Second Successful Ablation - if I only knew then what I know now

Where to start, just like so many of the stories I’ve read of fellow afibbers, I had no prior health problems or conditions. Barely ever got or get sick, hardly even a cold. I ate healthily, had pushed my self to wake-up at 5:40 at least 2X a week for a cross-fit workout. However, one Friday afternoon I was working, getting ready to go to my daughter’s parent-teacher conference and then out of no where, it just started, my heart beating, fast, squeezing, pressure, tightness, unlike anything I’d experienced before. I drank some water, that didn’t help, I laid-down for a few minutes, that didn’t seem to help, I took some deep breaths, thinking let me just get my head together and that didn’t help. So I went to my husband and said I think I should go to the hospital because something just isn’t right and I was 50 at the time. At the emergency room after they admitted me, the chief resident said, don’t worry, its just an electrical thing we’ll get you all fixed. After fluids and diltiazem drip, I self converted. I actually felt pretty good but because they didn’t identify any underlying conditions they wanted to keep me in the hospital overnight and run all the routine tests etc. The next day a cardiologist came in and other than saying they believed it was afib really didn’t offer up much information or comfort, just advised me to follow-up with a cardiologist and prescribed Metroprolol, which made me feel very depressed and uncomfortable. The panic began to set while I was in the hospital undergoing all the testing- why was this happening, how could this be happening to me with no prior health issues or family history, that I had two young daughters and was this going to take me away from them and why now when my life was in such a good place after working so hard for so long and overcoming so much. That was February and after seeing a top cardiologist, in Washington DC where I live, who told me that I wasn’t going to die, that it would probably happen again, and that we were just going to have to wait and see how it played out, I didn’t have another episode for 8 months and had pretty much gone back to my old life. Then again out of the blue, despite feeling happy and excited for thanksgiving weekend standing in my kitchen as family arrived, there is was, a hick-up/burp of sorts just above my sternum and then my heart started flip-flopping and racing, again…..

Over the next two and a half years, my episodes continued, out of the blue, with the time between episodes decreasing until in the end they were occurring every 10 days - two weeks, lasting around 6-8 hrs. I developed pain just below my sternum at the top of my stomach that often times became more uncomfortable prior an episode, almost like a warning. When the time between episodes was still often 4, 3 or 2 months apart, I began to think that maybe a digestive issue was the root of the problem. I had an endoscopy but they found nothing concerning, a small hiatal hernia which the doctor didn’t think was the source of my afib episodes. My episodes almost always came later in the day and or evening, and I was very symptomatic. I felt very incapacitated, light headed, pressure in my chest, heart flipping around, a squeezing sensation. I wasn’t able to eat and often just felt the need to lie down - just completely out of sorts. Luckily, I always self converted after about 6-8 hours. I tried the typical course of medications but they make me feel like either zombie or that I was going to jump out of my skin. I began a regular practice of acupuncture, yoga, changed my diet but unlike every other challenge that I had overcame in my life, nothing seemed to make the episodes go away or slow the progression. I was devastated and I felt like no one was helping me. The few that I divulged what was happening would always respond, is it stress?, you are young, healthy making me feel that somehow this was all in my head. I went to a top cardiologist in Washington DC and while the initial visit was reassuring, in a second visit when he bought of the option of an ablation he didn’t take the time to explain how effective it could be and that really, considering my overall health, not much risk involved. Instead it was a casual suggestion which he did not help me fully consider, nor did he take the time to fill in the gaps of my understanding to help me understand that an ablation could restore my life which felt like it was slowly slipping away. I had been active, enjoyed cooking, entertaining and traveling and now because of the unpredictability and increasing frequency of my episodes, I didn’t feel confident in undertaking.

As I reached for answers and support I discovered “Living with Afib”, “Afibbers.org” on-line forums that became my life line as I tried to digest what was happening to me. As I read through post after post, seeking support and hope with the increased frequency of my episodes, I finally came to the realization that I should give an ablation a try as I was becoming increasing worried my afib was going to take away my ability to work and take care of my kids considering how it was progressing and how very symptomaticI I was. I reached out to a friend for an other EP recommendation as I struggled to think that there wasn’t good enough EP in the Washington DC area despite Shannon and Travis’s advice to travel if necessary to a top EP. A month later I met with an empathetic sought after top EP in Washington DC who spent more time with me in my initial appoint than any other doctor I’d ever met with, educating me about afib that left me feeling hopeful. Despite Shannon and Travis’s posts, urging afibbers to ask the EP one might be considering to perform an ablation, how many and types of ablations the EP had performed and if only a PVI, to seek out another EP, my judgment was overshadowed by my increasing fear and desperation and and moved forward. After the ablation he assured me that he had essentially ablated all the live areas and everything went well. Afterwards my body did seem stronger, a tiny piece of that nagging anxiety seemed to have disappeared. Unfortunately just a day later an episode came on in the middle of the night and lasted twelve hours, longer than any other episode I’d had before. I continued to have episodes about every 10 days about the same as before the ablation and the EP and NP continued to assured me that this was classic blanking period activity. I went on Multaq but in addition to the afib episodes I began to experience a lot of PACs and PVCs so I stopped the Multaq. When I ask ed the local EP what he would do differently if I continued to have episodes and needed a second ablation and he point blank said he would perform the same PVI which the data supported. Right then and there I knew I had been duped. So I reached out to Travis at “Living with Afib” and Shannon here at Afibber. Org for advice. Travis quickly respond and said, I don’t have time to fully address your email but “DO NOT GO BACK TO THAT EP!” That gave me the push I needed and I called Dr. Natale’s office right then and started the intake process.

Shortly thereafter Shannon Dickson from afibbers.org reached out and and coached me through the whole process, educating me about the skills that distinguish an expert EP and other EPs and cardiologist, and so much invaluable information and confidence in Dr. Natale that gave me really hope that an ablation involving more than just the standard PVI could help as I awaited my scheduled ablation in 2 1/2 months time.

Then the Covid-19 pandemic hit……. We were scheduled to fly to Austin in the middle of April 2020 but I elected to push it back a month because I didn’t feel comfortable leaving my kids and asking friends to take them in with so many unknowns looming…..Finally in the middle of May 2020 as the country was starting to open up, I thought it might be the best time to take the risk. Instead of flying we decided to drive which took 2 days. I was worried it would feel reckless but thankfully it didn’t with most areas still shut down.

We met with Dr. Natale the day before the scheduled ablation. As everyone says, he’s more on the quite side but he gives off a sense of intelligence and assuredness that made me fell I was in good hands. During the course of our conversation around triggers etc, I told him I had given up coffee and alcohol almost of year ago in an effort to support my body and since occasionally episodes seemed to come on after I drink one of the two although I only ever really had one cup of coffee in the morning and only drank wine on the weekends and never too much as I have teenage daughters who I often had to pick up late in the evenings. As we chatted back and forth he told me to enjoy some coffee that afternoon and wine if I wished, that he wanted to see some activity the next morning. I figured what the hell, at least if I did go into afib he would have a better shot at finding all the areas that need ablating. So I happily indulged in a cup of coffee that afternoon which I had missed sooo much and some wine that evening. Of course nothing happened, go figure. The next morning we arrived at 8am and after a Covid-19 test which was negative, started the pre-op. The team was warm, encouraging and gave off an air of competence - it was like I no longer had to convince anyone how I was feeling - they understood and before I knew it I was out and waking up in recovery. Shannon called shortly thereafter, before I had even seen Dr. Natale to check on me and tell me he heard everything had gone well. Unlike my prior ablation, Dr. Natale, in addition to redoing one of the pulmonary veins that didn’t take from my first ablation , ablated my posterior wall of the left atrium, the left atrial septum, floor of the left atrium, roof of left atrium, lateral wall of the left atrium, the coronary sinus and the superior vena cava, quite a bit more than the standard 4 pulmonary veins. Shannon also talked me through all the details of my ablation so I would have a clear understanding of exactly what Dr.Natale had done - just wonderful support and I’m so thankful.

Despite feeling a little groggy, I felt pretty good after the ablation. The care the next 24 hours was absolutely amazing and very comforting. The floor nurses were incredibly attentive and the Nurse Educators went over several times, what my procedure entailed, what to expect in the future and how they would monitor/work with me over the next year. As many mention, the food at St. Davids is pretty amazing for a hospital, just as a side note, lol. Its been just about eight months since my ablation and I’ve not had one afib episode. Almost immediately after my ablation, the anxiety that had plagued me as my afib progressed disappeared as did the physical vulnerability I felt. I occasionally have bouts of PACs or PVCs which have been slightly uncomfortable but mostly annoying , and have subsided. I still feel discomfort in my chest, and upper stomach. With time, regular exercise, and good sleep, I feel my body is healing from the effects of afib. After 5 months I was able to stop the Eliquis and I am currently not on any medications other than a small dose of Zoloft that I began to take as my desperation took hold and vulnerability set in. Further, now that the afib is in remission it has now become clear too that in fact the small hiatal hernia that supposedly shouldn’t have caused any discomfort is in fact contributing to discomfort around my sternum that I have complained about all along but was difficult to discern from the fib as it progressed. Initially after the ablation I still felt scared about what the future would hold but mostly now I feel confident that with continued medical advances and the discovery and understanding of the skill that an “expert EP” has to offer, I can have a healthy, happy and full life, even if I need ablations in the future. For any of those scouring the websites trying to figure out next steps, I can’t stress enough the wise words of Travis and Shannon in selecting an expert EP. Other health concerns aside, I wouldn’t hesitate to have an ablation, preferably by Dr. Natale and his team. Its so encouraging to know there are such talented and good people out there working hard to discover the best ways to treat afib, considering also that many local top cardiologists here in Washington DC either aren’t aware or do not want to admit that there treatment options available beyond their abilities which was disheartening to learn. I will also say that the weekly follow-up from Dr. Natale’s office has been invaluable. Being able to talk to my assigned nurse, Trent Crum, weekly, and as needed, has also provided the support in putting the devastation and fear behind me including learning how to better evaluate my heart rate and understand my Kardio EKGs as well as discerning what I’m feeling in my body so that I can respond accordingly. Thank you to all the afibbers who have come before me, created these support networks and who have shared their experiences which created a path for me to follow, I’m so happy to have my life back, I really thought my future was slipping away from me but now I know better.



Edited 1 time(s). Last edit at 01/03/2021 06:22PM by MMiller.

Great post!

Thanks for sharing your experience and reinforcing the message to go to a very top EP. One of my best friends lives in Houston. I learned he had afib in 2014. In maybe 2015, he was long standing persistent and I insisted he go to Austin to Natale. He didn't understand. His local cardio didn't understand and said, "I'm sending you to the best guy in Houston." My friend called the Houston office and asked how many procedures he'd done - a lot they said, 800. He called Natale's office and it was something north of 11,000 at the time. He went to Austin and did require two procedures as they had to work on his LAA. 18 months ago, I was in Houston and my friend, his wife and I chatted over dinner. My friend was doing well, and off all meds. They both profusely thanked me for insisting he go to Natale. I credited them for actually listening to me, as most that I know locally don't understand the need to leave town.

Nice write up and congrats on the outcome.

Great post. So glad you found resolution.

Interesting story, thanks for sharing!

You're lucky that you got a doctor that wanted to do something. The VA is big Pharma's dream. All they ever do is prescribe drugs. That's L.A. and maybe all of SoCal. I don't know. I met a doctor who had his internship with the L.A. VA and he said that they are at least 30 years behind times. I'm so sick of blood thinners. I told the nurse "I want off of blood thinners." All she does is look at me. There's other methods to take care of this problem but seems they have no idea what they are.

Congrats to you...now it's time to enjoy life!

Congratulations!!!!!

Thank you for sharing your post @MMiller. Remarkable the number of similarities in our experiences. I did want to ask about your hiatal hernia though. I'm 11 days out from finishing my blanking period and had no issues throughout although Propafenone messed with my crossfit workouts and wish I'd had some insight from the EP.
About ten days ago I started having discomfort in my sternum area when swallowing food and liquids. My GP prescibed Pantoprazale and give two weeks to see if it resolves. If it doesn't then see a Gastro as it could be hiatal hernia.
During this past week the chest discomfort has remained and average resting HR has increased from 62 to 80, regular palpitations, HR spikes to 100 and a 2-3 hr AF episode. This has led to very little sleep which is killing my HRV and daily recovery (I monitor with WHOOP). And I'm hesitant to get back to normal exercise.
What ultimately did you learn regarding the impact, if any, that the hiatal hernia may have had on your AF?
Congratulations on your recovery and new outlook on a healthy and active life!



Edited 1 time(s). Last edit at 02/20/2021 02:31PM by deanpaul.