Post ablation- one good year & now issues

I haven't posted for awhile. I had a very extensive ablation by Dr. Natalie in Austin in July 2014 for persistent afib; and afterward had to be cardioverted locally in August post ablation. Then I had almost a year of great NSR with just ocassional PACs. I was able to get off Eliquis and Multaq last December and I've been feeling wonderful. I exercise briskly 3 mornings a week and run 2-3 miles another 2-3 days a week. Feeling great!
THEN- last Saturday after a brief 2 mile run I noticed my heart rate was not recoving and stayed around 130 for several hours (I always monitor exercise with my Garmin watch). Over the next 24 hours using my AliveCor it showed wide swings from NSR to "unrecognizable" to AF. By Sunday it was pretty much AF all the time with rates from about 70 laying down then jumping to 130 when I stood up. In hind site, the hot weather and I may not have been hydrated sufficiently was probably a trigger for all this.
(I take aspirin 81mg, Mag 450 mg, Potassium 150 mg, CoQ10 200 mg, Fish Oil 2100 mg, Taurine 1000 mg, Carnitine 500 mg and D3 5000 IU)
I already had a 6 month folllow up with my local cardiologist scheduled on Monday, and the EKG there showed flutter.
So, I'm suppose to be cardioverted again soon (hopefully this week) and I've restarted Eliquis. If cardioversion is successful I'm suppose to resume Multaq. I seemed to tolerate Multaq pretty well last time- EXCEPT it did elevate liver enzyme levels. So, I'm not looking forward to taking any antiarrhythmic due to possible side effects.
It seems evident I'll need a follow up ablation- and I knew that was a possibilty on the front end. Just disappointed since I was feeling so good.
Dr. Natalie is out of town, but the office has my recent episode paperword and he is suppose to review and also recommend an EP closer to me (Louisville, Nashville, Evansville, etc.) since locally the EP moved elsewhere (an EP from Cleveland Clinic is suppose to be moving here in a couple months- I don't know the name).
I definitely want to go back to Dr. Natalie for the follow up ablation when necessary- just coordinating time away for an out of town procedure again is something that has to be figured out in the future.
With all that said- I did have a year of feeling good and Dr. Natalie's staff has been good to work with.
This is certainly a journey!
Any comments about post cardioversion meds pending second ablation or comments about any good temp EPs closer to my area would be welcome.

Hey KenKY,

Yes I recall your persistent AFIB procedure and our contact back then when you were getting set up via TCAI. You certainly did have a pretty extensive ablation with a pretty wide spread, ... kitchen sink' ... array of active sources, as I recall, in that index procedure. I was wondering if you were going to be long term 'one and done' with such a history and progression, and not hearing from you all this time Ive wondered how you were fairing and was hoping you were one of the lucky longer term persistent afibbers who hit the jack pot with a single shot arrow.

Certainly, I empathize with that sinking feeling when, after a nice long reprieve as you have enjoyed, that very unwelcome visitor comes dknocking on your door again ... I know that feeling well.

But on the flip side, you are so well placed in both yourI experience and in your associations and in knowing what steps to take now, that with such a long solid remission even after having had such extensive spread of triggers over time, is very encouraging for this next one, as very likely no more than a true touch up, to hopefully and very likely will seal the deal for you for many years, if not indefinitely.

While setting up the nearest date for that touch up with only Dr Natale (you certainly got that right for sure) then please redoubly any efforts at life style risk factor reductions, if any, that could use some help and redouble the Strategy nutrient repletion protocol as well while also insuring low dietary calcum intake and insuring through blood testign and Vitamin D3 titration that your serum 25(OH)D3 levels are from 60ng/ml to 80ng/ml. Add in Vitamin K2 as well for good measure and to insure good balance with the Vitamin D.

Magnesium and Potassium repletion too is very wise to insure as well at a time like this along with L Taurine if you tolerate it as well as most people do.

Even if these agents never seemed to do you much good which, is not uncommon once persistent AFIB sets in ,... though as always in this business there are polar opposite exceptions to each of these rules of thumb ... nevertheless, jsut as sometimes after a very solid index ablation as you definitely had, when AAR driugs can become more effective when before the ablation they may have begun to fail miserably , sometimes a similar thing can happen with regard to retrying the Strategy protocol and good dietary adjustments, stress reduction, treating any high BP, Sleep apnea, any over wieght issues thoiugh I dont recall that being an issue for you.etc.

Sometimes when the beast comes back like this after a solid foundation has been laid down, you will still almsot certainly need that touch up to shut the door again on the arrhythmia for a far longer duration, but also every thing can seem to go much smoother and with less effort and feelings of instability even in the midst of NSR, when you have taken the time to redouble all those efforts as insuring better overall health as you approach and after your touch up ablation.

Many times, like in my case no amount of magnesium, potassium, taurine, Vitamin D, acetyl L carnation, glutathione, etc etc etc will put Humpty Dumpty back together again on the wall without another visit to Austin, San Fran or La Jolla, but I can swear I've seen a purely anecdotal but clear relationship in all those I have followed pretty closely with those needed such a touch up after a good period of quiet from a successful index ablation, who stuck to and redouble those efforts at eating better and insuring those vital nutrients we all know are heart friendly are all in strong supply for the body, just seem far more likely to have a smooth run of it in not only regaining their NSR but the stability and solidity of the day to day experience jsusst seems more 'planted' with generally less ectopy etc even after stable NSR has been regained with the follow up procedure.

Clearly in the lions share of these cases I have followed over the years its the ablation process that really had the biggest impact on first gaing and then anchoring longer term NSR, but just do'nt loose sight of the association of doing everything we can, in addition to partnering with the best EP we can, to help them help ourselves the most.
Give me your number by PM if you'd like to discuss some of this again Ken, will look forward to catching up with you.

Be well and no worries, this will all work out fine for you, just keep your eye on the long view ball.

Shannon



Edited 1 time(s). Last edit at 08/05/2015 02:28PM by Shannon.

Hi Ken,
Sorry to hear the beast is back. Glad you have had one good year. It can happen to any of us. Before my index ablation with Dr. Natale, my EP was Dr. Saavedra at Vandy cardiology. Although I self referred to Dr. Natale, Dr. Saavedra said he would be happy to see me for follow up after the ablation. You might try there.

Actually it has been two years since my ablation and I've not seen another EP because I don't know how they would improve on the perfection Dr. Natale achieved. I'm one and done so far--knock on wood!

Best wishes,
Betty

Ken
Sorry for your return. You will get it worked out. We have one of the best centers (well kept secret) here in Lexington.
Dr. Tomassoni at Central Baptist is a Natale study, very experienced. The technology here is top notch.
Just throwing that out there.
Tim

Hi Ken - Sorry about your recurrence... Just a quick comment on your electrolyte balance... You do take 450 mg magnesium... is this to bowel tolerance or could you add more? If you could add more, then continue to increase gradually to just below the bowel tolerance level. Potassium can't work if you don't have a solid base of magnesium...and potassium is the rhythm stabilizer.

Also... you should do a log of your dietary intake of potassium-containing foods to see how close you come to the basic minimum of 4700 mg/day. Compare that to your sodium intake... if you eat any packaged, processed, or restaurant foods, your sodium will undoubtedly be much higher than your potassium unless you make a concerted effort to change that. When sodium dominates over potassium, arrhythmias are one consequence. Your supplement of 150 mg potassium is a paltry amount ...unless, of course, you are eating tons of potassium-containing food.

If you are running in this extreme heat so prevalent in many areas of the country, your electrolytes are going to suffer so you need to get on top of that.

..... I'm short on time or I'd elaborate more. Send me a PM if you like.

Best to you,
Jackie