Ectopic beats

It's been a while since I've posted and would like to give an update as well as ask a question. First, as most of you know, I've had some right phrenic nerve stunning after my 6/15 ablation. Recently, I believe that either it is resolving as expected or I've compensated and I'm now feeling pretty good. I would consider myself back to 100% excercise tolerance as preablation. Since my ablation, my rhythm has been pretty rock solid and I am completely off of anticoagulants and antirhythmics. But lately it seems I'm having more ectopic runs of pacs. Hence, the question is what is your experience with increased pvs/pacs this far out from ablation? Is this the beginning of an inevitable touch up?

Regards,

RonM



Edited 1 time(s). Last edit at 04/03/2016 05:39PM by RonM.

Hello Ron, glad you are generally doing well.

" But lately it seems I'm having more ectopic runs of pacs. Hence, the question is what is your experience with increased pvs/pacs this far out from ablation? Is this the beginning of an inevitable touch up?"

Ron, more likely it is the beginning of your older body telling you in the only way it can that it needs better fuel to continue running smoothly. Cars also sputter for a while when the fuel tank is nearly empty or the fuel has water in it.. Do you still have some Dr.s Best brand magnesium glycinate from iHerb? How about some NOW brand potassium gluconate powder? Since things may have changed some from before your ablation, do a week or two's food diary with fitday or some other nutrient calculator to see how much magnesium and potassium are being provided by the foods you are presently eating, Then add a small dose- one or two tablets at bedtime -of magnesium glycinate. If it does not cause troublesome diarrhea, add two more tablets with breakfast the next day, then two more with lunch and two more with supper, for a combined dose of two tablets with each meal and another same size dose at bedtime. Continue this a few weeks and keep track of your ectopics on paper so you can tell what is going on with them. If they go away, be grateful and keep supplementing at that level. If not, keep increasing the Mg dose slowly until you find out what is the maximum amount you can take four times a day without provoking diarrhea. This dose is called the bowel tolerance dose and it is highly individual. Bowel tolerance is different for each individual, like fingerprints are. Also your bowel tolerance dose may vary with time or in concert with influences that deplete magnesium.

Once you are established on a bowel tolerance dose of magnesium glycinate, figure out how much potassium your usual foodstuffs provide you every day, then either increase potassium containing foods or supplement with potassium gluconate powder in lots of water to get to around 4.7 grams [4700 mg] of potassium intake every day. Keep track of potassium intake, Mg intake, and ectopics on paper so you can see patterns if any.

If these simplistic measures banish the ectopics to flap their leathery wings in somebody else's life, well and good. If they do not, there is another non prescription substance to try. It works real well for those it helps at all, called taurine, a readily available amino acid. The older we get, the less well our bodies do at manufacturing our own taurine.Look up some of Jackie's voluminous old posts on taurine giving dosages among other details. I have taken 2 grams twice a day with good results. The main side effect has been a notable lack of both ectopics and of afib episodes, and i think i can live with that. Taurine only works as an adjunct to electrolyte therapy, no use taking it without them.

Ron, these simple measures do not work for everybody, but they don't cost much when compared with doctor's fees and prescription prices, and are harmless as far as we have experience, also in contrast to prescription meds. They also do not work like magic or immediately. Give them a couple of months before giving up on them. It took all your life to get to your present state of nutrition, and it may not be corrected quickly.

Best of luck to you and please let us know how you do with it.

PeggyM

Hi Ron – Glad you are doing well. It takes time, but most often the phrenic nerve damage does resolve with time. The other important reminder is to be aware of your intracellular stores of the critical electrolytes....and as Peggy reminds, also taurine intake.

Refer to my responses in this post… it applies to you.
[www.afibbers.org]

Give it some time.

Jackie

I wouldn't say that my current supplementation is fully optimized as it should be but I have learned quite a bit from the wonderful individuals here on this forum. I do take 720mg of Magnesium Glycinate, 2,000mg Taurine, 1,000mg d-ribose, 250mg l-carnitine, 50mg coenzyme q10, 60mg ascorbyl palmitate, 140mg potassium citrate w/ 70mg magnesium citrate daily. Please, feel free to evaluate and recommend changes.

RonM



Edited 1 time(s). Last edit at 04/04/2016 10:46AM by RonM.

Ron - Good you are adding these. I'd look very closely at your potassium-to-sodium ratio in your food intake. Unless your food source of potassium is unusually high, my guess would be you are rather low and that could account for the ectopy.

The good news is that your magnesium dose isn't skimpy... but there again, you might try bumping it up a bit more... just to under the soft stool stage ...consistently. It can take several months or longer to stabilize magnesium repletion and because of the easy depletion of magnesium... ie, stress, exercise, and other drugs/chemicals and alcohol, it can be difficult to maintain the levels consistently.

On the potassium... as stated in the other thread/post... if you are too low, that easily allows for the shortening of the refractory period or the time between beats... which you physically sense as ectopy. Your 140 mg of potassium is virtually negligible, so calculate what you get from food... and if you aren't up to at least 4,000 mg, then you'll have to either eat a lot more of those foods or supplement or find a combination of the two that works. Don't forget to calculate your sodium intake as well since that cancels out the potassium.

You could also try at least doubling the CoQ10... many people need 4 - 5 times that amount for the ATP energy production.

The daily dietary log takes time but well worth the effort because most people don't realize how much food it takes to capture the essential nutrients in the amounts required ....or how much competing minerals add to the interference. In the long run, if you can stabilize with that approach, it certainly beats another ablation...which again, doesn't correct the nutritional shortfall.

Let us know how you do with your calculations.

Jackie

Hi Ron,

Great to hear your symptoms (whatever the actual source of them was) are now subsiding significantly and you can more fully appreciate your NSR all the way.

Both Peggy and Jackie have given some good tips and suggestions above regarding the runs of ectopy which is not uncommon, especially in the first year or so after an index ablation.

Just fir education sake for some of our readers it's good to point out that we don't know for sure if a phrenic nerve stunning was involved in your symptoms including the elevated diaphragm on XRay which by itself md even with the symptoms experienced are not fully diagnostic as a true temporary phrenic nerve stunning or palsy. Your symptoms plus the XRay indicating and elevated diaphragm could have been from such typically temporary phrenic nerve injury to be sure, but just so folks know, you must have a positive diagnosis via the 'sniff test' which us the gold standard for definitive diagnosing of phrenic nerve involvement.

It's rather acedemic for you at this point, thankfully, as it appears the symptoms are well on their way into your rear view mirror as it is which is what one would have expected too even if it caused by an RF ablation and which I felt sure you would enjoy before too long as the issue resolved, whatever the original etiology.

The main message here that I wanted to convey to our readers is that while phrenic nerve injury is not common aming patients of highly experienced EPs during RF ablation, it can and does happen on occasion even with the best operators with so many variables including anatomic variations between individuals relative to their PV/phrenic nerve proximity to one another.. plus more such considerations.

Nevertheless, while regular cardio's or clinical EPs can sometimes jump the gun in diagnosing phrenic nerve stunning post ablation, especially when they themselves aren't as familiar with doing large numbers of ablations, anyone here that is told they have a suspected phrenic nerve injury after an ablation based only on X-rays or CT scan alone should request a full 'sniff test' to make sure the diagnosis is accurate.

Perhaps you did get a sniff test after our last conversation Ron, but maybe not as things were already improving by then and you may have felt it was more or less a moot point by then?

Fortunately, the vast majority of actual RF ablation-induced phrenic nerve injuries fully resolve themselves (as Jackie noted) within 6 months to 9 months post ablation and certainly by a year if it is going to resolve fully.

Regardless if your symptoms were indeed from a phrenic nerve stunning or some other contributing factor(s) Ron, it's wonderful to hear that those symptoms are now fading from experience and you can more fully enjoy the fruits of your ablation full on!

Best wishes to you Ron.

Shannon

Jackie- I have doubled my Taurine = 4g/day
" " CoEnyzme Q10= 100mg/day
" " L-carnitine=500 mg/day
My potassium intake was very,very low= 1500mg/day average, so I increased by adding a banana & low sodium v8 ( large) daily. I estimate about 3000 mg/day. Ectopic beats are pretty much gone. Also, I notice that my blood pressure has been trending lower since increasing the Potassium. Thanks!!

Shannon- I do feel that the Sniff test is a moot point. If I ever need a touch up, I will get one at that point to evaluate my overall diaphragm function if there is no further resolution on the chest xray. Like always, Thank you, Shannon, for being You!

RonM