My Ablation Story

I used to tell people on the forum that once I was done with this awful time in my life I would move on and no one would see me again. I lied. This forum has been a blessing for me and I now want to pay it forward. My ablation was scheduled for December 17, 2014 at Brigham and Woman’s Hospital in Boston. I am from RI and consider my self lucky to have some of the best medical facilities in the country just a few miles form my home. Having an ablation is a big deal and I wanted to choose the best Dr for me to do the job. I interviewed 6 EPs. There is a lot of talk of “Rock Stars” on this forum. I interviewed one of these so called rock stars and found that we were not a good fit for each other so I moved on. I chose Dr Gregory Michaud to do the job for me. So far I’m happy with my choice and the facility where it was done. Dr Michaud is Director of Afib Management at the Brigham and does 5-7 afib ablations per week. He is cool calm collected and has answered every question I have asked of him. He speaks around the country (search him on YouTube) and has been frequently published. To me he is a rock star.

I arrived in Boston on Sunday night in order to be rested for Mondays pre-op testing. I stayed at the Lenox Hotel in the Back Bay section of Boston. My room on the 7th floor and had a view of both Boston Marathon bombing sites. Looking out the window and seeing the repairs still going on really helped put what my problems into perspective. I’m a lucky man. I feel I was put in that room for a reason.

I arrived at the hospital at 9am for the hurry up and wait process of the testing. I spend a few hours in the waiting room watching the news about the Harvard bomb scare wondering how much radiation I was going to get from a CT scan. It turns out it is 100 times more than a typical x ray. I am extremely claustrophobic and chose the CT scan over the MRI. 45 minutes in a coffin is not happening for me. The IV prep for the scan was longer than the actual test. I was in the machine for 5 minutes. Now it was off to find some of that Boston pizza I heard so much about and try to keep my mind busy in order to not think about what lies ahead the next day.

That night I met my brother the Bio tech lawyer in Boston for a nice dinner. We had a great time. He let me pick up the tab. I don’t know if he just wanted to make feel normal or he is still cheap. But now I know how he stays rich. I went back to the room and watched some football.

It’s finally the day. I can’t believe it is here. I more excited to have life back than nervous. My journey started with in July of 2013 and followed with 5 additional episodes of afib all lasting less than 8 hours. I knew right away upon diagnosis that an ablation was what I was going to do. I had Atrial tachycardia 7 years ago and waited a whole year before the ablation. I should have done it a lot sooner. At 49 years old I was not making that mistake again. I wasn’t losing anymore time in my life and I wasn’t taking drugs for the next 30 years.

The Brigham and Woman’s Hospital was a well oiled machine. Admissions at 6 am with paperwork. Blood taken, and then taken to a waiting area that looked like a hotel lobby. The Shapiro building at the Brigham is brand new and state of the art. There is a lot of competition in Boston and every hospital in Boston has to be better than the next. Five minutes later I was downstairs being prepared. My nurse Mel was a great guy. Id probably hang out with him if he wasn’t my nurse but he’s already seen way more of me than any friend should so Mel will just be my nurse. After some other nurse sheared me like a sheep I met with the anesthesiologist. He was pleasant and took his time to explain his role in the procedure. He wanted me to be comfortable but more importantly safe. One of my best friends is an anesthesiologist and told me to tell the Dr at the hospital that I’m nervous and Id like a little something before I go in the lab. I was told to tell him 2mg of Versed. The Dr wanted to do .5mg I convinced him to do the 2mg. After that I only remember the following... Being wheeled by Dr Epstein the head of the Department (who I recognized from the website) and at the encouragement of Mel I grabbed his butt. When I got in the room one of the PAs that I had met on a previous office visit came in from another lab to say hi and wish me luck. I thought that was a classy move on his part. Three breaths from the mask and I was in recovery.

I was very confused in recovery as I thought they did not do the procedure and had brought me back to prep area. Apparently the Foley was bothering me for reasons that I will explain later. I keep yelling to my nurse Mel that “I feel like I have VD but I have never had it before” Apparently everyone found me amusing.

Up to my room (which was a private suite) to lie still for a 6 hours, Just mild back pain. The worse part of the experience was getting the Foley removed. Apparently I had been cut when it was put in and now know how Mr. Bobbitt felt... For some reason I was hungry and continued to eat the rest of the day and all night. I was in NSR with a few PACS that’s it. Then I began to drunk dial my business partners and friends. I did not sleep at all that night so I watched my computer monitor all night. My heart was purring like a kitten. The next day it was more labs, ekg and a brief meeting with Dr Michaud. He told me he had a hard time getting me into afib but managed for a few minutes. There was no sign of Afib coming from anywhere unusual so he isolated the pulmonary veins and that’s all. He said there is an 85% percent chance I’m fixed and if not he will go back in and see if it’s coming from anywhere else. 70 burns total. I asked him if my case fell towards the easy side or the difficult side and he said the easy side. We laughed about Dr Epstein’s butt and he was off to Philadelphia to speak. I went home Wednesday afternoon and felt my worse Wednesday night. Its was hard to breath and I could not lie down. I took some Tylenol and by Thursday I began to feel better. My resting heart rate is 10 bpm higher than before and I’m only taking Xarelto, Prilosec and Sucralfate. I wasn’t on rate or rhythm drugs before or after the procedure. Dr wants me to wait a month before I start any exercise in order for my heart to heal at which time I will start a walking program. I see my regular cardiologist in 3 weeks ad and Dr Michaud in 3 months. The staff and Drs at the Brigham have been amazing. As of today I feel good and my heart is behaving. If I have to do it again, I will. I won’t be happy but I will. Now it’s a waiting game. Weight lifting is my trigger and we shall see over the next few months if I have won this battle. I’m here for anyone who wants to talk.

John

John….Thanks for sharing your ablation story and best of wishes to you for a speedy and successful recovery! You mention in your post that weight lifting is your trigger. Weight lifting is also a trigger for me. I haven't decided to have an ablation since I usually go about 3 to 4 months between episodes which generally last anywhere from 2 to 8 hours, (always at night while in bed). On Dec. 2 of this month I decided to give weight lifting a try again. I did 2 sets of 4 exercises targeting the shoulders and upper arms using just enough weight to work the muscles but not tire them. The following night after the exercises I went into afib for the first time in about 4 months. This episode lasted about 7 hours.

I thought it could be a coincidence since I was probably due for an episode anyway so I took a 2 week rest from weight exercises and went back to it a few days ago doing half the exercises. Once again on the following night I was back in a fib for another 7 hour ride. It never seems to happen the night of the episode but rather the following night which is a mystery to me.

I have controlled the afib beast for the most part by taking Rythmol SR, potassium, taurine, CO Q10, Fish Oil, and Dr's Best Magnesium and like you am extremely grateful to the wonderful people and posts on this forum. I have been an occasional afibber, (4-5 episodes a year) since about 1993 and am curious why light weight lifting would cause afib episodes. Any insight from you or anyone on this awesome website would be appreciated.


Jack

Great news. Mine was over a year ago now at MGH which doesn't have the hotel lobby ambiance but the same Foley experience you had.

Jack, Mine would trigger right in the gym. It was intially every 30 days but then I would go to the gym and do a few sets and off into afib. There is no use in trying to figure out why it happens. But if I had to guess. It has to do with blood pressure spikes and heart rate changes and how they affect the pulmonary veins. I say this becasue I can run 5 miles with no Afib. The running is a more consistent heartrate increase. In the end I just hope its fixed so I dont have to worry about why it was happening.

Sure hope they send me 30,000 feet when I get around to an ablation.

Murray L

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Tikosyn uptake Dec 2011 500ug b.i.d. NSR since!
Herein lies opinion, not professional advice, which all are well advised to seek.

Good news John, thanks for your report!

From your mercifully very brief and not too intense AFIB history, with little to no long term episodes from what I understand from your report, you are the ideal textbook candidate for a very straightforward and basic PVI/PVAI procedure with a good 80% to 85% chance of long term success from a single procedure when done by a good EP as Dr Michaud clearly is from other reports on him I have heard as well.

The fact that Dr Michaud had such a hard time even eliciting AFIB that would last for more than a few minutes is more evidence of the mild nature of your condition which is good news and is why he didn't even have to consider venturing beyond a relatively simple PVI or PVAI, which ever approach he uses for isolation the PVs.

While it isn't very often that we hear reports of ablations quite so early in the process, intervening so early is recently becoming recommended by more EPs as a first line step to help prevent longer term remodeling from happening and making the eventual ablation possibly more complex and challenging rom letting it go for a very long time unaddressed.

Im curious, though you mentioned you and not been on any rate control or AAR drugs leading up to or after your ablation, did your original cardio or EP ever suggest you try a course of rate control or rhythm control drugs at all before you set up your ablation? Also, did you have a chance or inclination to try a concerted effort at the Strategy protocol here using the mineral repletion program to see how that might effect your episode frequency and duration?

I fully expect too that you should have mostly clear sailing ahead after a solid PVI/PVAI only procedure, especially considering your episodes were mostly weight lifting triggered and were not very frequent as it was and for such a short overall time dating back to this past July, if I understood you correctly as to when this frustrating condition first appeared in your life?

Dr Natale recommends exercise post ablation after a period of healing, including resistance exercise without going 'Hercules', but he does strongly recommend to go lighter and not push it with most over head and shoulder presses, even after an ablation.

He doesn't suggest to avoid them altogether, but simply finds that its wiser to avoid straining too hard in that position which tends to put a lot of pressure on the heart, and particularly if weight lifting had been a prime trigger for you prior to the ablation as well. The better part of valor is probably to avoid waving a red flag in front of the bull's nose I imagine :-).

In any event, so far so good and congrats on taking the big step towards freedom from the beast. Keep us posted how it goes during your 3 month blanking period and beyond, though catching it all so early and while it was still so relatively mild gives you a real leg up on the likelihood of being one and done.

Cheers!
Shannon

Shannon,

My first episode of afib was July 15, 2013....my hopefully last one was November 1, 2013. As for drugs. I was given toporol to take on a daily basis in the begining by one of the more respected Eps at Tufts Medical. I like him. He told me to go back to the gym. When I did, I broke through right away. His response was to double my medication. I felt like he wasnt listening to me. When I asked hom about ablation he said it was too dangerous and he wouldnt do it on me. Thats when I continued my searched and wound up with Dr Michaud. The only mediction Dr Michaud told me to take was Flecainide and Toporol Pill in pocket. I needed to do it once. My episode was still 8 hours.

I also tried an array of supplments and nothing seemed to change anything. I took Magnesium Taurine, etc.

Dr Michaud instructed me to take 4 weeks rest then start a walking routine. Things not as calm as they were since my ablation 4 days ago. I think Im having more PACS. I have a pause every 4th beat or so. The beats seem regular so I dont think its afib. Does anyone know if this is this common that PACS get worse a few days post ablation? How long will this go on?
Thanks
John

Seems to be common. I had quite a few episodes up to 8 months after ablation.

Ablation does nothing to stop the reason you had afib in the first place and many times the afib returns. It would be my suggestion to remove the toxic residue that has built up in the body unless you want it to return. Many of us are exposed to more toxins in one day than out grandparents had in their entire lives. I have posted the cure for my a fib on this board and how I removed the toxic waste and still am in the process of that removal. also what is even more important is the good bacteria in the colon. Doctors do not do any of this, they are more into drug sales and operations etc etc, you know the things that buys them the life of luxury and days on the golf course. Of course let us not forget about the all expense paid drug sponsored lectures that take place in Hawaii and other exotic locations where the merchants of death get their hooks deeper into the doctors. Its all about money.

Just got back from ER had Ekg. Im having PACs every 4 beats. Im guessing this is normal post ablation. On the bright side its not Afib! Going to see my regular cardiologist on Monday Thanks for your help

Take some Potassium. V8 juice has a lot, bananas . It helps PACs

John - it's not uncommon after an ablation to have some breakthrough events and as Ron B wisely notes... Ablation does nothing to stop the reason you had afib in the first place and many times the afib returns

If you don't supplement with the core nutrients your heart needs to support proper electrical conduction as well as help prevent recurrent fibrosis, then you may want to start reading here at the many links that serve to offer the value of that. Repleting the nutrients your heart (and body needs) for overall proper functioning is just basic maintenance.

PACs are a typical symptom of low levels of both intracellular magnesium and potassium. You must have both and more to stabilize your heart and many factors easily deplete both.

Jackie



Here's a start:

The Strategy - What Metabolic Cardiology Means to Afibbers - (under revision)
[www.afibbers.org]

Conference Room Session 72
Potassium/Sodium Ratio in Atrial Fibrillation (February 7 - June 11, 2011)
[www.afibbers.org]

Magnesium Absorption
[www.afibbers.org]

Food sources of Potassium
[lpi.oregonstate.edu]

Taurine Posts – Deja vu
[www.afibbers.org]

Also check the Conference Room Proceedings and the Afib Resources Links for many valuable reports.

LAF and Cardiac Fibrosis
[www.afibbers.org]
[www.afibbers.org]

Im now in full blown AFIb...not happy

Hi John,

The thing about the Strategy protocol and heart calming mineral repletion, this has to be given at least a year of dedicated effort, combined with a number of key tests to verify whether or not this will help in a given case. It is common for folks to just try some magnesium, taurine and potassium for a while and find they still have some breakthroughs and dismiss it as ineffective when most often, they either are not taking enough and/or it isn't being absorbed and assimilated properly.

That is why many of us emphasis the wisdom of combining an expert ablation with rededication toward improvement ones overall nutritional profile and minimizing adding to dietary inflammatory triggers.

Just be aware that the effort made to educate oneself about how to implement these protocols properly and give them to time needed to help really restore the mineral imbalances, can really pay long term dividends for those with the patience and dedication to following through with it.

Keep in mind that having a significant intracellular magnesium deficiency is almost endemic in Afibbers and that it can easily take a minimum of 6 months to 1 year to begin to restore health IC magnesium levels. Serum Mag tests can be highly misleading and very often show what looks to be a sufficient level of Magnesium in the blood when it remains seriously deficient intracellularly which is where the rubber meets the road as far as helping to quiet AFIB is concerned.

In addition, one wants to insure they are replacing magnesium in adequate daily doses before jumping on the potassium in significant enough doses for it to do its magic in helping to calm down the flippies and ectopics like PACs and PVCs as you are experiencing now.

You should very much be able to quiet down those PAC runs with enough magnesium AND potassium intake. I suggest getting a Cardymeter ( there are many references to how to do so in the archives of this board) so that you can directly measure your Potassium levels each day and thus learn to titrate your Potassium intake from both food and supplemental sources so that you stay in the sweet spot of around 4.5 to 4.9 serum Potassium equivalent level. You also want to insure you do not take too much Potassium such that your serum equivalent levels as tested either in a blood lab or by Cardymeter, does not exceed around 5.2 maximum as too high a K level can be very pro-arrhythmic as well!

When your serum Potassium or 'K' drops below 4.0 you will definitely be in increasingly serious risk for Ectopics and even encourage runs of AFIB and Flutter to breakthrough should there be any leaks or reconnections in the ablation lines or should new Non-PV sources rear their head and get a kick start from letting a fundamental magnesium/potassium/sodium imbalance continue on unaddressed.

You've had a branding iron inside your heart very recently and it will be very inflamed at first post ablation, take 600mg of Motrin at a time ( with food if it upsets you stomach) for the first week and include a number of top supplemental anti-infammatories like high dose Omega 3 oil, Meriva Curcumin, and a combination formula called Zyflamend by New Chapter to help more quickly throw cool water on this fire of inflammation.

Forget the tylenol for now and stick to motrin for the short term with its much more pronounced anti-inflammatory effect.

Shannon



Edited 1 time(s). Last edit at 12/21/2013 09:25PM by Shannon.

Thanks Shannon I will start looking into that

Hi John.

Its not uncommon for their to be runs of AFIB after an ablation during the three month blanking period and particularly in the first 4 to 6 weeks post ablation. Keep in mind how raw and inflamed those ablated tissues are and visualize the continuously variable wall thickness around those PV antrum muscle sleeves where most all of your ablation too place.

With variable thickness and raw tissue all healing at variable rates its not uncommon for temporary new flutter or AFIB circuits to form as these ablation lesions solidify and heal at different rates such that a given blocking lesion that seas holding steady for the first few days, might now spring a temporary leak due to this variable healing process with the every changing LA wall thickness.

It can also be that there have been some PV reconnections due to the EP not being able to make fully consistent transmural burns and that can show up anywhere from a few hours to a few months after the ablation. If that proves to be the case, on occasion the ablation can still solidify and go quiet again, or else it will likely require a touch up procedure.

You won't be able to tell just yet which is likely the case right now. One of big the values of the most elite 'rock stars' as you call them is due to their large amount of experience and skill they tend to have a lot less reconnected PVs if, and when, any of their patients also require a touch up and more often those touch-ups are needed because of either new trigger sources that were not apparent during the original ablation or from trigger spots that may have been masked by the anesthetic effect such that they did not show up clearly on EP voltage mapping during the index procedure, in part, due to the 'louder' higher amplitude voltage signals from all the more obvious trigger areas.

Anyway John, the AFIB now by no means confirms that you will need a touch up ablation. Its too early to even consider that possibility. However, it is ALWAYS wise to approach ablation as a process that will likely require two procedures to get it all really behind you, assuming you choose a very skilled ablationist, and then if you wind up being 'one and done' consider it a bonus. That is the best and most realistic approach psychologically and in any event this index procedure is the most major step toward eventual real freedom from the beast .. even if another visit to the table winds up being in the cards.

In your case with your relatively minor and very young case of AFIB, I would expect a good solid PVI to do the trick most often in one shot. If you should wind up needing a repeat ablation, it would be at least prudent to find out how often this occurs with Dr Michaud's patients like yourself who have relatively straight forward PVI-only ablations.

But at this point you may well still be one and done, so just take the anti-infammatories and take the flecanide and beta blocker for now and start to add in the Strategy and do it with earnest focus and dedication and not half hearted and see if this might not settle down to real quiet for the long term as it is.

Best wishes John and hand in there!
Shannon

Just spoke to PA. He said its too soon to determine if my afib is a problem. It may just be from ablation inflammation but they wont know for a few months. I guess I just have to wait. He said this sometimes happens and I may never have afib ever again or it could be a problem. He said if by chance they have to go back in it won take long the second time.

John,
If you have some of the flippies,flutters, thumps and bumbs the first few months, know that that is normal. In fact, some research has shown that those who do have some afib in the first three months go on to have more durable PVIs. Some have suggested it may have something to do with the number of "burns", and thus inflammation, that the heart is adjusting to and healing from.

I went in and out of Flutter and AFIB at day 16 that morphed into full blow flutter at 133bpm which needed an ECV at day 30.
I'm at 6 months now and my LifeWatch 24/7 recoding last week showed pure NSR with a good heart rate.

McHale

Thanks McHale. That really makes me feel better. Merry Christmas

a glass of cold water and into afib last night for 3 hours. Dr said this may go on in 2 months or I may need a second procedure. This is very discouraging

John,
Try to relax, you'll be fine. I went into afib then flutter that went on for 16 days before getting cardioverted, not fun especially with my HR at a steady 133-145bpm the last 5 days!!!!

I'm at 6 months and doing great, pure NSR I was told the way the LifeWatch recording was for 8 days.

McHale

Jack/John,
Weight lifting put lots of stress on the pulmonary veins, especially the heavy weight I was pumping between 335-405lbs on the bench. In hindsight my afib started not long after hitting the 405lb benchmark, marvelous! Natale told me to stop with the heavy stuff, enlarges the heart and causes valve damage besides the afib.

McHale

Thanks McHale, your explanation makes perfect sense. I've pretty much resorted to the fact that weight training will no longer be part of my workout regiment. Happy Holidays!

Jack

I went into afib minutes after a personal record on the bench.