Three week update

Well it's now been three weeks since my Dr Natale ablation in Austin and I'm still kick'n. So far I seem to be staying in NSR . I think I've felt a few palpitations but not many. I get the impression this is going to be a slow recovery in terms of getting my energy back. I do as much as I can but fatigue pretty quickly. I have SOB most the time with a little dizziness if I push it too hard. With that said I do feel myself getting slightly stronger each day. My heart rate is still elevated and probably will be for quite some time. While sitting around the house its beats at about 82 bpm but shoots up to over 100 bpm with very little activity. The good news is at night just before I doze off its down around 65 bpm which is where I was before the ablation....when in NSR! That is a BIG improvement from where it was immediately following the ablation. While at St Davids it never got lower than 92 bpm. I still feel a bit of chest discomfort from time to time. It feels like quick achy spasms occasionally. The Nurse Educators who work with Dr Natale continue to be great. I try not to be a pest but if I have questions or concerns they are right there! So that's my report. Progressing but slowly.

Hi Craigh,
Thanks for sharing your post ablation experience. Please continue to update us as time goes on because I need to learn so much from you folks who just had ablations, especially with Dr. Natale.
I'm scheduled to have a consultation with Dr. Natale on June 23rd in San Diego, California. I have so many questions about how life is after the ablation, so I'm very thankful with the information you and others with ablation experience being shared on this website. I wish you a speedy recovery.

Duke

I had my Ablation for persistent AFIB with Dr. Natale Feb.27 in Austin, Texas. I have been in NSR ever since. It takes a while to get back to "normal but I have started back walking 20 miles a week a month ago.

I am so glad I had this procedure done. I have been off my multaq since April 24 and look to go off my Xarelto in about a month.

I was sore and also had high Anxiety after the Ablation but everything is looking good.

Hang in there; It only gets easier.

Hi Duke,

Even though I had my ablation done in Austin I plan to follow-up with Dr Natale at Scripps in San Diego. A close friend of mine had his ablation done by Dr Natale at Scripps and he was very impressed with the staff and facility. Just like i had in Ausin, they assigned a Nurse Educatator to him. She was his immediate point of contact for questions or concerns following his ablation.

Like you I had a ton of questions before the ablation. I still do. I learned a lot by reading about the experiences of others. Every case is unique but I almost alway found something of interest to my circumstance. Then there is the valuable input by the regular posters and in particular Shannon who help me out tremendously. The information certainly is not as important as that between you and your doctor but at least it provides ammo for further research and the ability for more comprehensive discussions with your doctor.

The best to you as you move forward with your care!

Hi smackman,

You mentioned it took you awhile to get back to " normal" . If you don't mind, how far out from the ablation did you feel you were able to confidently resume normal activities without fatigue or other issues? Did the SOB and//or elevated hr hang with you for awhile? As I mentioned above I recognize each case is unique but it still helps me with perspective. I know I've already over done it a couple times. I was feeling pretty good so I went out and worked in the yard and I paid for it those evenings with additional fatigue and overall feeling like .....well...like I screwed up. I'm more careful now!

Congrats on your 20 mile weeks! That's excellent!

Thank you!

Two years ago my ejection fraction was 36%. Today it was 60%! My EP helped my heart get stronger with amiodarone and flecainide. But amiodarone elevated my liver enzymes and flec stopped working even at 150mg 3xday. Thanks to this board and those here and in the past I had my Natale consult May 13. My ablation is in Austin June 19. On the stage you say "break a leg". What do I say to the mistro, "burn me real good"?

", how far out from the ablation did you feel you were able to confidently resume normal activities without fatigue or other issues? "

3 weeks (my 2c)

But PACs etc showed up for 6 mths (probably just as many before)

Heart is going to take a while to re-establish equilibrium. These are burns after all.

Craigh Wrote:
-------------------------------------------------------
> Hi smackman,
>
> You mentioned it took you awhile to get back to "
> normal" . If you don't mind, how far out from the
> ablation did you feel you were able to confidently
> resume normal activities without fatigue or other
> issues? Did the SOB and//or elevated hr hang with
> you for awhile? As I mentioned above I recognize
> each case is unique but it still helps me with
> perspective. I know I've already over done it a
> couple times. I was feeling pretty good so I went
> out and worked in the yard and I paid for it those
> evenings with additional fatigue and overall
> feeling like .....well...like I screwed up. I'm
> more careful now!
>
> Congrats on your 20 mile weeks! That's excellent!
>
>
> Thank you!

Maybe 1 month and I was extra cautious. I never had the elevated heart rate. My Resting Heart now is around 65. I did have one tachycardia event but I was at a Doctors office and I always white coat.

I finally got a consultation appointment with Dr. Natale at Scripps for July 10. I have been in afib (or at least have an irregular heartbeat) for 3 years, so I'm quite sure I will never get to NSR without an ablation.

I am wondering what you mean by "normal activities." Are you talking about strenuous exercise that you used to do, i.e. running; or driving to the grocery story, shopping, walking around normally, cleaning the house, etc. I am in a service business (pet sitting) and have to give my clients a lot of notice when I am going on vacation, etc. so they can make other arrangements for their pets. I am wondering if I take a week off it will be enough. Of course I will talk to Dr. Natale about it and the nurses, but I like to hear as much from "those who have gone before" as I can.

I am otherwise in very good health. I have never gone to the ER for afib and it does not interfere with my life. In addition to all the dog walking I do, I also work out with weights every other to every third day (and I plan on upping my regimen of core strengthening exercises prior to the ablation.)

So glad to hear the reports above -- smackman, I know you were very, very anxious and I'm glad everything is turning out well for you!

Louise

Hi Louise,

I realize your question was directed at smackman but I thought I would chime in with my two cents. I hope you don't mind.

Dr Natale and staff will certainly be your best source for projecting your recovery time but I agree that hearing of personal experiences helps. In my case there would have been no way I could have returned to work as you describe in one week. Fortunately I'm retired and didn't have to face that delima. Dr Natale, and others, explained to me that sometimes his patients come out from ablation with an elevated heart rate. In my case that happened. I'm not certain of how much that plays a role but I still fatigue and experience SOB with only minimal activities. However, I've never gotten to the point I can not function. Its more like I have to slow down and rest if possible. Now just last night I went shopping at Home Depot......no problem. I could not have done that at week one. I did do some light work in the yard just after week one that really caused more fatigue than I should have allowed. I didn't realize I was doing that to myself. I just kept pushing to get the job done, I felt really exhaused that evening. That was a learning experience for me. At week two my Nurse Educator gave me the green light to start taking short walks but to avoid hills as much as possible. Also to ride my upright bike. So far I only walk out to the mail box and back...about 1/4 mile. I'm sure I walk around the house and Home Depot more than that. I ride the bike without a resistence setting for about 8 minutes. I do seem to feel just a little stronger every day.

Like you, other than my arrithymia issues I'm in good health at age 59. The only other ailmennts I have are orthopedic in nature. Prior to the ablation I was very active . My arrythmia problems were getting more severe rapidly 3 months prior to the ablation causing one ER visit and one overnight hospitalazation. I was only on xeralto prior. I now also take 25 mg metoprolol. Dr Nalale expects he will be able to take me off both of those in three to six months.

Thats just my story. As you see others have gotten back in the swing quicker.



I think you will find Dr Natale very down to earth and off the charts knowlegable. I don't think you'll stump him with any of your questions. I will say this, be prepared for a heavy italian accent. In person I was able to understand him okay. Then, the night before the procedure he called me on the phone. Holy smokes, I think I understood about every tenth word. Actually just enough to kind of understand what he was saying! LOL!

Louise Wrote:
-------------------------------------------------------
> I finally got a consultation appointment with Dr.
> Natale at Scripps for July 10. I have been in
> afib (or at least have an irregular heartbeat) for
> 3 years, so I'm quite sure I will never get to NSR
> without an ablation.
>
> I am wondering what you mean by "normal
> activities." Are you talking about strenuous
> exercise that you used to do, i.e. running; or
> driving to the grocery story, shopping, walking
> around normally, cleaning the house, etc. I am in
> a service business (pet sitting) and have to give
> my clients a lot of notice when I am going on
> vacation, etc. so they can make other arrangements
> for their pets. I am wondering if I take a week
> off it will be enough. Of course I will talk to
> Dr. Natale about it and the nurses, but I like to
> hear as much from "those who have gone before" as
> I can.
>
> I am otherwise in very good health. I have never
> gone to the ER for afib and it does not interfere
> with my life. In addition to all the dog walking
> I do, I also work out with weights every other to
> every third day (and I plan on upping my regimen
> of core strengthening exercises prior to the
> ablation.)
>
> So glad to hear the reports above -- smackman, I
> know you were very, very anxious and I'm glad
> everything is turning out well for you!
>
> Louise

Well, I walk 3 miles a day; I actually do whatever I want. We are headed to the beach with our kids and grand kids in 3 weeks.
I drove 520 miles 2 weeks ago coming home from a vacation in Atlanta, Georgia.
I only have limitations with a past back injury.

Craig, I'm 59, had an ablation by Dr. Natale January 24, 2014. Starting gentle, short bike rides and light, short fitness equipment workouts at the YMCA 2-3 weeks after ablation. No problems. But, with heavier exertion, even brief, I was SOB and felt exhausted as late as 5-6 weeks after ablation. I'm now doing cardio and YMCA fitness equipment workouts 5 days a week...but limiting to 1/2 hour or less and keeping the exertion on the mild side. Chronic fitness was probably one of several contributors to my afib and I have no need to over-exercise anymore.

Thank you all for your replies! I just read them because my computer crashed this weekend. I just spent an hour and a half with India getting it back! It sounds like I may be a little optimistic about recovery. I'm sure all ablations are a little different and the work that has to be done determines the recovery. Anyone else who wants to chime in, I'm all ears!

Louise

Hi Lousie,

Everyones body responds a little differently to similar insults and no two ablations are exactly identical as well, but most have a relatively easy time of it with the harder issues primarily resolving around latent fatigue and need to conserve energy for a few weeks. Most often any transient chest pain from the ablation lesions is short lived though some remain hyper-aware of it for a few weeks. Most, like my friend 'Tony' who just had a very extensive persistent AFIB ablation at CPMC last week and is now on day 6 had no more mild to moderate center chest pain on taking deep breaths after day three and has reported no real esophageal or swallowing issues at all other than a little raspy voice and throat the first two days.

His most uncomfortable experience was due to forgetting to shave the hair on the upper sides of his legs and waist area so when they wrap your waste and groin area with wide and thick 'criss-cross' pattern tape to squeeze your hips together for the first 24 hours to keep the compression bandages firmly pressing on the two groin punctures to insure they dont spring a leak wihile clotting up good, he said it was painful when the nurse came in and yanked them off along with a clump of leg hair while he was sleeping at 4:30am!

Must have been a new floor nurse at CPMC. Most of them there are pretty courteous and know not to do that while you are asleep.
Also, he got the new Medtronics LINQ implantable heart monitor which transmits signals collected 24/7 every day to Dr Natale's staff as well as to a box he can view his EKG with at any time for 3 full years with no battery change. Its a cool small device inserted just under the skin on the chest area but can be a bit sore the first 5 to 6 days before subsiding over the next month to the point you are unaware its even there.

Other than than he hasn't had any issues,. he has been taking increasing long walks so far and said he is careful not to overdo it and can feel when its time to back off and does so but feels great otherwise and is back doing some of his legal work as a PhD economist working with a number of large law firms.

So recovery can cover a fairly broad range of experiences but all of them typically are significantly less affecting that most more invasive surgeries and certainly most cardiovascular surgeries.

Shannon



Edited 1 time(s). Last edit at 06/10/2014 09:43AM by Shannon.

Craig,

My Natale ablation was one year ago. My heart rate has been elevated since. Am not complaining about that since Bradycardia was a problem before the ablation and not a problem now. Recovery was slower than I expected. Took three weeks off from work which was not enough. Developed bouts of pleursy the first couple months relieved by Motrin. Although sedentary activities were fine in a few weeks, I was very short of breath with PACs and exhausted quickly with strenous activity such as running. Dr. Natale told me that my tolerance for exercise would probably improve but they didn't know when. This intolerance for strenous activity persisted most of a year and is now finally better. Four months post ablation I began having bouts of PACs and Tachycardia which seem to be triggered by the same things which used to trigger Afib. The good news is that since my Natale ablation I have been free from Afib and am now off all prescription medicines. I guess each of us is different. I am thankful to be well.

Betty

Hi Craig,

So Glad to hear things are going well. The kind of experiences you are having are very typical and well with in expected types and time frames. The higher HR is very typical and actually is a good sign that a lot of good work was done in your index ablation and no surprise there with who you went to. The elevated HR can last anywhere from 4 months to a max of two years with gradually declining levels over time until you really aren't aware of it until one day you realize you are pretty much back to your old baseline resting HR on waking.

If its uncomfortable or annoying you can ask for a low dose of a cardio-specific beta blocker like 2.5mg of Bystolic or a modest dose of a calcium channel blocker if that better suits your body to take for 6 months to a year to keep your HR nice and low while the pacing cells all heal and reestablish your natural resting HR.

Cheers!
Shannon

Hello everyone,
As I mentioned before, I will have Dr. Natale consultation in a couple weeks in San Diego. But I have to admit, I simply can't make up my mind yet regarding yes or no for the ablation. I looked at what I have now and what I currently experience versus from what I gathered so far from your experience post ablation.

With no ablation scenario:
What I have now is 1.5 years of lone paroxysmal Afib with a darn pacemaker (which is useless I think, but I'm stuck with it), I'm not on any type of medication at all, CHAD score of 0, episodes come may be once or twice a week which is self converted at max after 3 hours, episodes are tolerable and I think (I'm still learning) can be prevented by observing triggers such as salt, potassium, calcium, MSG, etc., and when I'm in NSR, it is often perfect and pure NSR with no ectopics, exercise regularly with no restrictions, pretty much still do what I normally do, like playing in the band, singing, screaming, yelling my heart out with no problem, take a bunch of supplements daily, costs of supplements.

With ablation scenario:
Costs for the ablation, at least 3 months (blanking period) and possibility much longer with restrictions, pain in the chest, shortness of breaths, ectopics, Afib episodes, higher heart rates, must take medications (blood thinners, pain reliever, BB's and antiarrhythmic drugs) for some time, a possibility of 2nd ablation, take supplements, stop screaming in the band for possibility a long while. All this eventually will go away after however long depends on my body, costs of medications, costs of supplements.

What would you choose if you were me? I'm 48 y.o., still young? and can wait for better technology in the future? Or ablate now since I'm paroxysmal with good chance for good result from ablation? I ask this question everyday in my mind.

Thanks for any comments.

Duke

Duke, in reading your concerns above I think you are worrying too much about side effects relative to the typical reality... Its NOT that bad and you'll be hard pressed to find hardly anyone here who had gone through their ablation process with a real expert ablationist like the man you are seeing, and is not just in the early days post ablation when every twinge or new experience seems heightened in significance for some folks, and that will say it wasn't worth the relatively modest transient issues that you have read about here. The benefits of NSR long term are very much worth trusting your heart to an expert like him.

Twice a week episodes is plenty too many as that level will get typically only worse over time at that rate of activity. How long have you been doing the nutritional protocols religiously now?? And are you still having 3 hour episodes a couple times a week? You are at the perfect vector between having enough activity yet still being relatively early in the process such that your odds for a very successful procedure and possibly being 'one and done' are high.

You can decide when you speak to him, if you choose not to have an ablation with a guy of his calibre now, I hope you make that decision for another reason instead of misplaced fear about some complications with a top expert ablationist. The odds are extremely high you will sail through the whole thing and be very glad you did.

Cheers!
Shannon



Edited 1 time(s). Last edit at 06/12/2014 07:22AM by Shannon.

My own experience fwiw

" pain in the chest"

None

,"shortness of breaths"

None

"ectopics"

Not many and decreasing with time - then mostly due to dehydration - also ectopic beats would often precede AF before the ablation.

"Afib episodes"

None

"higher heart rates"

Went back to what it was before or slightly higher. Cardiologist says heart function as good or better than before.

"must take medications (blood thinners, pain reliever, BB's and antiarrhythmic drugs)"

None at all after the ablation.

"a possibility of 2nd ablation"

Sure always possible but if I hadn't been ablated who knows how long the Flec would have continued to work. That is not too benign in itself.

"take supplements"

Sure, but not for AF. as I don't get it any more (touch wood)

Hi Shannon,

Is it your experience the Bystolic or calcium channel blockers might be more effective than the current 25 mg Metoprolol ER I'm taking? I think the Metoprolol helps a bit but not significantly. I'm tacky with any amount of exersersion. I think this leaves me a little breathless and fatigued. Interesting enough, as the evening wears on my HR seems to drop like its on a timer. Maybe there is an internal clock? Its not driven by a change in activity...except when I retire for the evening. Another phenominon I've noticed my hr stays slighly tacky for at least an hour following exercise ( stationary bike). I'm slowly working the rate up through exercise. Right now I max out at 130 bpm. On completion of my ride it will slowly drop but only to about 105 bpm. Then after about an hour at that rate it drops slowly into the high 90's and stays there for several hours even at rest.

Intitially Dr Natale did not order any rate drug. He was satisified with my resting rate of 92 bpm while at St Davids. He told me a rate between 60 and 100 we with-in normal limits. My local cardiolgist prescribed the 25 mg Metoprolol. I didn't start taking them until I consulted with my Nurse Educator at Dr Natales office.

Pending your input I will discuss the alternation drugs with my Nurse Educator.

Thanks!

Craig

Hi Betty,

Thank you for sharing your experience! If you don't mind sharing what was your HR immediately following your ablation and where has it settled into? Like you, I also had bradycardia in addition to afib and aflutter. Dr. Natale correctly predicted the ablation would resolve the bradycardia. At least so far! Like I've mentioned, My resting rate has slowed since leaving St Davids. It just with exertion that it quickly elevates just over 100 bpm's. Breathing continues to be a bit problematic. My speech is pretty hoarse most the time. I just can't seem to get a full wholesome breath...even when my rate is down in the 70's or 80's. My Nurse Educator has me back on Lasix over the weekend but it's not helping. I will mention pleurisy when we talk next week. I've never knowingly had pleurisy so not sure of the symptoms.

Good for you that you're off drugs and feeling so much better!

Thanks!

Craig

afhound99 Wrote:
-------------------------------------------------------
> My own experience fwiw
>
...
>
> "ectopics"
>
> Not many and decreasing with time - then mostly
> due to dehydration - also ectopic beats would
> often precede AF before the ablation.
>
....


afhound, when you say "ectopics," what is the sensation and how long did they last after your ablation? Or do you still get them occasionally?

______________
Lone paroxysmal vagal atrial fibrillation. Age 62, female, no risk factors. Autonomic instability since severe Paxil withdrawal in 2004, including extreme sensitivity to neuro-active drugs, supplements, foods. Monthly tachycardia started 1/11, happened only at night, during sleep, or when waking, bouts of 5-15 hours. Changed to afib about a year ago, same pattern. Frequency increased over last 6 months, apparently with sensitivity to more triggers. Ablation 6/27/13 by Steven Hao.

"afhound, when you say "ectopics," what is the sensation and how long did they last after your ablation? Or do you still get them occasionally?"

I guess the definition is skipped or extra beats. Sensation to me was just 'something going on' with my heartbeat. Sorry to be so vague. I had AF after exercise and sometimes during the day without exercise for some time, without being too inquisitive. I was diagnosed with PAF on a routine annual checkup and an EKG. It was a surprise - that's when I started finding out more about the condition. Before I found this forum I found someone who posted he'd had an ablation in France back in the late 90s or early 2000s and I wrote him an email and he responded he hadn't had AF since.

As I've posted elsewhere it is very hard to tell what the frequency was prior to ablation. I didn't keep accurate records but it seemed that quite often AF was preceded by a slow heartbeat or by skipped beats. Other times the extra beats disappeared without AF showing up.

Now I hardly ever get them, but if do it's typically when dehydrated. Must have been months since the last time.

Mostly I don't even think about my heart any more. Hope it keeps up.