!st Ablation scheduled

Hi Everyone,
I have an ablation scheduled in early Dec with an extremely capable EP here in Los Angeles. I've had 7 years of lightweight lone paroxymal afib until last September when I developed 'flutter' symtoms. -Via a 2 week zio patch monitor, it was confirmed I'm in flutter100% of the time .

In my afib history, initially I was placed on a few different calcium channel blockers along with Xarleto. The past 3-4 years I've only taken Metroprolol 'as needed'. When the flutter started I was placed on 125 mcg of Digoxin since BBs lower my BP to uncomfortable levels. I currently take 15 mg of Xarelto which was approved by my cardiologist (and new EP) due to a strong family history of cerebral hemorrhages.

In all my years of treatment by 3 different cardiologists, none ever suggested Flecainide. Only one doc suggested a cardioversion, which I turned down at the time. This same doc tried me on Amiodarone but I stopped it fairly quickly because of side effects. I've taken mag supplements very dedicatedly for the past year along with calcium only from diet and then, not much. I also take supplements that align with most of this forum's recommendations, although I have trouble with taurine, as the sulfur content is hard for me. (Btw, the Exa test I had 9 months ago showed normal amounts of all minerals). / I eat well and am steering myself into more of a paleo diet. I'm in good general health.

Forgive if I am repeating myself here, as I've posted a few time recently. What I'm wondering is whether I may be prematurely jumping into this ablation. The flutter is definitely not something that I want continuing, but I don't know that I've received the most thorough of cardiac consultation. Even in the midst of the flutter symptoms, I had to beg my cardiologist for a referral to an EP. The EP I've met with was present for 5 minutes of a 20 minute visit (the other time was with the PA). I asked for a second visit, and the EP spoke with me for around 8-10 minutes. The EP's opinion is that I need this, so no other discussion was offered. (Maybe this is how medical care works these days...).
My advantage insurance plan covers 3 EPs who do ablaitons. My EP is director of the ablation lab at a prestigious LA Hosp. I feel I would be in capable hands. He plans to do balloon cryro ablations of the pulmonary veins and then see if there's other spots requiring radio-frequency ablations. My impression is he's conservative and doesn't 'over-ablate'. / I've been tempted to consult with Dr. Natale when he comes to So. Cal, but the benefit of having a local doctor for 'follow up' IS an advantage of having a local EP do the procedure.
I currently have an HMO and will be switching to a PPO insurance come Jan. 1st. I'm not afraid of having the ablation done and sometimes feel it may be just what I need at this time. I only wish I was going in with the knowledge of having a team give me their best knowledge and being sure that no prescription med might also rectify the flutter. (Is there?). I guess I need a little hand-holding here.
Thanks for any comments.

Good questions. I have had a long history of Afib controlled quite well with antiarrythmics (mainly Flecainide)—so while It has been 12 years since I was diagnosed, my overall Afib burden was very low—until this last year when I developed flutter. I started the inquiries for an ablation with Natale last spring and had my ablation 2 weeks ago. By the time I got to Austin, I was have Afib and Aflutter every day—just to say that things can change quite quickly. In hindsight, I wish I had had an ablation earlier but my EP discouraged me as she preferred medical management. Because of waiting, and perhaps other factors, I needed an extensive ablation. And though “conservative“ may sound reassuring, reading my ablation report and talking to Dr. Natale, it is clear that he could not have corralled the arrhythmias without an aggressive ablation—he doesn’t do more than he needs to and he had warned me that I would need a somewhat aggressive approach in a telemedicine appointment beforehand. So, in my experience, earlier would have been better for an ablation.

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californiagal
Maybe this is how medical care works these days...).

Not necessarily…I felt that I had all my questions answered. Your new PPO in January should give you more options if you feel unsure that your cardiac team may not have been giving you their “best knowledge.”

Daisy has the right message: your signs of typical progression seen in this disorder are all there. Any cardiologist and/or EP worth her salt are going to know that you're on a path where some heavy reckoning is coming up soon, and you'll be potentially harder to treat by then. IOW, once you have an arrhythmia, especially left untreated or unmanaged somehow, you can expect progression. However, a progressed/advanced disorder is harder to treat...that's a fact.

If it helps, my wife and I spent about 20 minutes with a cardiologist/assistant to my EP, and when he was satisfied that he had what he needed, he went and briefed the EP who, I think, had recently come back to the clinic from two procedures at Royal Jubilee Hospital in Victoria, Vancouver Island. When Dr. Novak entered, it was quick, factual, he listened (I even corrected him about choices for management of central apnea, and he agreed with me, even though he has somewhat of a reputation for being 'arrogant'.) He agreed to perform an ablation, and that was it...maybe five whole minutes. When he returned to discharge me four months later, post ablation, I asked to shake his hand and he extended his.

These people are...well, I just said it...people. They have private lives, they're extremely busy if they're competent, and they deal with dozens of people every week, let alone assistants, clerks, nurses, anesthetist, etc. They really don't have time to play nice. They have to play 'good.'

I understand your anxiety about having an ablation. It is your heart after all. It took me 2 years to decide to go ahead with an ablation and I have not regretted it. Dr, Natale performed that ablation and I have been AFib free for almost 2 years now.
IMO if your PPO insurance will cover Dr. Natale then I would wait. Whatever you decide to do best wishes to you.

Thanks to all of you who replied to me. Great reponses all. Greatly appreciated.

Frankangelo, glad to hear you had great succes. I just decided to get an ablation after 3 years of pondering and I’m
Going to try to get Natale to do it. How long did you have to wait to get Natale. I called and left a message and waiting to see how long the waiting list is.
Thanks.

I just had an ablation with Natale and was in touch with others who were waiting to be scheduled. I discovered that the wait time varies according to the patient’s situation—more severe cases will be seen sooner. First Dr. Natale carefully reviews your medical records and may ask for more testing, like an echo or holster monitor for a period. Once he accepts you as a patient they will keep in touch and put you in contact with scheduling. At some point in the process you can request a telemedicine consult —I had one to discuss co-morbid medical conditions. Scheduling also depends on his travel schedule as he performs ablations in several centers, attends conferences and teaching events. So the wait can vary from person to person but is generally several months. You can also request to be on a cancellation list though then you might need to travel on short notice.