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MeganMN
@WhyMe. I am being recommended to take Rhythmol for the PACS AND inappropriate sinus tachycardia. They are not opposed to another ablation but man, I feel your pain. Either option feels frustrating....

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Daisy
I did find that PACs triggered Afib and I think that is the experience of some others as well. Many of the pacemaker models have an algorhythm that tries to outpace PACs and thus stop them from triggering Afib.


I am left dealing with his team and frankly they are of little help.


It must depend on who your nurse navigator is. I have always had a very quick response -- usually overnight and they would consult with Natale if the answer wasn't obvious to them. I'm sure that it is very frustrating to be in the situation you are in and I really hope you find a good solution.

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tvanslooten
I agree. Dr. Natale's team is very hit or miss (mostly miss). Aside from the expert ablation you'll get from Dr. Natale, any issues post or pre op you are on your own. That's why it's imperative to team up with a solid "local" EP. I look at Dr. Natale strictly as my mechanic who does the hardcore mechanic work. For everything else, I work with my local EP.

Now, regarding your PACs, I share my story only to give you hope. After my first Dr. Natale ablation for afib, I started getting nonstop PACs and PVCs 3 months after my procedure. They were never ending for TWO YEARS, but they were never so bothersome that I couldn't function. I just said "F it" and lived my life and largely tried to ignore them. It got easier over time. Then suddenly one day I woke up and they were gone. I haven't had an issue with PACs ever since. That was 9 years ago.

The point is, they may just disappear but it may take some time.

I was always told here and in other resources online that ablating PAC's is a never ending game of whac a mole. You ablate the sources and then additional sources pop up down the line.

It's my understanding that every heart cell has the ability to trigger a heart contraction. That's what causes PACs and PVCs. It's these defective heart cells that have a mind of their own and they go rogue. I imagine we have billions of heart cells. Let's say an EP spots a handful and ablates them, then what? Won't more defective ones just pop up again? This is also why PACs often go away on their own. I was told these heart cells have a lifespan of about 2 years. So if you have a handful of them triggering PACs and PVCs and they eventually die after two years, the problem is gone (until other heart cells act up). At least this is how my local EP explained all of this to me during my two year battle. He kept telling me to "let it ride" and see how things unfold. He told me the issue would likely resolve in no more than two years. He was spot on because after 2 years my PACs were history.

Travis

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McHale
Sorry for the run-on sentences, let me clarify..... I had my first extensive non stop run of PVC's in January 2017, 10 months after my second ablation with LAA isolation March 1 2016 ...those lasted approx 9 months.

All my stress tests and echos since showed all heart diameters within normal range.....

I started having my most recent runs at the end of January, high stress and emotional time after my younger brother got sick and passed...so I was 2 months plus in PVC hell already.....

I hope I didn't Jinx myself.....

McHale

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johnnyS
Long post here, but I’ve been thinking about all the different things that people aren’t considering any longer on this forum and I think it should more discussed.

The heart is a muscle, it gets irritated like any other organ, if it’s missing something it will let you know, and if you give it what it needs it will reward you by doing what it’s supposed to do. If you are deficient, your heart will simply keep pumping with deficit.

It’s really funny when you think about that we still don’t know what causes Afib but we are treating it with an ablation, but an ablation leads to another form of arrhythmia which is also indicative of heart not being well after the ablation, and the cycle goes on.

I think Carey said correctly that one should always consider all dietary and supplement options for six months prior to considering an ablation. When I had issues isolating my PACs triggers with diet I began to understand that it’s much more important to focus on deficiencies in isolating possible causes rather than simply looking at diet restrictions. So fasting and or restricting certain foods is useless if your body is already deficient to begin with. For example, magnesium, potassium, and taurine are essential but there are many other important essential vitamins to consider as well, deficiency in iron, copper, selenium, carnitine, b12, thiamine, and iodine can all cause arrhythmias. Correcting the deficiency will correct the underlying condition. Thiamine for example is involved in countless processes in the body, from energy production to fat breakdown, acid production, all the way to nervous system and much much more. The sad part is that most of thiamine is lost by age 30 due to our limited diet of pork and seafood and that’s where most thiamine is found, and forget about getting any from your daily wheat intake which is fortified due to gluten depleting the thiamine in the first place, and if you’re deficient the only way to fix it is to megadose with benfothiamine.

If you don’t test for nutritional deficiency you won’t know what to treat, or the only other way to fix it is to fix your diet by eating nutrient dense foods like meats and seafood. Avoid wheat, sugars, and vegetables which contain anti nutrients which are depleting your body. Sorry for the rant, I know it’s not easy but I feel your pain and I wish you all the best.

Johnny

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McHale
My two cents.....I had 3-4 months of very frequent PVC's recently, day long runs of bigeminy or trigeminy after a family death that triggered it in February.
I had a stress test in September, so no heart disease or underlying conditions.

I had a redo ablation and a Watchman implant April 11 at St David's with Natale,he came into my room that afternoon to speak with me about the procedure that morning but he was laser focused on the monitor and PVC's.
I told him I had 6 and 9 months of PVC runs before, I told him I had Shannon forward him my EKG in 2017 and spoke with his Nurse Norma to schedule a PVC ablation but then the mysteriously stopped.
He told me that needs to be addressed if the burden is too high and to schedule an ablation with him.
He said as long as he can see them he should be able to tame them.

I have added Taurine, Arginine and increased my magnesium and potassium supplementation, it worked to calm my heart back then and evidently about 3-4 weeks ago PVC's stopped and blissful sinus rhythm.

Tomorrow I have a TEE scheduled at day 48 with Dr Di Biase at Montifiore.

McHale

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Daisy
I did find that PACs triggered Afib and I think that is the experience of some others as well. Many of the pacemaker models have an algorhythm that tries to outpace PACs and thus stop them from triggering Afib.


I am left dealing with his team and frankly they are of little help.


It must depend on who your nurse navigator is. I have always had a very quick response -- usually overnight and they would consult with Natale if the answer wasn't obvious to them. I'm sure that it is very frustrating to be in the situation you are in and I really hope you find a good solution.

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ama1952
I used to have thousands of PAC's each day about 12 years ago, Using a modified protocol from researcher George Eby, here's how I knocked them out:
6000 mg. of Taurine ( 2000 mg in the A.M., 2000 mg. in the afternoon, 2000 mg at night)

3000 mg, of L Arginine (1000 mg in the A.M., 1000 mg in the afternoon, 1000 mg at night)

Here's an article from 2006 concerning this problem- [afibbers.org]

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MeganMN
That's frustrating. That is very similar to my burden and it is tough. I never had afib, only had the PACs and SVT. I would be curious why the increased PACs after ablation, or is it that the PACs always happened and triggered the afib/SVT? Either way it is hard and the meds are harder. Metoprolol quit working for me. What do you think you will want to do?

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MeganMN
Lots of previous ablations/scarring. Not sure what the potential path would be. At some point, I would think they couldn't just keep ablating?

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MeganMN
I also have a very cyclical pattern to mine . as it has progressed, they are now most of the time, but for over a year, mine started up like clockwork at 6-7pm and stopped by 6-7am, EVERY SINGLE DAY.. There was no rhyme or reason that I could ever figure out. I tried a journal, I tried supplements, hormone testing, cortisol testing, etc. Taurine HAS helped, but I agree, it is very disheartening. I dread the meds as well. They all feel like poison to me because of the high incidence of side effects for me with low return. I'm sorry. I totally get it. Where was the site of your original ablation? I initially had mine done on the right and now it seems there is an errant site on the left. If you are willing, could you talk more about where it started? I know it doesn't help the frustration, but you are not alone!