questions about bloodwork and blanking period

Hello all.....I am going to have an ablation with Dr. Natale end of December, since my afib has slowly been getting worse over the 4 years since my ASD, closure of the congenital hole in my septum, and I have not been able to affect the afib by anything that I do. My heart went down to a normal size after the closure and all is good with the closure except for the afib. I am appreciative of George suggesting I talk to Shannon and appreciative of Shannon being very helpful to me in understanding many things and getting the ablation set up.

My husband and I are living outside the US and will be coming to Austin for only 1 week. I am requesting some extra bloodwork, since I haven't had bloodwork in a long time and won't be back to the US again for at least 6 months.
I am going to request a vitamin D test, maybe serrum ferritin and a thyroid test. i've thought about A1C but I don't think so, I don't have blood glucose problems. I'm actually quite healthy except for the afib. I would appreciate some advice about getting magnesium and potassium tested since I've been supplementing with them, but can't get good supplements outside the US. I will be stocking up on good supplements while there also.
What tests would anyone recommend for magnesium and potassium (is there a name to ask for?) and are there any other tests that anyone would recommend I get?

Another question...
I've been reading on the list some of people's experiences with the blanking period, but I don't have a good sense of it overall. I know everybody is different. If anybody would be willing to share their experience, especially those who have had ablations from Dr Natale, I would appreciate hearing some more stories to get a feeling for what it might be like.
I do better if I am a bit prepared for things. We will be traveling to Mexico 4 days after the ablation but then staying put in one place. We also have our daughter visiting from Europe shortly after arriving in Mexico.
We haven't seen her in a year and a half as she is living in Europe...so it's a big deal!....and I'm wondering if I will likely be in at least fair shape to be able to visit and maybe function in the house.
I don't expect to go out a lot and that's fine and she and my husband can help out in the house, too. I just hope I can cook a bit for her, my girl, who we hardly ever see. Anyway....thanks for any input ! I am grateful for this list and for you all, helpful and kind people

Others will jump in to answer some of your questions too. Bottom line is that there is a lot of variation between many of us that have had ablations.

Ablations for me were a piece of cake - but not by Natale. First one 13 years ago was easy. One night in the hospital and at a normal life the day after. I was told to lay off exercise for one month. There were three insertion points and a lot of bruising.

My last ablation in January - day surgery, in at 6 am and out by 5 pm. One insertion point and almost no bruising. All things normal the next day and walking a couple of miles. Told to lay off exercise for one week. I made sure that I was in excellent physical condition before the surgeries.

Blanking for the first ablation didn't exist. Zero afib after the ablation, but the heart does take time to heal. It took about a year for my resting heart rate to get back to normal, The second ablation - no afib for a month while on meds, but then I had 5 episodes over the next couple of months after stopping the meds. All stopped quickly with Flecainide, "pill in a pocket". My episodes were technically after the "blanking period", but I have had no afib since last May and I am not on any meds. I am 75 years old and doing an hour weight workout twice a week and swimming one mile, twice a week, plus playing golf twice a week, weather permitting.

There isn't much in the way of blood work you need to do. An electrolyte panel will tell you where you stand with serum levels of potassium, calcium, sodium and magnesium, and Natale will almost certainly have one done before your procedure. You don't need to ask for more tests and doing things like an Exe test is an interesting experiment but not relevant to dealing with your afib once you go down the ablation road.

So you're kind of thinking about this thing all wrong. Once you've had a successful ablation, all those things you've been supplementing with become almost irrelevant as far as afib goes. What an ablation does is make it impossible for your heart to sustain afib regardless of how out of whack your electrolytes might be, how much you've had to drink, how dehydrated you are, what sort of vagal things are going on, and so forth. Whatever triggers you've been controlling for years will become irrelevant because the afib pathways are blocked and afib signals get stopped cold in their tracks. So once you've had a successful ablation, this alternate life you've been living of trying to control the afib becomes a thing of the past. You no longer need to worry about the things that triggered your afib in the past.

I know this is a hard concept for people to wrap their head around, especially if they've been battling the beast for years. It took me well over six months to quit obsessing about every little hiccup I felt, and a full year before I finally took the batteries out of my Kardia and tossed it in a desk drawer. But that's what an ablation does. You might still experience some ectopics afterwards, but those ectopics cannot turn into sustained afib.

2 days after Natale ablation (traveled 2200 miles) ready to start normal life again, wife made me follow docs orders and wait 7 days. I experience ectopics which are annoying but don't hinder my life physically. Im 40 yr old active male in decent shape 6'4 205lbs.

Carey is right, tough to wrap this afibb thing up and quit worrying over triggers, causes etc. 10+yrs of dealing

Good luck!

About blanking - once in NSR - how long before flecainide dose can be tapered and then ceased?

Still in NSR last 2 weeks + but looking forward to the day when I can get off flec.

No longer taking diltiazem with Dr N's approval.

There's no hard and fast rule on that. If you ask, Natale might have a specific time period in mind or he may just say go ahead and quit and see what happens. That's the only way to know for sure that you don't need it anymore.

Quote
Barbcat
My husband and I are living outside the US and will be coming to Austin for only 1 week. I am requesting some extra bloodwork, since I haven't had bloodwork in a long time and won't be back to the US again for at least 6 months.
I am going to request a vitamin D test, maybe serrum ferritin and a thyroid test. i've thought about A1C but I don't think so, I don't have blood glucose problems. I'm actually quite healthy except for the afib. I would appreciate some advice about getting magnesium and potassium tested since I've been supplementing with them, but can't get good supplements outside the US. I will be stocking up on good supplements while there also.

What tests would anyone recommend for magnesium and potassium (is there a name to ask for?) and are there any other tests that anyone would recommend I get?

I assume you are asking about blood tests, not with regards to afib, but just for general health?

No time for the EXA test. They quarantine the tissue package for 14 days before testing it. Plus they don’t test outside the USA due to slow shipping and delays. Great test.

Thanks for all the replies.....I appreciate them all.
George, I am asking for general health, but also for my heart. Since they offered to let me get some extra tests and I am rarely in the US where I can more easily get bloodwork,
I want to take advantage of the offer.
The magnesium, potassium and vit D tests, especially, have to do with afib, but also general health. It's good to know they routinely do an electrolyte panel. I haven't been able to monitor anything, so I'd like to know where I stand.
I mostly understand your point, Carey. It's an interesting one and important. But I'm trying to understand several things I have heard a lot on this list and actually from one of Dr. Natale's nurses, also.....that an ablation is not a cure, only hopefully will give some remission. Afib certainly does seem to come back at some point, usually, from what i read here. It seems that people who have gotten ablations, still feel that all those measures, such as supplements and hydration, keep our hearts healthier, and are important to continue.

Thinking about it, in terms of what you said, Carey,....it seems to me that there is a difference between trying to control our afib and figure out triggers.....and trying to keep our hearts healthy, even after an ablation. I, also, did everything I could think of that was available to me, and was not medication, to try to control my afib. I also spent 4 years trying to figure out triggers, and never found anything definitive. Most of the things that are considered common triggers....I don't do anyway, long before I had afib...caffeine, alcohol, etc. The absolutely only thing that seems to be a pretty consistent pattern is how often the episodes come (about every 10 days). So, for about a year now, I have given up on trying to control it. I don't think it's possible. And that's what led me to deciding to try ablation, since my afib is slowly getting worse.
So, a few remaining questions....
1. If ablation makes it impossible for the heart to sustain afib, why does it come back at times?
2. I am now noticing on this list....something I wasn't aware of before......A lot of people talk about being put on anti-arrhythmic meds after an ablation. That concerns me for several reasons. Is that Dr. Natale's usual practice....or is it only occasional with certain people? I am not talking about eliquis....I understand the need to that for at least 3 months, but I haven't been told and didn't realize that i may be told to take anti-arrhythmic meds also.

Thanks so much, everyone, for your help and input.

Quote
Barbcat
But I'm trying to understand several things I have heard a lot on this list and actually from one of Dr. Natale's nurses, also.....that an ablation is not a cure, only hopefully will give some remission. .

That’s how I think of it...a hopefully long remission. I was told one’s AF could be the result of your genetic disposition. That said, I am dosing magnesium and staying hydrated to hopefully remain in nsr until a successful vaccine.

Barbcat,

I agree with Carey and the others here. Once you get under Natale’s care, it’s time to relax and let him do his job. You don’t need to steer the ship. He will do all needed labs which include more than what is done by the average EP. He has a variety of pre op and post op nurse practitioners who are well informed and prepared to spend all the time you need answering remaining questions. His staff is excellent and well prepared.

He did my initial ablation 7-8 yrs ago; a touch-up ablation and Watchman last week and I couldn’t have asked for better care. I wish I had taken my own advice.

Best wishes for your journey.

Betty

barbcat said: "2. I am now noticing on this list....something I wasn't aware of before......A lot of people talk about being put on anti-arrhythmic meds after an ablation. That concerns me for several reasons. Is that Dr. Natale's usual practice....or is it only occasional with certain people? I am not talking about eliquis....I understand the need to that for at least 3 months, but I haven't been told and didn't realize that i may be told to take anti-arrhythmic meds also."

During the blanking period when the burns in the atrium are healing and turning into scar tissue, afib normally reoccurs on occasion. Taking an anti-arrhythmic helps keep the afib at bay until the scar tissue "dams" are in place.

Hey Nlama,

Great to hear your latest ECV (Electro-cardioversion) is holding you in steady NSR after two plus weeks! Confirm my following suggestion with Dr Natale's Shannon (Nlamas assigned NP at St. Davids Med Center is named Shannon too), in light of your prior persistent AFIB and your relatively short term NSR success with your previous ECVs before this latest one.

I suggest you not be in a big hurry to stop the FLEC that at least appears to be helping sustain your NSR. Why not give it a full three months or even a bit longer to let your heart enjoy the groove of NSR for a longer period of time ... perhaps leading to even an indefinite long term NSR?

That would be my best option, but as always with such suggestions from our forum, confirm doing so with, in your case, the Boss back in Texas.

Cheers!
Shannon

Thanks Shan,

Definitely, I will be letting Dr N and Shannon (female NP) dictate this schedule - maybe go down to half tabs BID then ween off---- what ever they say. It doesn't bother me to be on flec but curious on what to expect. Definitely staying on it and avoid triggers. Let the heart remodel in NSR.

Good to see you back in the forum. I'll take it as a sign both hands are working (typing) well.