One Week Update

Greetings to all,

I will try to keep this as short as possible. Since my ablation last Tuesday with Dr. Natale, heart rhythm has been perfect with two very specific exceptions that I will explain below.

Soon after awakening following the ablation, I began feeling that special rythmic pulse in my carotid artery. What a joy to experience after the hundreds of times I've felt the afib in my neck. After discharge from the hospital and through the trip home, it continued to feel rhythmic---a thing of beauty.

Last Sunday night, immediately after eating dinner, I sat down on the couch and reached up for my carotid pulse. It had been so perfect....I had no worries. I was stunned to feel the rapid, irregular pulse that I previously experienced pre-ablation while in afib. I grabbed the AliveCor and saw the rapid rate and irregular spacing in the QRS complexes. They had been perfectly spaced post ablation. This episode lasted a few minutes and the heart calmed down. Still, I was on alert and feeling less confident. I went to bed after the Super Bowl in a good rhthym and woke up in a good rhythm.

Monday was a perfect day all day. I began thinking Sunday night was just a fluke, as we have all been told to expect some irregular stuff post ablation, at least for the next few weeks. The bothersome thing was that everything had just been so perfect up to that point....perfect. I thought I was back on the right track. I wrote Shirley Seever and asked her to pull the strip from the specific time Sunday night.

Today, Tuesday, all was good in the morning. For breakfast around 8am, I ate a small bowl of oatmeal with some cranberries, almonds and granola added. A couple of hours later, I began feeling a little bloated. I ate lunch today later than I normally do....eating around 1pm. I put the dirty dishes away and sat down on the couch. I reached for my carotid pulse again expecting grandeur.....but alas, irregular, rapid pulse, reminiscent of afib. I grabbed the AliveCor and it said no afib, but logged a very high rate----150's. I felt it racing in my carotid. After a couple more AliveCor's, I got a couple of afib readings that displayed the unevenly spaced QRS complexes. Ugh......I remembered this time to use the pager thing with my LINQ and I flagged several spots on today's irregularity. This session lasted much longer Sunday night's irregular session. After about an hour of irregularity I performed a manual download with the LINQ and wrote Shirley notifying her.

I swear, I believe it is related to the eating.....I had this feeling of fullness under my sternum and just below there today and Sunday. I've had this feeling before my ablation when I was trying to figure out triggers, but at that time I was taking Flecainide twice daily as well as experimenting with other variables.

Fact: Post ablation my heart rhythm has been perfect---except for these two very specific instances. Both occasions, I ate beyond the feeling of fullness----not extraordinary overeating----but because I started with a little bloating, then ate a regular meal.....which pushed the level of fullness into maybe a slight feeling of discomfort.

I've read a little about the potential for GERD and irritation of the vagus nerve. I suspected it before the ablation. These two instances following an otherwise perfect post ablation experience give me further confirmation that there is a connection between the two. I don't get heartburn.....I get a little pressure......again, right under the sternum and just below.

I've read that a hiatal hernia can actually protrude enough to encroach on the heart. I'm not saying that is what I have, but based on what I've experienced this week, I think it is worth checking out. I'm 52 and haven't had any type of GI exam since I had a GI bleed back in 2006 while taking Celebrex daily. I've made an appointment with my primary for tomorrow at 9am to discuss options for examining this.

Shirley emailed me back and then called me later. She is a big sweetheart and very responsive. She could not find anything on Sunday's strip but we thought it could be because of the shorter duration. However, she clearly saw today's irregularities and discussed them with Kay. By the time we talked, a couple of hours had passed. The irregularity and very high heart rate had mostly passed and seemed to be leveling off, even though at that time I was feeling a HR of 96 on my carotid (16 beats in 10 seconds), which is a lot higher than the 78 or so it has been measuring at rest. We discussed that I could take Flecainide if I felt it was appropriate----I didn't, because again, it appeared to be leveling off.

As of this moment, about 835pm EST, I am still in perfect rhythm after eating a very small dinner, consisting of only a very small garden salad and a small 1/2 chicken breast. I didn't eat it all. I still have an uncomfortable pressure under my sternum and bloating in the upper GI. The difference is that I didn't continue to eat and create additional pressure in there. I really believe if I had continued to eat more, I may have quite likely initiated afib.

Anyway, feel free to comment with your ideas/comments/knowledge on your experiences/my experience. I enjoy hearing from you all.

Best wishes to you all for NSR.

Sincerely,
Ken



Edited 1 time(s). Last edit at 02/03/2015 08:56PM by kls5834.

Hi Ken,

Aw we discussed this morning as I was driving to the airport in Phoenix to fly to La Jolla where I am typing this now at the Hilton next door to Scripps where my second follow-up TEE will take place tomorrow, this kind of activity is all pretty much par for the course for most people in first 6 weeks to two months after an ablation. Not infrequently the little runs will start only after 3 to 7 days, or even a bit more, after the ablation when over the course of the variable healing of all the inflammation from having a branding iron inside your left atrial as it was dragged around forming deliberate barrier scars across the variable atrial wall thickness, what often happens is the early near total quiet, is joined be episodes of various flippies that usually come and go as entirely new and typically temporary new arrhythmia circuits arwe formed in new places within the LA or RA simply from some areas of a given intened ablation lesion on thinner tissue healing up faster than a thicker portion of the same lesion, and thus you get solid scar formation at one spoke and still some inflamed chopped liver at another, which sets up a predictable milieu for just the kind of transient activity you are noting.

Again, this is all garden variety Blanking period activity. Only should it continue to increase in frequency and duration of episodes out beyond the two month period will such activity then more likely suggest a touch up ablation is in order ... But it isWAY too early in your case to even lose one wink of sleep over any possibility like that. Ive seen and heard of hundreds of cases over the year where this very same kind of activity quiets down nicely after around two months and before you know it a year has past and all is skating right along.

Also, since you told Dr Natale you wanted to try to forgo the flecanide, when such AAR drugs like that are typical standard of care after an ablation during this blanking period so as to try and minimize the amount and/or intensity of blanking period triggering while everything heals up nicely.

I fully understand that before your ablation, you did not feel flecanide did you any good and may have been a bit pro-arrhythmic which is entirely possible and so you asked Dr Natale if you could just not take any AAR druf and see how you do. That is perfectly fine too with a case like yours, but as Dr N noted, the two of you would see how you do during the blanking and adjust that decision if warranted in the coming days or first few weeks.

Keep in mind too Ken, that one key feature of an expert ablation, is that even if there is some blanking period (or longer) activity, it is very often that case that previously ineffective AAR drugs suddenly now will work much better again from the added major benefit of the ablation, even though during this period the ablation has not yet fully set up and firmed up as yet, and is not yet close to fully locked in to the degree of protection it is going to offer you.

Anyway, I know from our discussions that you have all this well understood and none of this is more than a minor nuisance for you as it is. Just role with it all and make note of times and duration of any irregular periods while taking it all in stride.

Cheers!
Shannon



Edited 1 time(s). Last edit at 02/03/2015 10:27PM by Shannon.

Shannon,

Thanks for taking the time to write.

First, good luck tomorrow with your TEE. Give yourself a break and get some rest!!

I completely understand all of your aforementioned points. As I discussed with Shirley today, had the irregularity lasted longer, I would have taken the PIP flecainide. If I ever need to take it, it would be great if it provides calming to the rhythm.

I understand about the potential intermittent irregular rhythm/high rate that is normal during the blanking period. However, you didn't address the correlation I discussed above and believe exists related to eating somehow triggering it---whether by vagus nerve or other stimulation. I just don't believe it is a simple coincidence in the timing of these two events---especially considering pre-ablation suspicions. As I said earlier, I will continue to explore this.....and try to prevent triggering any heart irregularities by eating smaller portions if I have that pressure in the sternum area. I still feel bloated now from that very small dinner that I had tonight....but no heart irregularities as a result. I'm thankful for that.

Yes, it is only a minor nuisance for the moment. I'm so thankful for all of the NSR I've had in the last week....and still have right now! What a great feeling!!! I just counted 35 beats in my carotid over 30 seconds.....so 70bpm HR.....perfectly at peace and beautifully rhythmic. I'm still looking forward to a successful end result ablation.......I just want to solve this last little piece of the puzzle.....if possible.

Go get some sleep, Mister! You have a big day tomorrow.

Thanks again for responding......and for the phone call earlier today.

Best wishes.

Ken



Edited 1 time(s). Last edit at 02/03/2015 10:55PM by kls5834.

Ken - It's not uncommon to have bloating after eating grains. It can be a gluten or gliaden component or it can be another of the lesser known proteins to which your body is reactive. A solution is to avoid eating any and all grains for several weeks and notice whether or not you've had bloating after meals. Then, if you feel like risking it, eat a grain meal typical for you and see of the bloating recurs. That way you prove to yourself that you need to make those dietary adjustments on a permanent basis.

In a couple weeks, I'll be posting a report on grains and the many connections to ailments that typically go unrecognized. Another common factor in the bloating issue is that you lack nutrients involved in making both digestive enzymes and natural stomach acid to break down foods and the result of that is bloating....but since yours occurs relatively quickly, I'd think more likely it is a grain sensitivity. (I know no one wants to hear that, but it's very common ... moreso than most people realize.)

Keep in mind that when bloating occurs, and if the vagus is in a relatively continuous state of irritation from inflammation... which is common with existing food sensitivities, then that can become a stimulator of some type of heart activity...such as a run of PACs. As you mention, if you do have a hiatal hernia, then that also makes the vagus more "reactive" when there is concomitant bloating.

Meanwhile, I certainly wish you well with your recovery.

Jackie

Ken.

As noted in our conversation this evening after my successful TEE today, I recount here for other interested readers too, that throughout my long and winding AFIB road both vagal and various digestive triggers ... which invariably were presaged by bloating, burping, fullness etc, ... were a significant bane in my history.

being in the early blanking period, will tend to exaggerate those influences even if f the only manifestation is short runs of AFIB and/or ectopy for a while as the atrial tissue continues to heal and the necessary lesion scars full firm up. At that point, by 8 to 9 weeks post ablation, everything should quiet down considerably, if not entirely.

And since you are not on any AAR drug now that is standard of care for most post ablation care the first few months to help keep the substrate more quiet and stable while this healing and scar forming take place.

As we discussed this afternoon, if you continue to get more runs and/or its frequency increases, by all means add in the Flec or discuss another AAR with Dr N for the next couple of months on a daily basis ... not just PIP. Its possible too that you could get a prolonged period of flutter, that does not respond to AAR drug ion which case a quiet cardioversion is in order and often times that will do the trick and settle things down long enough for the lesions to firm up and settle in for a very nice stable result long term.

And, as you know, there are times when such breakthroughs or flutter indicate the need for a targeted touch up as soon as its need is clearly recognized. Typically Dr N doesnt like to do any touch ups prior to 3 months post ablation, if possible. And the odds are you will not need that in any event, but it is a possible scenario in this ablation 'process' and its always wise to take the long and broad view here knowing too that no matter how the coming months unfold you can take great heart in knowing that you have already accomplished the single biggest possible step in the whole process and in your AFIB history toward real freedom from the beast long term, by getting past this index ablation with a maestro like Dr Natale as you have done now.

All the rest is just details really and knowing that big picture makes it all so much easier along the way.

Cheers!
Shannon