Natale ablation for persistent afib - recovery update

My recovery from my Sept. 21 ablation has had some setbacks. The initial phase of eliminating the excess water from the ablation process was successful. The first couple of nights home I managed to get some sleep which helped me start feeling better. The achey feeling in my chest associated with the various catheterizations resolved with taking ibuprofen for 2 nights, allowing me to breathe freely. I started taking Multaq on the 22nd as prescribed. By Friday I managed a trip to P/U a few grocery items and even cooked breakfast for my wife and I on Saturday. Saturday evening, my heart rate started to climb. By 8-9 PM the "achey feeling" when breathing had returned and my heart rate was at 120bpm, possibly in AF. By 10 PM pain was excruciating; I could not lie down, much less sleep. I called Natale's office and the nurse again recommended 600 mg Ibuprofen 3 times daily, not to exceed 3 days. Again the ibuprofen did the trick and after a couple sleepless nights the pain had resolved. My heart rate remained elevated around 90-100 BPM, mostly in sinus rhythm as indicated by alivecor. My sleep became increasingly fractionated, I spent more time awake than asleep during the night. By Thursday or Friday of the second week my appetite disappeared. I started to become constipated/bloated and developed frequent belching. Sleep became harder and harder, I was dreading going to bed. Natale's office recommended I take Melatonin. I explained that my previous experience with Multaq had caused severe insomnia among other things.

On Monday (2 weeks from procedure date) I went to see my local cardiologist (per Natale post procedure instructions). As I walked up the wheel chair ramp to his office, I felt like I was going to pass out. My O2 was good, lungs sounded clear, and the EKG showed sinus rhythm at around 90 BPM. By Tuesday I was so weak, I could not walk around my house. I again called Natale's office about constipation, bloating, belching, insomnia, lack of appetite, weakness. They prescribed some sleeping pills, milk of magnesia, and requested I get a blood test as soon as I could. On Wednesday they requested I stop taking Multaq, which I did. The results of the blood test were "close to normal" (I’ve not seen the tests so don’t know the particulars) and on Thursday they told me my case was unusual and that they thought I should seek local care (I'm 50 miles from San Francisco).

Each day since I discontinued Multaq, I feel a little bit better and sleep a little bit better. Last night, the 5th night off Multaq, I only got up twice in the night. Also my pulse is dropping a little each day, now around 75 ppm and in NSR. However, I'm still bloated, constipated, and weak ( but feeling a little stronger each day). I have little appetite; small amounts of food or water are hard to process. I estimate I'm 10 lbs heavier than I ought to be, especially considering how little I've been eating. Most recently, I experienced persistent sharp pains in my left shoulder, which feels better today. I went to my regular Doc yesterday, pulse, O2, were good, blood pressure was low - 110/58 and she ordered a complete metabolic panel, and thyroid test. She is particularly focused on Multaq side effects list which includes all of my symptoms, especially kidney and liver effects.

I have been reading about new complications from extensive ablations such as I had. The inflammation from an extensive ablation can lead to Congestive Heart Failure ( [www.medscape.com] ) Lack of efficient pumping results in lack of blood for organs, weakness, water retention from kidneys not operating, digestive problems etc, etc. Looks very much like the Multaq side effects list. Apparently it is readily treatable and quickly resolvable with early recognition.

Natale's office says they are unaware of kidney issues with Multaq, or really any symptoms that I have as relating to Multaq. They've never mentioned CHF during my calls with them. They suggested I see an internist, saying they don't think my symptoms are electrophysiology related.

I am encouraged that I am feeling a little better each day off multaq, and that for 3 weeks now, in spite of my difficulties, I’m in NSR. I'm trying to eat and drink just the right amount so I don't overload my system, limiting water to 2 liters/day. I've eliminated supplements for the time being - to begin again after this is resolved. I’m hoping the symptoms resolve with rest and care and without medical intervention. My local doc is on the case now so I will be guided by her.

Sorry you had and are having such a hard time.

After my first ablation with Dr Natale I felt like i was hit by a bus. It took quite a few months to start feeling near normal.
At the time was 46 and in good health, other than the afib. The ablation was my first medical procedure where I was put under. I think the shock of feeling so bad and all the burning to the heart caught me off guard. I never knew I could feel so lousy. My resting heart rate returned to normal almost to the day at 13 months.

I was prescribed Multaq by Dr. Natale for the blanking period after my first ablation in 2010 .
After about three day on it I started having tunnel vision and feeling like I was drunk.
I ended up going to the ER. All test were fine. They told me to stop Multaq. I did. I start feeling better within a day.
My local Dr. said she would have stopped the Multaq right away if I had called her.
To make a long story short, I ended up taking about a 1/8 of a Multaq pill twice per day. In the lower dose, it did seem to help. It could have just been placebo.

My second ablation with Dr. Natale in 2014 was a walk in the park compared to the first one. I have been in NSR 13 months now.

Hang in there. It will get better.

Don



Edited 1 time(s). Last edit at 10/13/2015 07:20PM by gmperf.

gmperf,

To what do you attribute the difference between your first and second ablations?

Erich,

The first ablation required much more burning.

Quote

I called Natale's office and the nurse again recommended 600 mg Ibuprofen 3 times daily, not to exceed 3 days.

That Ibuprofen advice seems extraordinarily conservative. I've had multiple MD's tell me that I should take 800 mg Ibuprofen, 3x/day, due to my size (I'm 230, 6' 4.5" ). They also said it was fine to continue that protocol indefinitely (for 4+ months), as long as the pain persists (in my case, it was a c6-7 disc herniation).

I've seen the PubMed paper linking Ibuprofen to afib, but IIRC the evidence was very weak.

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Constipation after general anesthesia is quite common, even for those who are (otherwise) never constipated. Stool softener is often helpful. Propofol (and other general anesthesia agents) often put the digestive tract to sleep for longer than the rest of the body.

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Your prior post mentions your ablation procedure was 2.5 hours. I'm assuming that's how long you were under sedation. Does your report also contain a sentence like "A total of X minutes of radiofrequency was delivered"? If so, what is your "X" number? That X number might be better indicator of how much burning you underwent. My impression is that Natale index ablations usually have an X which is less than 60.

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I'm surprised Natale isolated your LAA on your first ablation. I was under the impression that he usually tried to avoid that on a first ablation.

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You mentioned that you've stopped all the supplements ("The Strategy" ) until you feel better. Could it be that your body has become accustomed to the daily "boost" of magnesium, etc, and that suddenly stopping it is actually contributing to your slower recovery and other symptoms...?

Even if you hadn't had an ablation, I suspect that suddenly stopping a supplement regime would leave one feeling a bit out of sorts, as the body adjusts to the new normal and attempts to maintain homeostasis on a reduced nutrient profile. Throw an ablation into the mix (where one's body needs extra nutrients to deal with the lesions and inflammation from the burns), and it's a double whammy. Perhaps you should restart the supplements (gradual ramp up) sooner rather than later?

Hope you're feeling better soon.



Edited 2 time(s). Last edit at 10/14/2015 02:09AM by apache.

Hello John - I'm sorry to read your report... Was there a specific reason given for why you were prescribed Multaq? Had you used that before the ablation with no issues?

Others have previously reported not feeling well while using it. Typically, it's not common to experience all of the symptoms you've mentioned so I'm inclined to think it could be that drug and perhaps once it is cleared completely from your system, I hope you'll begin to feel 'normal' again.

Starting at age 67, I've had three Natale ablations and the second, included the LAA isolation but did not have pain or any of your symptoms so that's why I'm leaning toward the drug interaction. I'm glad you've stopped and want to urge you to try to relax and be calm while your body acclimates.

I also think it's a good idea to go back to your nutrient support regimen. That's what I always did as soon as I was free to walk around after the 6 hour waiting period. Start with low doses and work up to your standard dosing within a week or so.

Let us know how you are progressing.

I certainly hope you start feeling better so you can enjoy the peace of a calm heart.

Be well,
Jackie

I agree with Jackie. Obviously most people don't feel that bad post-Ablation. We would have heard about it on this site.
Maybe its a combination of post-Ablation recovery complicated by Multaq Allergy.

Jackie: At the end of his 1st paragraph JohnM does state that he previously had issues with Multaq.

Also John, you were one with a low HR, even while AFIB right? You are not used to the higher HR's. I would try taking something for HR control, and see if that helps. The closer you can get to your normal HR, the better you will feel. Bystolic has been used successfully post-Ablation for HR control by others on this site.



Edited 1 time(s). Last edit at 10/16/2015 01:08PM by The Anti-Fib.

I spoke with John yesterday, and it sounds very much to me like primarily a Mutlaq reaction. I have heard of three such cases before with similar side effects especially the severe and sudden fatigue and lack of appetite, but John was going to his cardio too yesterday for some follow up tests. Barring anything truly unusual, this will all resolve in due time in any event. He has been off Multag 6 or 7 days now and while it has much shorter side effects after stopping than does its parent drug it is derived from .. Amioderone ... it still can have lingering side effects for several weeks or more after stopping in some folks.

Most people do not have pronounced side effects to Multaq, though a smaller percentage clearly do and some are severe, especially with liver issues at times.

Dr Natale uses it for some patients, especially those with the more work needed, as did John M, as its good at helping to keep the heart quiet for the three months blanking period with the inflammation heal and the vast majority do well or have just minor side effects that are reasonably manageable. JohnM is clearly an exception there as his side effect were much more on the order of a real reaction or allergic reaction to the drug. If that was the main cause of his issues which it appears to have been.

Shannon



Edited 1 time(s). Last edit at 10/17/2015 12:34PM by Shannon.

John,

After my ablation with Dr. Natale, for a few weeks I felt like I had been run over by a truck. His very capable nurse practitioner, Kay Zedlitz, seemed familiar with it all and helped me through rough days with advice and Motrin. Potassium and Lasix helped too. An extensive ablation knocks out the atrial pacing cells awhile but that gets better over time.

I was on Multaq before and after the ablation but that drug bothered me less than other rhythm drugs. I never regained my preablation ability to run as much, but at my age I don't need to run so much anyway. My heart rate never returned to my preablation 40s and now bottoms out in the 60s. That is great because the bradycardia zapped my energy and I am glad to have it gone. Also no more Afib and I no longer live in fear of it.

Best wishes, John, for continued improvement.

Betty

bstevens Wrote:
-------------------------------------------------------
> John,
>
> After my ablation with Dr. Natale, for a few weeks
> I felt like I had been run over by a truck. His
> very capable nurse practitioner, Kay Zedlitz,
> seemed familiar with it all and helped me through
> rough days with advice and Motrin. Potassium and
> Lasix helped too. An extensive ablation knocks
> out the atrial pacing cells awhile but that gets
> better over time.
>
> I was on Multaq before and after the ablation but
> that drug bothered me less than other rhythm
> drugs. I never regained my preablation ability to
> run as much, but at my age I don't need to run so
> much anyway. My heart rate never returned to my
> preablation 40s and now bottoms out in the 60s.
> That is great because the bradycardia zapped my
> energy and I am glad to have it gone. Also no more
> Afib and I no longer live in fear of it.
>
> Best wishes, John, for continued improvement.
>
> Betty


Betty: How long ago was your Ablation?

My ablation was over two years ago.

Who was the other individual who posted on here after his Natale ablation that experienced some severe issues. I would like to go back and review his posts.

Hi Lynn that was RonM,

And he had a mild to moderate phrenic nerve stunning which can happen rather rarely in cases like his, but is one of the complications that are listed in the possible side effects .But especially with the tools and method of Dr Natale's ablations it is quite rare for this to occur, and a fair percentage of it happening is down to the wide variability in each patients anatomy. And where there is some phrenic nerve stunning its almost invariable temporary and typically gradually resolves until is back to normal usually from 4 to 6 months give or take 2 months with a gradually improving recovery.

Again these are rather rare, and I think you will find RonMs latest posts most positive and he is enjoying full NSR and off all AAR drugs and I believe he is off OAC drug too now.

JohnM's case was not from an unusual complication, he extended issues solely arose from a NP who said the wrong thing to sent John off to only the care of his local cardio and GP instead of recruiting his local docs to work closely with Natale and his staff to follow and insure JohnM had the fastest and best protocols to follow from the beginning of his symptoms'

JohnM is also now back under Dr Natales care once this communication mix up was cleared up and looks to be on his way to a pretty rapid resolution. I spoke with him tonight after his visit wit hDr Natale which he found very reassuring and he said he has been feeling increasingly better since the colchicine was added last Friday and Dr. N is sure he will recover without incident going forward and just once him after the first week on colchicine to cut the dose in half and continue it for one month to insure knocking the inflammation fully out of the park by then.

Every once in a blue moon there will be a ball dropped by a staff member, or some mis-communciation along the way, but what is remarkable in our over 12 years of actively following an increasing number of patients who have gone to Dr Natale, is the sheer consistency of very good outcomes time and again with him and his various staffs. You can do you own search on the forum and will see all the real time reports as each ablation and recovery happens, so we tend to see and hear about nearly every single hiccup that happens ... and yet the huge majority of patients that have come through here that have been treated by Dr Natale even many months and many years later continue to rank that as one of the best overall decision they have ever made.

This is invasive cardiac surgery for sure, so its not always going to be an easy walk in the park getting from AFIB to lasting durable NSR, ...and yet its simply amazing to me, and many others here who have been through the whole gamut, what real experts like Natale and a good number of other such very experienced ablationist can now achieve for us all, and yet have such comparatively minor and transient issues over all for the most part.

Its all documented here too over the years. That is what makes us so confident in our on-going recommendations.

Shannon