Ablation Report (Dr. Natale)

My name is Jim, and Dr. Natale performed my recent ablation April 9, 12 days ago, and told me all went well. The areas he found needing his exquisite attention included the right superior vena cava, the posterior left atrial wall, the coronary sinus and the left atrial appendage, where he was able to leave the appendage contractile, meaning for now no need to close it.

By way of background, I had an ablation 11 years ago, and I redeveloped paroxysmal LAF symptoms last October.

I would have posted a report sooner, but I have experienced a rather changeable basket of symptoms and complications, all of which are on the list of possible post-ablation symptoms. The initial annoyances have stopped, but I am experiencing nearly daily short episodes of flutter. And my blood pressure and pulse rate swing from low to normal to high and back again.

Today a nurse with Dr. Natale’s team at California Pacific Medical Center (San Francisco) told me to try temporarily stopping my normal, year-in-year-out antihypertensive drug, Lisinopril, leaving me on the beta blocker, Metoprolol, only. I was not on Metoprolol in the time leading up to the ablation. She told me to consult my local family physician first to get an OK to try this.

During those times of low BP and flutter, I am weak and sometimes a bit dizzy. During normal rhythm and normal BP, which is more than half the time, I feel fine.

Shannon Dickson, in a phone chat, reminded me that I am, after all, 73 and have had an ablation previously, and therefore I might reasonably expect to have a greater susceptibility to these annoyances than a younger, first time patient. I trust I will progress through this and be getting back to normal soon.

Before leaving San Francisco I was issued a Life Watch event recorder, and I phone in recordings whenever I feel symptoms and will continue to do so until I return to full-time NSR.

I am on the rhythm-control drug Propafenone and on the anti-coagulant Xarelto, in addition to Metoprolol.
I’m having a follow-up hospital EKG in a few days.

Traditionally I have led a very active outdoor life, biking, hiking mountaineering, backpacking and sea kayaking. So I certainly will resume exercise, but as Shannon has counseled, I’ll do it gradually and take it easy.

And with the help of Jackie’s excellent post of Jan. 5, 2015, titled “Magnesium – what’s in your supplement?” I will be looking into starting magnesium soon.

As I progress, I’ll update you all. Thanks for your help.

Hello Jim - and thanks for your detailed report. My story is similar to yours... in that after 11 years post ablation, I also developed some recurrent AF that required a second ablation and then recently a touch up to that. I'm 79.

I'd just like to comment that while my blood pressure is normal, when I used Rythmol/propafenone prior to the second ablation, I found lowered my heart rate and blood pressure enough that often I felt dizzy. I don't want to suggest you tinker with your med dosing yourself, but perhaps you can work with your cardiologist to adjust something so you don't have the symptoms you mention. You need to feel 'normal' while you go through the recovery period.

I wish you well with your post-ablation progress.

Jackie

Thanks, Jackie. I will work on that with my internist. I've seen a cardiologist just once in 12 years, a month before the Natale ablation, and he was not in favor of my having an ablation. I don't think he will be sympathetic now, so I'm reluctant to seek his counsel now. But if he has any sense of duty, he should try to provide some constructive advice, I guess. We'll see.

Hi Jim, check for any more sympathetic Cardio's in your regional area near Idaho with Salwa at CPMC who they might have worked with in the past.

Some runs of flutter are indeed common during the blanking period, though should calm down as you move past the two month mark, or at least not pick up speed or frequency past 8 full weeks post ablation. You want there to be either no arrhythmia or tending downward if you have had some early flutter, tachy or AFIB during the first 6-7 weeks or so. However, keep in mind now that you are still in very early stage blanking period where all the annoyances you describe are pretty par for the course.

If your combo of BP meds is making your BP swing too much that can encourage an already inflamed heart to be jumpy and more prone to have such runs, hence the recommendation to D/C the lisinopril for now while on Metoprolol with it's strong BB action.

Hang in there Jim and things will get smoother.

Cheers!
Shannon



Edited 1 time(s). Last edit at 04/24/2015 11:13AM by Shannon.

Best wishes, Jim. I hope things calm down for you quickly!

Ken