Ablate or Not ablate: That is the question.

Hello everyone,
Just a quick recap about my situation again: I have arrhythmia or Afib for over 1 year now, have pacemaker, 48 y.o male, active, in general good health, not taking any meds at all, episodes occur every few days up to 2 weeks if lucky, episodes may last few minutes up to 3 hours with rate may be in 80's up to 130's. Lately, I've been leaning toward having an ablation. I know I'm fairly new to this condition, but I somewhat feel tired of having to remember so many things, dealing with having to remember not eating this, do eat that, take supplements certain times throughout the day, don't do this, and don't do that, eat more potassium, eat lesser salt, don't eat too much calcium, drink this and drink that, on and on.
May be I'm just looking for a quick way out so I can just live a "normal" life. By no means, "normal" life doesn't mean I want to consume alcohol, smoke, do drugs, eat anything I want, etc. I was not that way before I had Afib and definitely won't be after ablation (if I decide to go through with it).
Granted, I've only tried the supplement and diet method in a short time, but I just hate it so much when Afib beast just show up whenever it wants even when I do everything that I supposed to do. It just really depresses me.

Of course, I don't mind taking supplements, eat right and take good care of my health. I'm allergic to alcohol anyway, I don't smoke and I love to exercise anyway. So, it's not like I want to be AFib free, so I can party. I just don't want Afib to show up surprisingly while I'm having dinner with my family, or having a conversation with friends or while I'm sleeping, or anytime at all.

I know I may have touched this question before, but I ask again and try to gather more information as much as I can from all you to help me with the decision of ablation or not.

Per most of your recommendation about Dr. Natale, today I scheduled an initial consultation for June in La Jolla, Calif although I live in Los Angeles. This is just a consultation and of course, Dr. Natale has to decide if I'm a candidate or not and of course if I decide to proceed or not, and hence the question of this post.

Shannon, am I a candidate for Natale's ablation eventhough I'm fairly new with Afib and never taken any meds yet?

With being fairly new to Afib condition, would I stand a good chance just for 1 ablation only and be done with and no need for touch up?

Any comments to share from folks who had ablation. Do any of you regret to have an ablation?
I appreciate anything all of you can share with me. Thank you.

Duke

Duke,

If my afib had progressed to once every two weeks or more, I would sign up for the ablation . I know how devastating it feels, and I personally would not tolerate it that often. I think ablations have progressed significantly, especially with a highly trained practitioner, that the risk is low and the reward is high. It's a personal decision for everyone, but waiting too long may make the ablation more difficult. Continue to work on the diet and supplements. That will be of great benefit whether or not you have the surgery.

John

Duke,

In your shoes, I'd go for the ablation. Your episodes are relatively frequent, and the lesson is that earlier in your afib career equals higher probability of success in the ablation world.

George

I would definitely go for the ablation with the symptomatic frequency. Plus, you are an excellent candidate from all that I've read from you here Duke. At your stage and having done what you have more procrastination is most likely to only beget a more difficult scenario over time. Your increased frequency and symptomatic nature is your biggest clue that you are more than ready.

Shannon

Duke, you said you "scheduled an initial consultation today for June". How did you get in so fast? I called 3 weeks ago and sent Dory a release for medical records (I am also in L.A. -- Santa Monica actually) and she said after they had received my records she would call me to schedule an appointment. UCLA isn't known for their efficiency, so maybe they were/are slow to get them there. Did you have to do this before they scheduled an appointment? I have not heard back from her yet.

Louise

Louise,
My cardiologist and EP sent Dr. Natale's office my complete medical records as soon as I requested them to do so. My cardio & EP are in Orange county, not in Los Angeles. Perhaps, they work a little faster.

Duke

Since everyone has come in pro-ablation, I thought I'd voice another side of it. I'm not advocating either position, but just want to say that when my afib came on strong 3 years ago (almost every day for 2 - 10 hours at a time for most of 4 months - equally greater than a 10% afib "burden") I started trying lots of things. Recently I'm down to less than 0.5% burden (briefer episodes every 3 or 4 weeks), with basically no PVC's (as opposed to 30 years of fairly frequent ectopics). I've already seen Natale once to set in motion the possibility of an ablation, but things are getting better and I'm learning lots about myself in the process, so I'm not going that route for now. But I could change my mind and sign up soon if things start getting worse instead of better.
The most important things to me are Potassium-Sodium balance, Magnesium and, I think, Fish Oil. I'm also learning some techniques for stopping afib when it starts.
Good luck in however you proceed. Ralph

Hi Ralph,
How short are your episodes now? What are your supplements regimen like? And what are your techniques to stop afib when it starts?
Thanks.

Duke

Duke,

If I remember correct you are an exerciser who runs 3 miles each day. Have you tried not doing that?
GeorgeN would be best to advise you, I think.
Also you might try taking ginger capsules, one with each meal and one before bed. You can get it from the vitamin shop.
Ginger Root Extract (NOW Foods -250 mg)
Even if you go through with an ablation you will have cut back on your training, and keep taking supplements.

Colin

Duke - A strong influence to opt for the ablation procedure right away is certainly your age. Many of us who were older at the onset were not dealing with busy lives, employment, families and so on. Afib certainly can be highly disruptive when it prevents from going to work or performing while at work. I certainly can relate to that because afib forced me to retire early.

As Ralph so wisely points out in his post, there are a number of things that need to be addressed to help ensure your ablation recovery... not the least of which as he offers, the all-important electrolyte balance. Definitely Omega 3 fish oils to hold down inflammation and a good look at dietary choices that can help promote afib. If you are exposed to a large amount of electromagnetic frequencies (EMFs) 24/7, you'll need to take steps to reduce that exposure as well since it's not only your heart that is affected, but your heart's afib could be the first signal that you are on overload. Hydrating well and frequently with pure, non-fluoridated water is important for both immediate and long-term health for everyone.

I wish you well with your decsion.

Jackie


Ralph -
I love your approach to managing your afib. In the long haul, you'll be much healthier with or without the ablation. Good for you!

If you haven't considered the EFT or tapping solution to ending or shortening an event, consider trying that.
Since I introduced that in a post a while back, I've heard from a number of people who have been able to stop the beginning of what felt like an event from progressing to full-blown Afib and others have said it definitely helped shorten the event. Easy to do. Looks weird, but highly useful for a lot of situations.

EFT for stress and anxiety with AFib
[www.afibbers.org]

Be well,
Jackie

Duke,

Hesitation and procrastination over the ablation decision is natural, but do not forget that this is a progressive disease. I look back on my own experience and wish I had done the ablation sooner. I had afib for eleven years before seeking Dr N. In that time I had 15 cardio-versions by shock and countless days and hours of worry. When I finally had the ablation my condition had progressed to where Dr N could not get it all in the first procedure. He told me I would be back. Another four years of kicking the can ensued, and five more aflutter cardio-versions, and now I am headed back next Thursday to the cath lab for what I hope will be the last time.

Even after a successful ablation you will need to adhere to good supplementation and diet protocols as the procedure does nothing to the underlying processes. You will need to find a way to incorporate those into your life ablation or not if you are going to control this beast. A successful ablation can save you from long term anti-arrhythmia drugs and warfarin usage and that is a big advantage.

Seeing Dr N and following his advice is a great idea.

Good luck

I've had 6 episodes in the past 16 weeks - 2 hours, 2 hours, 10 minutes, 45 minutes, 2.5 hours, and 5 minutes. I've probably stopped 2 or 3 others during that time by standing up quickly which sometimes stops them before they get started. Most recently I've had success pushing the stomach down - that's right, digging in (firmly) below the ribs with both hands and then pushing downward towards the navel. I'm convinced that my main trigger is my stomach pushing my diaghram into my heart (they are all physically in touch with each other), so this is relieving that. My 2.5 hour one listed above was a rockin' crazy one, and it stopped IMMEDIATELY when I did this technique. It didn't work immediately on the 5 minute one, but may have helped cause it stopped a minute later after I turned over.
All I take is a 200mg mag tablet as I cannot tolerate more. Occasional potassium supplementation via a banana or some potassium gluconate (1 teaspoon) when I've had a somewhat salty meal. And fish oil. I watch my salt much more carefully now, and whether or not my afib goes away, I can say with great relief that my ectopics are radically improved by getting a better Potassium to Sodium ratio.

Ralph - You definitely are on to something with your manipulation. You probably weren't reading when I posted years ago about my experience in having chiropractic manipulations that pulled down on the stomach to release the pressure on the diaphragm (and impingement on the vagus nerve which innervates the heart).

I had been in AF nearly every day for long sessions lasting 24 hours and more. Had an ablation date set for six months out. Willing to try anything to get relief and avoid the ablation procedure. I was taking flecainide at 300 mg daily but it wasn't working. After two treatments, I actually went something like 5 days in NSR. A miracle to me. I had more treatments and the AF stopped completely. All the while, I was increasing both magneisum and potassium supplements which also helped regulate the tissue pH to be consistently alkaline since it was running acidic.

The chiropractor said that since the vagus becomes irritated by both the impingement of the stomach and the acid pH which is also irritating....(plus we know if the sodium/potassium ion pumps aren't functional due to lack of 'supplies' ), the conduction will have interferrence.

The rest of the story is that while I remained in NSR and had weaned down to 50 mg a day of flecainide...which was a huge overall accomplishment, I ran out of time to see if I could be off the drug entirely. My insurance then was at risk of changing and I didn't want to risk having to pay a large amount out of pocket... so I had the ablation by Dr. Natale in 2003. Not sorry, but I always felt I really could have avoided it, given more time.

That said, after 10+ years post-ablation, I know that my system is vulnerable to suboptimal levels of the critical electrolytes... and anything that influences that will give me breakthrough events. When I treated for the Lyme infection, the inflammatory results were so toxic, I had multiple events that had to be cardioverted and I'm still struggling in the aftermath of that.

Congratulations on making the Na/K ratio connection. Also consider what may be in your diet that causes stomach or GI irritation.

Jackie

Duke:

I just had my Natale ablation done at Scripps in La Jolla and I can tell you from being there in the hospital on my back starring up at a gaggle of nurses and meeting the good Dr. Natale that you will be in good hands if you decide on Scripps.
Linda Couts is Natale's nurse practioner at Scripps and she's simply the best. She'll walk you through every aspect of your procedure.
Since March 17 I've had no afib or flutter, some occasional blips of Pacs, but I truly feel I'm finally afib free, (for the most part.)
I still need to go in in Septmeber and have a TEE done since I had an LAA, but no worries. At least it will all be done at Scripps.
Truly a great hospital using a great EP.
Take it from me, Duke, if you want any semblance of freedom from afib, then Natale's the guy.

Chris

Chris,
I was thinking about Scripps facility and then I see your comment this morning.

I was wondering if Scripss Clinic has all the latest and advanced equipment for the ablation since it is not the "main" center like Austin, Texas or San Francisco where Dr. Natale does more work. I'm not at all familiar with the latest technology for ablation, but I was reading some of the archived posts where Shannon and others discussed about Carto3 or Stereoaxis? or something like that. I learned from this site that Dr. Natale is skillful with his hands, but I'm hoping that Scripps Clinic also have all the latest tools that he needs to do a "perfect" ablation.

Do you or anyone know if Scripps Clinic is up to par with Austin, San Francisco or Bordeaux facilities in terms of equipment and technologies?
Chris, you mentioned that you had LAA worked on as well. Is it because you had Afib for quite a while or is it just a condition that you get what you get? Is your case a difficult or challenging one for Dr. Natale? How often were you getting your episodes before ablation?

Yes, I do think ahead, have many questions, worry, have cold feet and wish to have 1 "does it all" ablation with no hiccups, etc. even I haven't get the chance to talk to Dr. Natale yet. My mind started to wonder a lot as this search for a possible perfect ablation begins. Thanks Chris and everyone who can chime in with your comments.

Duke

Morpheus,
I'm confused as to the information you mentioned about pacemaker lead removal?
Do I need to have my pacemaker removed in order to have an ablation?

BTW, thanks so much to everyone so far for your comments in this post. I hope to hear and learn more from all of you.

Duke

Duke, My opinion is to go with what Natale advises. the only reason not to ablate would be if you were trying the supplement /nutritional approach like some members here. If you are hesitant to do that dance then go to the best.

After ten years of afib and 2 failed ablations I finally went to bordeaux for a successful Dr. Hocini ablation. My afib had developed from frequent to persistent and finally full time. The reason I waited so long was to enable my local EP's to get better at the procedure. It didn't seem to help as there quoted success rates were poor. 2 years + now afib free and I don't regret the decision to go to bordeaux.

Good luck with your choice.

Adrian now age 60



Edited 1 time(s). Last edit at 05/17/2014 04:22PM by Adrian.

Morph:

That is what is wrong with our system, people suing all the time, healthcare has gone up because of people suing, surprised at your post.

Liz



Edited 1 time(s). Last edit at 05/17/2014 11:03PM by Elizabeth.

Hey Elizabeth. Here is an article pointing out the discrepency between some people's beliefs and the reality of litigation costs in health care [prescriptions.blogs.nytimes.com] 1 - 1.5 % of overall costs to ensure people have to answer for their negligence and worse

This is, indeed, a progressive disease and if you are eligible for ablation I would jump on it. My first cardiologist messed around with me for some time (two years) and then a year after aFib diagnosis, allowing my left atrium to enlarge to 60mm and putting me in the "ablation not recommended" category. I was started on TIKOSYN and have been in NSR since December 2011 as a result (after ECV). Lately, the side effects of the TIKOSYN have become almost intolerable and at my next followup with my EP in a couple of weeks I will determine (he will determine) my LA size and ejection fraction and we will make a decision on ablation based on empirical data and my strong desire to get the heck off the medications.

Had I been properly diagnosed and acted on at the first signs of Afib it would all be behind me at this point I think.

The moral of the story is to get with a top EP and discuss ablation as a fist line action to correct the aFib.

Just my opinion.

Good luck.

Murray L

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.

Duke:

I Can't help you any regarding Scripps facilities compared to Austin; I'm sure Shannon can chime in with the pertinent comparison. But still, it comes down to the EP's talent and Natale's skill is second to none. Scripps is a research university hospitial comaparble to Loma Linda or UCLA and from what I saw there, from my layman's perspective anyway, the staff and facilities are for sure up to par.
Besides, as Shannon explained it to me, Natale uses a more hands-on approach to his procedures and doesn't really require all the bells and whisltes that some EPs need.
Trust me on this, Duke, like you, I live in the LA basin, OC, and Scripps is very convenient compared to an Austin trek.

Chris

Duke: As to your question per my afib history and needing an LAA; yes, I was at the beginning stages of persisitent afib. My episodes were once a week pregularly, lasting from 1 hour to 6 hours. I had an ablation done at Kaiser LA in 2010, but it failed miserably. I was in constant flutter and afib during the blanking period and only had 6 months of no afib. Since then I was progressing into persitent afib.
That's why is ABSOLUTELY imperative that you use Natale. Do not settle for second best with this beast.

Chris

Ralph:

As usual you can find anything on the net to support your views. Anything that runs up costs is going to increase healthcare, also doctors have to pay a lot of money in order to carry insurance.

There are legitimate reasons to bring suit but there are a lot of frivolous lawsuits which costs the rest of us more in our healthcare. I am not going to post articles which contradict yours, although there are many, it is a useless endeavor.

Liz

Hi Duke,

Scripps is a perfectly fine institution for your index ablation with Dr Natale. The only limitation there is that he is only there a couple days at a time and less frequently than in Austin his large home base and San Fran where he ablates for 5 days out of every 4 or so weeks. So it can be easier to get a quicker slot in SF or Austin. But there is no question Scripps is the physically closest to LA and Linda Couts who is his main Cardiac Nurse Practioner there is excellent and highly skilled. Plus, Dr N has been going there long enough that the whole support staff that works with him are well-oiled by now as I have heard from several sources, so you won't have to put up with some of the early first six months growing pains as can happen when Dr Natale, or any such prominent EP or surgeon after first opening up shop in a new region often experiences, as the inevitable adjustment phase occurs where all the new staff learn the high standards that he expects in his practice.

No worries at any of the three facilities where you can now get ablation with Dr Natale, as long as he is running the bus you'll get an expert ablation regardless.

Cheers!
Shannon



Edited 1 time(s). Last edit at 05/19/2014 01:48AM by Shannon.