giving of time from all. Then there have been the most intelligent & helpful communications here on these threads (though I do not frequent the site daily). After so many years of studying thyroid & adrenals, I was hoping not to have to get too addicted to an afib group for years too!!! I believe my ablation will be one of the many successes to add to the list & I will be able to get off the meds I am now on & continue without any more heart issues as I did not have any structural abnormalities, just the electrical stuff.

Thank you all & if any insights to share as to my cough in particular, feel free...............

The GI problem isn't something I ever experienced but we've seen enough reports of GI issues following ablations around here to know it happens to some people. It could also be lingering effects of the anesthesia. Most people snap out of the anesthesia right away, but for others it takes a while. Sounds like you're one of the latter kind. One of the things that can happen with anesthesia is your bowels don't resume functioning normally right away. What you're experiencing is probably something like that, and it should pass on its own fairly quickly. If not, bring it up with your nurse practitioner. In the meantime, I'd go for lots of fiber.

Natale commonly leaves patients on an antiarrhythmic for a month or two, depending on the patient and how he feels about their particulars. Just shoot your NP an email and ask what the plan is with the sotolol.

The sotolol is very likely the culprit with the cough. It's a beta blocker and BBs are known to cause a dry, chronic cough in some people. Hopefully, he'll have you stop it fairly soon. Definitely ask.

Those hard lumps you feel aren't the collagen plugs. They're just small hematomas and they'll resolve slowly over the next few weeks. The collagen plugs are actually very small things. They're just little tubes about a half inch long about as wide as a toothpick. I would expect they already dissolved long ago.

Glad to hear things went well otherwise!

Hi Carey,

Well, you answered a lot for me. I have actually been constipated since the ablation last Friday until the frequency started a few days ago after I had a small juice glass of prune juice one night & then have had the swing from the constipation to too much movement. I thought all might be due to anesthesia effects. I had a bad headache, irritable mood & some depression when I came out of it in the PACU, which lasted a few hours.

I guess since I was off the sotalol for about a week for the ablation that it is affecting me more now that I have started it back. I just was not having such a wheezy reflex this much before though.

Dr. Natale did mention putting me on Inderal later after I got off the antiarrhythmic because I do have moderate hand tremor & the sotalol helped that. I hope the cough won't happen on Inderal too. Don't know what dose it would be.

I had no idea those lumps were hematomas or that the collagen plugs were so small.

Thanks for the helpful info!

Lots of centres (including Bordeaux) don't give GA for AF ablation procedures - such as Propofol - at all. They use conscious sedation instead - such as Midazolam - and even this can cause fairly hefty constipation issues for a few days afterwards.

My ablation in Bordeaux was almost 14 months ago and I'm still having bowel problems. It started as serious constipation for about 3 weeks. Laxido cleared this but I had recurring episodes of constipation and diarrhoea with good spells in between. The good spells gradually became shorter and stopped a few months ago, leaving contiuous problems. I'm having a colonoscopy next month (the NHS moves very slowly!).

I seem be be having benefits from Curcumin powder which I started a recently.

Sam

PS I'll post shortly about the effects of the ablation on my heart but at the moment I'm not able to enjoy the benefits I've had with that.

It must be down to the individual Sam - I was at Bordeaux a month or two after you and even though I had a lot of Midazolam and a shot of Propofol for a CV I only had a few constipation issues for a couple of days and that was it. I recall yours was a long procedure: maybe all of the Midazolam you had combined with your particular system is the problem? Fingers crossed for the colonoscopy. Had one 4 years ago and the worst bit (even worse than having it with no gas and air which I was determined to do so I could drive myself home) was starving for 36hrs and having to give myself the runs to empty everything out beforehand!

Carey, I have written one of the nurse practitioners at Saint David’s but haven’t heard back yet. I would like to experiment not taking the sotalol today. Would that be all right? The thing is I can barely take a breath in without the tickle in my chest followed by the immediate dry cough all day long and I’m sick of it. I don’t want to keep ingesting something that’s causing that to happen to me. The chronic coughing is also giving me a bit of a headache. I don’t believe I ever described that my ablation procedure was not one of the complex ones. I guess you would say it was rather straightforward and did not last long. I just wanted to put that out there since I’m asking to experiment coming off the anti-arrhythmic. My medicine dose is due in about an hour to an hour and a half. Thank you.

Following my ablation in July I experienced heartburn. But it was after they had given me a medication that u believe was for heartburn and lasted only a couple of days.

The other thing I experienced was bouts of hickups for several days following.i am still experiencing Tre hickups but only occasionally.

This is the first time I have ever experienced this.

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Madeline
Carey, I have written one of the nurse practitioners at Saint David’s but haven’t heard back yet. I would like to experiment not taking the sotalol today. Would that be all right?

Well, sure, you can do that. Worst case is you end up in afib. It's a bit early to stop everything, so definitely talk to the NP about this. Sounds like they need to switch you to something else that isn't a beta blocker, like maybe flecainide with diltiazem. Unfortunately, in my experience and others I know of who've gone to TCAI, it's likely to take the NP a day or two to get back to you. You might want to give her a call to move things quicker.

Madeline - be careful of stopping or (worse) starting Sotalol without medical supervision. When starting or changing dosage on Sotalol, your QT interval can elongate and cause major problems for you. When I used to take it, I had to go in for an ECG when I either began or increased Sotalol to make sure that my QT interval was in range. Best wishes.

There's no risk associated with stopping sotalol. You can stop it anytime you want if your only condition is afib. The worst case outcome is you end up back in afib.

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Carey
There's no risk associated with stopping sotalol. You can stop it anytime you want if your only condition is afib. The worst case outcome is you end up back in afib.

It often isn't clear that one's only condition is afib. There may be latent coronary or thyroid disease, or perhaps some issue with not having a thyroid, which is aggravated by sudden discontinuation. That's why gradual reduction of nonselective beta blockers over a period of 1-2 weeks is safer. This is a seperate issue from monitoring for QT prolongation when initiating or increasing dosage. I would find out from your provider whether you can reduce your dose of Sotalol. Inderal is also nonselective beta blocker, which is the most effective for essential tremor. It has a similar side-effect profile. There is however more flexibility in finding a dosage for this latter condition, possibly a sufficiently small dosage that would help with the tremor but would not be considered therapeutic for other conditions.

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safib
It often isn't clear that one's only condition is afib. There may be latent coronary or thyroid disease, or perhaps some issue with not having a thyroid, which is aggravated by sudden discontinuation. That's why gradual reduction of nonselective beta blockers over a period of 1-2 weeks is safer.

I'm familiar with Madeline's situation and she just underwent an ablation with Natale. I'm confident if there was structural heart disease present she would know it. The sotalol was prescribed to control afib, nothing more.

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MissSunshine
Madeline - be careful of stopping or (worse) starting Sotalol without medical supervision. When starting or changing dosage on Sotalol, your QT interval can elongate and cause major problems for you. When I used to take it, I had to go in for an ECG when I either began or increased Sotalol to make sure that my QT interval was in range. Best wishes.

Thank you Sunshine. Good reminder. They did that at St. David's after my ablation - monitored me after restarting the sotalol since I had been off of it 5 days, per their instruction. And of course prior to that 5 days there was a 4-day taper. But the nurse did tell me why I had to be monitored again - same as what you said here. The first time I was started on it in my hometown was in the hospital too, but I had no problems then either.

So, am not sure if I will completely stop it or just taper it down maybe until I see my cardiologist next Wednesday. That way I won't have to worry about starting it back as I certainly don't want anyone putting me in the hospital again just for that.

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safib

It often isn't clear that one's only condition is afib. There may be latent coronary or thyroid disease, or perhaps some issue with not having a thyroid, which is aggravated by sudden discontinuation. That's why gradual reduction of nonselective beta blockers over a period of 1-2 weeks is safer. This is a seperate issue from monitoring for QT prolongation when initiating or increasing dosage. I would find out from your provider whether you can reduce your dose of Sotalol. Inderal is also nonselective beta blocker, which is the most effective for essential tremor. It has a similar side-effect profile. There is however more flexibility in finding a dosage for this latter condition, possibly a sufficiently small dosage that would help with the tremor but would not be considered therapeutic for other conditions.

Well, I will say I am thyroidless - removed totally in 2005. I am on replacement meds for life & I too thought that perhaps when I got off sotalol, my thyroid med effects might indeed be stronger as the sotalol beta blocker part suppresses a lot & with that no longer in the picture, once again, my thyroid might need to be adjusted.

Perhaps I said it earlier here, but Dr. Natale did say he would probably put me on Inderal for my tremor later after I got off the antiarrhythmic, since I mentioned to him about my hand tremor. No one at St. David's has given me a timeline yet for how long they had planned for me to be on sotalol though. I have lived with a moderate hand tremor for probably over 45 years, 30+ of those years before my thyroid was ever removed, so it was not due to thyroid in the beginning anyway. I chose to live with it rather than do Inderal in the past. But having been forced to be on sotalol, I must say I did enjoy the tremor settling down & thought I might try some Inderal after all this. If I get side effects I don't like, I will just go on without Inderal.

Carey does know my picture re afib & no structural abnormalities, but I can't remember if we have discussed my being without a thyroid, so I do have to balance that in too.

Thanks.

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Carey

It often isn't clear that one's only condition is afib. There may be latent coronary or thyroid disease, or perhaps some issue with not having a thyroid, which is aggravated by sudden discontinuation. That's why gradual reduction of nonselective beta blockers over a period of 1-2 weeks is safer.

I'm familiar with Madeline's situation and she just underwent an ablation with Natale. I'm confident if there was structural heart disease present she would know it. The sotalol was prescribed to control afib, nothing more.

It may not be structural, and/or it may be latent , e.g., sudden discontinuation can cause angina, myocardial infarction, and rebound hypertension. It is not an issue of what it was prescribed for. My point is to ask Natale.

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safib
It may not be structural, and/or it may be latent , e.g., sudden discontinuation can cause angina, myocardial infarction, and rebound hypertension. It is not an issue of what it was prescribed for. My point is to ask Natale.

Madeline is not at risk for those complications. Angina and MI are risks only in the presence of cardiac disease. Tapering off beta blockers is usually only necessary for people who've been taking them for many months or years. Yes, her BP will rise somewhat if she stops it, but dangerous levels of hypertension aren't a risk for her. Of course she should ask Natale, but she's a free agent and if she chooses to do so the most she risks is a possible afib episode.

When to stop taking the sotalol is probably in your discharge papers. I was instructed to continue taking multaq for two months following the ablation. I initially had some wheezing that was caused by fluid buildup in my lungs—seems like it took around a week to subside with the help of diuretics.

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Leo J
When to stop taking the sotalol is probably in your discharge papers. I was instructed to continue taking multaq for two months following the ablation. I initially had some wheezing that was caused by fluid buildup in my lungs—seems like it took around a week to subside with the help of diuretics.

No it does not say when to stop. Just to continue sotalol 80 mg twice daily - which to me was not even specific enough as it should be taken more exactly q.12 h. she left the line blank for when to stop...............

My discharge nurse was not even Dr. Natale's, but one of the other drs' NP & she was odd, very smug & just not informative or friendly like all the other nurses, so that was not great.

Why not go for a compromise tapering off? 40mg 2x/day for a week etc.?

Hi Madeline,
I hope that your GI and coughing issues have subsided by now and that your ablation continues to be a success.

I am a new Afibber recently diagnosed and reading as much as I can on this forum. I am 55 year old healthy female that had a recent Afib episode that lasted 10 hours before I converted. This has happened a few times before but only lasted 1-2 hours. I never went to the ER for any of these issues, but I feel I will the next time if it lasts any longer than 2 hours as I am on no meds, or anticoagulants - just some supplements. I am trying to stay off meds as long as I can...

I saw in your post a comment about the "time you were sent by dr to ER & was able to text Carey while in the ER to find out what was going on & what to expect & what not to allow, etc." What should I be aware of the next time this happens if I go to the ER that I should not allow? I am afraid of a cardioversion and blood clots or a stroke. I also have a low resting heart rate which is why my EP does not want to put me on heart rate meds at this point.

Also, I see that several people including you have gone to Dr Natale for an ablation. I am willing to have an ablation if that is what is recommended. However, I live in Florida and he is in Austin I believe. Did you travel to see him and is it hard to get in to him?

How long have you had Afib and do you have to be in Afib to have an ablation procedure? Any insight you have would be appreciated.

Thanks! Ingrid

Hi Ingrid, Sorry to be slow in responding.

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Ingrid
Hi Madeline,
I hope that your GI and coughing issues have subsided by now and that your ablation continues to be a success.

I am a new Afibber recently diagnosed and reading as much as I can on this forum. I am 55 year old healthy female that had a recent Afib episode that lasted 10 hours before I converted. This has happened a few times before but only lasted 1-2 hours. I never went to the ER for any of these issues, but I feel I will the next time if it lasts any longer than 2 hours as I am on no meds, or anticoagulants - just some supplements. I am trying to stay off meds as long as I can...I would not go to ER just bec of 10 hr episode. I had afib a year & a half & took no meds & did not go to ER. I only went to ER that time because my cardiologist wanted me to start on propafenone, which I did on a Saturday & by Sunday night I was having afib (same as usual kind). I had an appt in cardio's office Monday & when I got there, they "freaked" bec I was in afib on ekg & he was seeing pts in clinic, so nurse said he wanted me to go over to the ER. Maybe he also sent me there bec he knew the next antiarrhythmic he wanted to start me on was the kind many do in the hospital to monitor for other heart irregularities. It was the 1st time in my life to go to the ER for myself (age 69). It is crazy bec once you get in their hands, they just start all kinds of protocol, much of it not necessary. Carey & Shannon have both talked to me by phone before to help re my decisions for what to do on treatment of my afib. So I had Carey's number & was able to text & sure enough, what he told me the ER doc would put in my IV drip was not the right thing & I asked him to do what Carey advised (Cardizem) & once they got an order from the cardiologist on call, they said the same thing. It is that kind of thing. ER doc was going to put in metoprolol & I had unpleasant reactions to that before & besides I believe Carey said the ER doc usually did not really know how best to handle afib. It was just calming to know what was going to happen & what should happen. I certainly did not want to be cardioverted as I had had no problem with my afib episodes the last yr and a half & then all of a sudden everyone is treating you like it is a major crisis. The person on here who goes by anti-fib told me about a 40-hr window before he goes to ER, bec 48 hr is how long it takes for a clot to possibly form.

It was a good year & a few months before I agreed to Xarelto & sotalol. I did get on carvedilol before that though for rate control (since metoprolol did not agree with me). I also took aspirin. Like you, I read stuff on the site here & presented it to the different drs I saw (re taurine & hawthorne & ginkgo biloba for my blood thinner, & I already was taking loads of magnesium & fish oil. It is hard bec most of the docs don't know all about this other stuff & can't stand behind it, so eventually I gave in to doing what they wanted since I was not getting rid of it on my own. I too am considered very fit & healthy other than the fact that my thyroid was mistakenly totally removed (due to suspicion of cancer, which proved not to be the case) in 2005 I did have Hashimoto's thyroiditis. Because of my thyroid problems, I was used to drs scoffing at most of the ideas about my health & treatment that I bring to the table. I did find one dr open to it though, an endocrinologist, & I can tell you it is a rarety. I was "fired" from the first female cardiologist because I questioned some things they wanted to do & resisted others. Example: After her nurse put me on metoprolol while dr was out of town for a while, I got symptoms of GERD, nausea, discomfort & the nurse tried to put me on PPIs & I adamantly refused saying I only had the problem bec of the med they instituted & I was not going to start on a med to reduce stomach acid because of that. I digress, but it is an example of the complicated web you get drawn into.

Unlike you, even though I exercise a lot, I am not one with a low resting heart rate. I am on the higher side. I do yoga, Pilates, walking, moderate biking, TRX, MX-4, swimming - like to try lots of different things over the yrs. But I am NOT a runner. I see that your group of low heart rate afibbers have special needs with regard to some of the meds & others can advise you on that.

I flew from Tennessee into Austin to see Dr. Natale. I think it took me 3 months to get an appt, though they started processing my papers & I got accepted very quickly. I would go to him if I were you rather than going to any ablationist. Shannon will inspire 100% confidence in you re that, as he did me. I wanted to run for the first year after the 1st EP told me about ablation & how it had risks, how it might not work, etc. It was this group that gave me knowledge & confidence.

Over the year & a half, my afib did get more frequent & episodes lasted longer. Most of the time the longest length would be a possible 15 hr, tho maybe 3-4 times I went into 24 hr. It is hard to tell duration sometimes bec I go to sleep with a sleeping aid & many times my afib would be gone the next morning & sometimes it would still be there. Many times my afib would just be ~4 hr.

You do not have to be in afib to have the procedure as Dr. Natale induces it to see what is going on if nothing is happening. I got the ablation because I did not want to be on the 2 other meds for life & I read here that they will lose effectiveness over time in addition to the possible side effects meds can bring, and also the longer you let afib go, the more complicated your case becomes & will be more complex to fix & also Dr. Natale is ~58 y/o & I wanted to make sure to get it done before he retired or moved somewhere further! And also my age is up there, so I figured more odds were in favor of doing this now. The anesthesia is the most bothersome part to recover from. I do have an unexplained dry cough, but I am stopping sotalol in hopes if it has a hand in this aspect, that it will stop. Time will tell.

In addition to Carey & Shannon, Anti-Fib, GeorgeN, Pompon, Wolfpak, Jackie Burgess, etc., just loads of ppl who understand all this complicated stuff & are an immense help to people like us. They give of their time to give us answers that the drs just don't have time to do in our quickie office visits. So, my husband went with me. We rented an airbnb less than 5 minutes from St. David's. Flew in on Wednesday, office visit on Thurs, Procedure on Fri w/overnight stay in hosp for me, Sat & Sun on our own - to stay in town just in case anything happens, & flew out Mon Morn.

I started this green color bec I was going to go into each paragraph where you asked a question & give my answers, but it was just easier to look at your post on my pad while I kept answering in the same area on this post (instead of having to insert the commands each time I responded in a different paragraph).

Now, I have to go ask the group some questions for me Best of luck to you in making your decisions. Can't be easy with little ones you are still caring for.



I saw in your post a comment about the "time you were sent by dr to ER & was able to text Carey while in the ER to find out what was going on & what to expect & what not to allow, etc." What should I be aware of the next time this happens if I go to the ER that I should not allow? I am afraid of a cardioversion and blood clots or a stroke. I also have a low resting heart rate which is why my EP does not want to put me on heart rate meds at this point.

Also, I see that several people including you have gone to Dr Natale for an ablation. I am willing to have an ablation if that is what is recommended. However, I live in Florida and he is in Austin I believe. Did you travel to see him and is it hard to get in to him?

How long have you had Afib and do you have to be in Afib to have an ablation procedure? Any insight you have would be appreciated.

Thanks! Ingrid

Today is 16 days post ablation & I had what felt like an afib episode this morning with 171 bpm, but Kardia deemed it unclassified & by 40 minutes later it was deemed normal. I was disappointed though we were told these episodes are possibilities in the 1st 3 months.

And also as a reminder, I got off my sotalol 80 mg q.12 h by 8/14 & 8/15/19 & started the lower dose Inderal LA 60 mg qam on 8/16/19. Today is 8/18/19.