Contemplating 1st ablation

Hi everyone.
I've had a light case of a-fib since 2014. This September I progressed to flutter, several times a day with accompanying energy dive and shortness of breath. Lately I've also noticed minor leg and foot edema, and never had this prior so know my heart's not working as well as it used to. After a Sept. stress test (which showed no blockages) I was placed on 125 mcg Digoxin (since the Metroprolol that I'd taken PRN in the past lowered my 'normal' BP too much). The digoxin helps a little w/ the flutter, but not dramatically so. My desire is to have a Natale ablation (I live in So. California which he visits once/month). Currently I have an Advantage insurance plan (HMO) and only 3 local EPs are coverable for an ablation. They are Cedars/Sinai docs and C/S has a good reputation for cardiac care, but I know very little about these guys, altho am working on learning more. I met with the EP my cardiologist recommends. He thinks an ablation willl help me greatly. He uses a ball cryro ablation which freezes all the tissue around the pulmonary vein. When I gently mentioned Dr. Natale, he said Natale's technique doesn't involve the ball but instead --certain localized burning of the tissue of the pulmonary vein. In other words, this local EP feels the ball technique is more comprehensive- a better solution.
I asked this local EP about cardioversion and he pooh-poohed it.
I have an appt to see Natale's nurse practioner Kelley in 2+ weeks, paying out of pocket for the visit. In my mind, she can offer a 2nd opinion and whether my heart can handle the wait for Dr. Natale, as I plan to switch to a PPO Jan. 1st. I figured the visit might also position me to have Natale do a procedure in Jan or Feb, 2023.
I don't want to wait too long to help my heart so am weighing having the local doctor perform the procedure. / Or perhaps there's a different med that can help me as I wait for Natale. I take health and heart supportive supplements and am faithful with daily magnesium, spread throughout the day, so on that count I think I'm aiding my heart from an alternative standpoint but maybe there's more I can do.
(Actually, my mag orotate, glycinate, (and a few other forms) seem to reduce my stomach acid and have affected my digestive power, even if taken between meals. My plan to counter this is to drink a little apple cider vinegar and water with meals. But I'm curious if anyone else experiences these digestive side effects of taking magnesium).
Thanks for any comments on the gist of this post.

I was also recommended to take Digoxin but (thank you Carey) found there are other better drugs. If Digoxin doesn’t work, I’m a huge fan of Cardizem. Love it.

In January when you switch plans, can you get coverage in Austin? Natale has been doing pulse and someone (Ralph?) recommended it because it is supposed to be better because it uses no heat. Natale actually told me once to schedule my next ablation in Austin because he has better state of the art equipment and imaging. It makes sense to not limit the toolbox available. On the flip side I’m a fan of Robles hospital where he performs ablations in T.O., CA. He has an excellent team and Jose the nurse during the ablation is top notch.

A suggestion- if you frequently are getting flutter, are you stable? I was running to Robles so often and my biggest concern was needing an ambulance a day or two before the ablation and having the EMTs send you to a closer hospital where you would miss the ablation. Gordon recommended a great little hotel close to Robles and the phone number of an excellent car service company that can take you to Robles. What I did was to check in two days before just in case as insurance I wouldn’t miss it if I had a strong episode and needed to call 911. Be aware you will be weaning off of your BB and arrhythmia drugs thus raising the odds you may get an episode.

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californiagal
When I gently mentioned Dr. Natale, he said Natale's technique doesn't involve the ball but instead --certain localized burning of the tissue of the pulmonary vein. In other words, this local EP feels the ball technique is more comprehensive- a better solution.

The ball (cryo) technique only addresses arrhythmias that are coming from around the pulmonary veins. That is usually about 80% but there could easily be sources in other areas of the heart that a cryo ablation will miss. Natale does a very thorough “hunt” and will ablate sources wherever he finds them. So you could say that his approach is more comprehensive rather than less. Susan.d’s suggest of going to Austin for a pulsed field ablation might be interesting for you. It is only offered in a trial so far but the results are looking excellent. You could call their research department to see if you qualify. I will be getting a radio frequency ablation there in a few weeks (I didn’t qualify for the pulsed field because I have a pacemaker) and while the wait time varies according to Natale’s schedule, it can be quite a few months so starting enquirers early makes sense.

Also, and recalling that we're all different, especially in our ability to tolerate what we have and how it affects us, I have a 78-year-old friend who only learned he had flutter during a visit to his physician for another problem. Nobody can say how long he had the disorder, but it could have been a year or more. He's very active, a kayaker, hiker, and other sports he indulges in several times each week.

So, for the several weeks it takes for you to make up your mind, or to learn more in order to do so, I don't think you need to fret overmuch. I would counsel you to use your energy to deal with your circumstances as efficiently as you can, one benefit of which will be a quicker decision and a quicker resolution at the hands of a qualified intervenor. People live with flutter for quite a long time.

Thanks for all these posts, you guys. Gloaming, I appreciate your advice to simmer down-- that my symptoms, as worrisome as they've been to me, might not deserve such concern. :>)
Along those lines, and noting that I'm usually pretty mellow overall, but today, when my flutter started up, I took a Puritan Pride product called 'Calm Tabs' (herbal blend with Valerian extract, Passion Flower extract, Celery seed extract, Chamomile, Hops Flower extract, and Orange Peel extract). I ALWAYS keep a bottle of Calm Tabs in my cabinet but rarely feel the need to take a tablet. For some reason, I reached for this product when my heart was starting to misbehave. It surprised me by bringing my heart rate back to normal fairly quickly. (I imagine by dampening my sympathetic NS and strengthening the parasympathethic tone). Now I intend to give this herbal tablet some attention and see if it continues to help with the flutter.

Daisy, my local EP also said he'd 'hunt' for any other instigating tissue in addition to the cryro ball ablation of the pulmony vein. That was good news. / Thanks for mentioning the pulsed field ablation. I haven't had time to google this. / As I say, thanks for all of your comments.

In searching for the following topic post about Aldosterone mentioned below by Jackie, I couldn't find it on the forum but DID see in the Data Base many 'boxes' to instruct the new 'fibbers about lots of topics, including ablations and flutter. I've always known I should be reading this forum with a fine tooth comb but now I'll follow through... but getting back to the topic I wanted to read about aldosterone, it was Jackie's words-
The importance of potassium to sodium ratio
February 04, 2010 01:56AM
"The current Conference Room topic deals with the ultimate loss of potassium due to urinary wasting of both K and Mg. This is very important information and if you haven’t been to the CR, by all means go there and read this new topic entitled: The Aldosterone Connection - Breakthrough?"

Does anyone know how to locate this older topic about Aldosterone?
(A blood test years ago showed I was low in aldosterone. The general practitioner said the med to raise it was expensive---that I should simply raise my salt intake to compensate. To tell the truth, I love salt and never feel very well on high potassium/veggie diets).

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californiagal
In searching for the following topic post about Aldosterone mentioned below by Jackie, I couldn't find it on the forum but DID see in the Data Base many 'boxes' to instruct the new 'fibbers about lots of topics, including ablations and flutter. I've always known I should be reading this forum with a fine tooth comb but now I'll follow through... but getting back to the topic I wanted to read about aldosterone, it was Jackie's words-
The importance of potassium to sodium ratio
February 04, 2010 01:56AM
"The current Conference Room topic deals with the ultimate loss of potassium due to urinary wasting of both K and Mg. This is very important information and if you haven’t been to the CR, by all means go there and read this new topic entitled: The Aldosterone Connection - Breakthrough?"

Does anyone know how to locate this older topic about Aldosterone?
(A blood test years ago showed I was low in aldosterone. The general practitioner said the med to raise it was expensive---that I should simply raise my salt intake to compensate. To tell the truth, I love salt and never feel very well on high potassium/veggie diets).

The Conference Room archive is here: [www.afibbers.org]

There are three links with aldosterone in the topic:
SESSION 11: Hydration and Aldosterone (August 1 – August 31, 2003) [www.afibbers.org]
SESSION 26: The Aldosterone Connection - Breakthrough? (March 3 - March 31, 2004) [www.afibbers.org]
SESSION 33: Baroreceptor Sensitivity and Aldosterone (November 4 - November 21, 2004) [www.afibbers.org]

Is the link to the conference room archive recorded somewhere on the site if we lose track of this post?

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Daisy
Is the link to the conference room archive recorded somewhere on the site if we lose track of this post?

In theory, it is on the affibers.org main page (not the forum) at the very bottom under research. Unfortunately the Conference Proceedings link there is incorrect. This Google search will find the correct link:
conference proceedings afibbers.org

This is the correct address if you remove the spaces after the / s (which I inserted so the automatic link formatter would not hide the full link):

afibbers.org/ conference/ index.htm



Edited 5 time(s). Last edit at 10/21/2022 01:29PM by GeorgeN.

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GeorgeN
Unfortunately the Conference Proceedings link there is incorrect.

We'll get that fixed. In the future, if you or anyone else comes across a broken link, please PM me to let me know.

Many thanks, George! --You too, Daisy and Carey. :>)