3 month Natale post ablation update

I saw Dr Natale yesterday for my 3 month follow up for my AF ablation. From November 27th to December 11th prior I wore a 14 day Zio patch so the results would be available to Natale before yesterday’s appointment.

While I am still on Multaq (my choice for another month-they usually keep a patient on for only 2 months), I have not had an AF since the ablation. Natale said It looks good. I asked Dr Natale if he thought the reason was because I was protected by Multaq? I previously was on Flecainide from 2004-2019 and in the end I was getting AF even while being medicated. He said Multaq is a weaker drug and if I was getting AF while on Flecainide, multaq wouldn’t probably help me now since my inflammation has healed...but he is such a nice person and is allowing me to continue the Multaq because my local EP remarked his patents stay a bit longer but my local EP stepped back and said he obviously is leaving the decision to Natale, who he recommended to do the procedure over himself. My local EP patients - 6 months on multaq, Natale -2 months... so I’m splitting it to 4 months as an emotional safety net to be more comfortable for stray firing pathways so soon after the ablation. I had a series of Berkeley Heart lab inflammation tests done and my cardiac inflammation levels are better now than pre ablation.

A short bit of history: After my mom died in March, I started getting AF very frequently. I asked my local EP if I could increase Flecainide from two 100mg doses a day to 3. He said no because I don’t weigh that much. So I regret this with all my heart (pun) by not listening to him. My local small vessel disease specialist @ Cedars asked me to be seen by yet another EP (second) so I would have a complete umbrella care @ Cedars. That EP told me to increase to 3/day and after 5 days come in for treadmill to see if I could handle it. I was foolish to listen to him and I ended up with a flecainide overdose and spent 3 days in ICU. I never had PVCs beforehand according to 2/19 zio and twice a year zio patches going back years. After my overdose I experienced (recorded on the Zio) my first lone pvc for 22 seconds in August a week after my ICU stay for flecainide overdose.

Does pvc begets pvc? I know AF begets AF.

Natale just told me during the ablation he noticed some PVCs. I always thought I never had any PVCs because 2/19 and prior years Zio never recorded them, ERs never recorded them and yesterday I looked again at my 8/19 zio and saw “Ventricular Ectopy (VE/PVCs were not “zero” but <1%.

Now I have them very frequently. My Zio patch shows a 17.2% average of my total heartbeats:-(. The 1st week wearing the monitor my PVCs per day average was 10.4%, 9.5%, 14.1%, 18.1%, 16.6%, 20.1%, 15.8%, 8.9%. The second week was more frequently at 10.7%, 20.6%, 17.2%, 22.8%, 21.9%, 26.9%!!, 27.8%!!

There now is a discussion of a possible pvc ablation option if my heart doesn’t calm down and if I am still symptomatic. Natale told me to take coq10, magnesium, drink before exercise, stay hydrated even knowing my PVCs flair up the worst during and after drinking, exercise more at a regular cardiac training program starting @10 minutes 3/day... even if I am symptomatic because it may help my PVCs and try to control stress (yeah right-I feel I have a caged animal in my chest that is my constant uninvited companion). The zio patch high HR was 164, low 52, average 70, and as I have previously vented and posted, I am very symptomatic. It’s interesting I posted a long post on the 10th how horrible I felt when the Zio recorded my highest 27.8% that same day.

The plan is to discontinue multaq in a month, see his NP in a month to get a new Zio patch and to see Natale in 3 months.

That's a lot of PVC burden. Sucks. But during that time it never led to afib? (I'm assuming a PVC could start an afib attack) So there is some good news. The ablation seems to be doing its job. Hopefully Natale can get the PVCs straightened out and that'll help get things back in line. You're in a viscous cycle of having PVCs, not being able to sleep, and getting more PVCs as a result. But do PVCs actually lead to more PVCs via a mapping mechanism? That would be interesting to learn more about.



Edited 1 time(s). Last edit at 12/19/2019 03:22PM by keeferbdeefer.

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keeferbdeefer
That's a lot of PVC burden. Sucks. But during that time it never led to afib? (I'm assuming a PVC could start an afib attack) So there is some good news. You're in a viscous cycle of having PVCs, not being able to sleep, and getting more PVCs as a result. But do PVCs actually lead to more PVCs via a mapping mechanism? That would be interesting to learn more about.

That is a question I forgot to ask him. I would like to know. No AF but also I had 73 episodes of SVT runs during the 14 day monitor. Highest was a 164 tachy. Other 72 episodes were high as well. Not pleasant. I do have a history of atrial tachy aberrant conduction that was originally diagnosed as v-tac In the ER and ICU @Cedars that Natale figures out and corrected the diagnosis during the ablation to be the atrial tachy when he saw it on the screen and both he and his PA were remarking when it was happening to not be v-tac. They remembered that. I would like to know if the ablation of my sternum corrected it or if I have SVT or if SVT is related to v-tac (which is now determined I never had).

SVT means Supra-ventricular tachycardia. In other words, above the ventricles. So, no, SVT and v-tach aren’t related unless there’s an accessory pathway around the AV node, which connects the atria to the ventricles electrically. The AV node is more refractory (lazy) than the atria so the pulses don’t all make it through. Thus the flutter rates of 150-ish while the atria are humming at 300. Or the chaos we all know as AF. Those accessory pathway conditions, such as Wolf Parkinson White syndrome, are congenital. You’re born with them. You can’t “get” them over time. So your SVT won’t turn into v-tach and kill you.

Quote
keeferbdeefer
That's a lot of PVC burden. Sucks. But during that time it never led to afib? (I'm assuming a PVC could start an afib attack) So there is some good news. The ablation seems to be doing its job. Hopefully Natale can get the PVCs straightened out and that'll help get things back in line. You're in a viscous cycle of having PVCs, not being able to sleep, and getting more PVCs as a result. But do PVCs actually lead to more PVCs via a mapping mechanism? That would be interesting to learn more about.

From my own experience, which is worth its own, PVCs don't lead to afib. But they may induce PACs, and PACs trigger afib.
For me, PVCs were frequent during the weeks following ablation. They then became less present. They're likely a sign that my heart needs time to heal, even if the burns were made in the atria, not the ventricles.
One year since my last touch-up ablation, PVCs are now rare. They've stopped coming in awful bi and tri geminal patterns.

Thank Pompon,

Today and yesterday was “calm”- meaning I had PVCs in high volume but they were not symptomatic enough to be couch bound. (From being too dizzy) If you see the below report, the second week was worst than the first with 27.8% being a real high pvc burden!

Dr natale has me increase my magnesium from 200-400mg a day. It makes a difference in improving my symptoms.

I asked him if the PVCs are from my inflammation and he nodded no. I had lab done (Berkeley heart-negative for inflammation) and he thinks it’s not from the ablation. I never had a pvc until I overdosed on flecainide. I had one episode on August’s zio. 2-19 and prior to 2014 never showed a pvc, just a few PACs. Natale saw some PVCs during the ablation and in the hospital no PVCs afterwards until a week after my ablation. He said some patients with no symptoms live with it but in my case it’s something to discuss in 3 months after my next zio patch.

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You can see how many I get with 164hr being the highest. The worst at the time was almost 1 every 3 beats, but I get them in a run.

@susan.d Have you ever tried high-dose taurine? That helps stabilize arrhythmias for many. [www.ncbi.nlm.nih.gov]

No Daisy, I read a tread on this forum in 2004 that for some readers it triggered AF...so I didn’t want to try it.

Hello Susand, I think we sat in the freezing cold office bundled in blankets at the same time on Dec. 19th. I was waiting with my son who had driven me up from Mar Vista (just south of Santa Monica.) I had my ablation on Dec. 20, and I'm now feeling like I've been hit by the proverbial Mac truck. I'd had a previous ablation, and I didn't have any recovery time at all. I think the symptom that most concerns me this time is the breathing tightness and pain. Anytime they start ablating pulmonary veins there is always a danger of stenosis. During the ablation I had received before, there was no PV isolation, so I'm left wondering without any guideposts. Of course, I'm 7 years older and I'm in my eightieth year. Thought I might as well get it done, however, before they started muttering about my age. Slogging through life with 3 blood pressure medicines under your belt is no fun.
I'm sympathetic with your PVC problem. They always seemed harder beats than those during AF. In that respect, I would take the suggestion of Magnesium and taurine, but the L-Arginine I wonder about. L-Arginine can support shingles, which I can attest to as being a misery you might well want to avoid. I had them after cataract surgery, and I had been given the vaccine prior. Stress is a killer, and AF and PVCs are just one of the many stressors we face that can bring us to the door of herpes zoster.

[www.ncbi.nlm.nih.gov]
[www.sciencedirect.com]