Just Had My Ablation With Natale

Hey everyone, had my first Natale ablation 2 weeks ago and I can't speak highly enough of the guy, his staff, the facility etc, you really feel like you are in the best possible hands.

The issue I am having is that after 10 days post surgery of zero episodes whatsoever, I am now having daily occurrences of PACs that last a couple of hrs and surprisingly
are breaking through my usual Flecanide dosage (100 twice daily)

Now, I understand that technically there's a 3 months blanking period etc, BUT, lots of newer research online states that the actual recovery time for scars is 4 weeks and the real blanking period should be closer to a month (in other words if you start having episodes in month 2 and 3 you are doomed).

So I guess I am just a little discouraged that I have less than 2 weeks left til the full month and my daily PACs are breaking through my Flecanide, which is something that before did not happen, Flecanide was able to keep them at bay (I decided to have an ablation cause my goal/hope is to be off meds due to the side effects etc)

So my question is....am I reading too much into this, or the fact that PACs are occurring daily, for a couple of hrs, and are breaking through the Flec is a sign of ablation failure?

Thank you.

Episodes in the first month are not unusual, but as you have learned, recent learning suggests that occurrences of AF, flutter, and PACS/PVCs does not bode well if they begin later in the ten week blanking period. So far, I would not sweat it out...just yet. In my case, I had to endure a decidedly failed catheter ablation until the Holter at 12 weeks. My results showed a lot of PACs, too many, and my EP very shortly agreed to try again. It continued to get worse for me until the second procedure mid-February.

So, this should also tell you that I was among the approximately 30% of patients globally who are not successfully ablated the first time. You may be included in this non-august group, but give things a chance. I think the heart is wonky in most of us for many months. Some report a high resting HR up to a year out, and then it settles down.

Some only ever develop PACs after a first ablation. If the burden is too high, say near 10% of the daily total of expected beats, that is too high and your EP should know how to help. Some EPs won't help those with PACs because they either don't think they can do it, or they don't know what to do, or they convince themselves that PACs are entirely benign. They are NOT benign. They are an indication that something is amiss, even if only temporarily. If they persist, and especially if they become more numerous, then you're going to find it difficult to enjoy living if they are detectable and noticed by you when they happen.

But, in the end, it's the Holter Monitor at about 12 weeks that will tell the tale. Make sure you behave entirely normally, normal routine, including exercise that you do regularly when you have the Holter. That is key to establishing what may be amiss. Also, you should be off any meds except statins and anti-coagulants during this time, ideally off them by about 10 days or more. Again, you want a veridical assessment, not a doped up assessment, of what is really happening in your heart electrically. No chemicals!!

Thank you very much for the thorough explanation, I appreciate it. Nothing annoys me more than EPs and/or cardiologists that say "oh, those are only PACs no worries!" If only they knew how demoralizing and depressing one feels as soon as those skippy beats start coming. All you want to do is lay in bed, defeated. And I agree with you 100%...I am never ever going to buy the tale that PACs are harmless. A lifetime of a heart exposed to PACs is definitely going to lead to issues, no questions about it.
Anyhow, all I can do is wait and see at this point. It is what it is. Thanks.

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WhyMe
So my question is....am I reading too much into this

Yes.

I am almost one year out from a touch-up ablation and Watchman implant and just started having PACs, etc. that are very symptomatic and disturbing. Coincidentally, this started happening when I was scheduled to have my post procedure 7 day heart monitor. I am on the monitor now and will wait and see what is going on. Of course I feel every abnormal beat. I will now be dealing with a new set of question, etc. I am also dealing with the emotional issues that occur with this happening after an ablation.I appreciate having been in NSR 11 months. Emotionally it is difficult to deal with the fact that my AFIB remission will/ may not be longer. I continue to rely on Dr. Natale for EP related issues. Hopefully, he will see me through all of this!

In rereading this, I apologize because I think I should have started a different topic for this.



Edited 1 time(s). Last edit at 09/09/2023 09:33AM by Pixie.

Nah you are totally fine for posting here, pretty much what I fear it's happening to me...Afib potentially fixed, but now it's a PACs party. So no real relief cause to me they feel exactly the same, no matter how you want to call them. Very depressing, I wish they would warn you in advance that an ablation may lead to unleashing the PACs beast. Seems many deal with this.

Hi Carey. I read your post about the many ablations. What's your latest update if you don't mind me asking?

WhyMe, everyone is different. One may bike 50 miles a few days after an ablation and some take longer in healing. Some don’t get even a hiccup missed beat afterwards and some get PVCs or PACs.

I think the highest of Dr Natale. You have the odds that you will be ok. You had the best and many readers here can testify their own nsr success and how they got their life back. He is skilled and a compassionate person with a high success rate.

In my situation, there has to be some that can’t be fixed-percentage wise, even by the best. So when my three ablations failed after 6 months, three months and two months and eventually all drugs stopped working, I just realized it’s just me (I never read here anyone with my situation). I got closure and realizing it’s meant to be because of my bio-makeup and genetic disposition, I had a 4th AV node ablation in December that castrated/nuked my upper chambers from the lower so even though I’m now in controlled afib, I can have a modified life outside the ER.

I like to recommend atenolol (Tenormin). It stopped my PVCs cold turkey after my ablations. Perhaps ask if you can try the experiment and see if it helps your heart settle during the blanking period. Good luck.



Edited 1 time(s). Last edit at 09/09/2023 04:04PM by susan.d.

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WhyMe
So my question is....am I reading too much into this, or the fact that PACs are occurring daily, for a couple of hrs, and are breaking through the Flec is a sign of ablation failure?

Yes, we are all different but it gives perspective to hear a variety of experiences. I had an index ablation with Natale last November and it was extensive and he had to isolate my LAA. I had a few little bursts of arrhythmia in the few days following, a quiet couple of weeks, and then a few more short arrhythmias for a few weeks...and then nothing! My resting pulse was quite high though, 95 or so. In April I went back for a Watchman and while he was in there, he found a few areas with potentials and he did a 12 minute touchup as well as implanting the Watchman. (He also had monthly readouts from my Pacemaker to alert him to anything amiss)

Immediately after that my resting pulse returned to it pacemaker set-point of 70 and everything has been quiet since. So, I'd say that, if you are able to, forget about it all unless something knocks sharply demanding attention. I know that it is very tempting to watch like a hawk, but that level of attention can bring stress which can exacerbate symptoms. As others have said, you are in good hands and the weekly follow-up with your nurse navigator and NP will be extremely helpful.

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Daisy

.. I know that it is very tempting to watch like a hawk, but that level of attention can bring stress which can exacerbate symptoms. As others have said, you are in good hands and the weekly follow-up with your nurse navigator and NP will be extremely helpful.

Very savvy words from someone who knows. Stressing about what devices tell you from minute-to-minute is as bad as any other reliable trigger in my experience. My wife held out her hand when I went into the ER a 13 months ago for help during a run of AF six days after my index. She caught me glancing at my Galaxy smart watch's indication of my current HR and said, 'Gimme that thing.' And I did. We also had the nurse shut off all alarms. They were as bad as my watch at that point.

Thanks everyone for your inputs, I really appreciate it. This journey is a pain in the a**...I never in a million yrs thought I would be dealing with this crap at 40 yrs old (always been active, never smoked, don't like drinking, not even coffee, zero drugs, healthy weight, no family history etc...).

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Daisy

As others have said, you are in good hands and the weekly follow-up with your nurse navigator and NP will be extremely helpful.

If after a year and you are told you do not need to send weekly or monthly readings to the nurse navigator and you develop PACs and need to be advised of treatment options, does anyone know if Dr. Natale would continue to see a patient for treating the PACs or if the patient would need to see a local cardiologist for this? I know premature atrial contractions are an arrhythmia, but in reviewing the bios of the docs at St. David’s Medical Center, non mention the treatment of PACs. If an ablation for PACS is necessary I am sure it could be done there, but what about other monitoring for this condition?

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Pixie
As others have said, you are in good hands and the weekly follow-up with your nurse navigator and NP will be extremely helpful.

If after a year and you are told you do not need to send weekly or monthly readings to the nurse navigator and you develop PACs and need to be advised of treatment options, does anyone know if Dr. Natale would continue to see a patient for treating the PACs or if the patient would need to see a local cardiologist for this? I know premature atrial contractions are an arrhythmia, but in reviewing the bios of the docs at St. David’s Medical Center, non mention the treatment of PACs. If an ablation for PACS is necessary I am sure it could be done there, but what about other monitoring for this condition?

It is my understanding that we can continue with Dr. Natale indefinitely as long as we have an annual telemedicine consult. When I was there recently, I asked if, when my Pacemaker needs to be replaced in 4 years, whether Dr. Natale would be able to advise me, and I was told yes. I believe this would be true for any cardiac-related concern as it can all be related to arrhythmias.

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Daisy

It is my understanding that we can continue with Dr. Natale indefinitely as long as we have an annual telemedicine consult. When I was there recently, I asked if, when my Pacemaker needs to be replaced in 4 years, whether Dr. Natale would be able to advise me, and I was told yes. I believe this would be true for any cardiac-related concern as it can all be related to arrhythmias.

Thanks for responding, Daisy. I was hoping he would continue to see patients as you mention above.

3 years post ablation, Dr Natale has kept me as his patient. Matter of fact he's my only Dr at this time. I might be his only patent in South Dakota, there not many folks up here



Edited 1 time(s). Last edit at 09/11/2023 11:48PM by Kleinkp.

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Kleinkp
3 years post ablation, Dr Natale has kept me as his patient. Matter of fact he's my only Dr at this time. I might be his only patent in South Dakota, there not many folks up here

Thanks for responding. I want to stay with him also. Telehealth and remote monitoring makes this more possible. Enjoy South Dakota!

Well...I suspect I will also need to remain his patient lol cause so far my daily "supra ventricular ectopies" show zero sign of stopping, 3 weeks post ablation. So far I got zero relief from the procedure, these occur daily for a couple of hrs, just like before the ablation, and only stop when I take my morning and nightly Flecanide dosages.
In theory next week is my 4 week anniversary and most of the scarring should be healed. If this continues after the 4th week....then looks like I officially join the "failed attempt" club. Just. Kill. Me. Now.

“ then looks like I officially join the "failed attempt" club. Just. Kill. Me. Now.”.

I’m talking from experience from someone who couldn’t get fixed.There will be a light at the end of your tunnel from this journey. You just got to wait it out a bit. Investigate what Marco has posted lately about GI triggers and sleep apnea contributing to Afib as examples that maybe helpful, along with stress and triggers reduction and staying hydrated. Nobody said it’s easy but you are not part of the failed club after 4 weeks post ablation. I would still try atenolol. I had over a 30% pvcs burden after my ablations and atenolol, as an experiment my local EP recommended, may stop your pvcs and pacs cold turkey like it did for me. I was scheduled for a pvc ablation and my local EP asked if I would humor him with taking a drug that helped some of his patients-atenolol- and I started slowly at 12.5mg/day the first week, 25mg a day the second week, 37.5mg on week 3 and three days later it stopped-4 days before my pvc ablation. What I’m saying is there is always hope. Good luck.



Edited 1 time(s). Last edit at 09/12/2023 04:42PM by susan.d.

Thank you very much Susan, but isn't it just like Metoprolol, a betablocker? Cause Met+Flec actually give me relief, but Met lowers my BP and HR too much (never had them high in the first place). And frankly, my whole point of going through an ablation was to avoid being always on meds. I am 40 and I suspect not the best scenario to be on these meds for another what, 30-40yrs? I mean if I have to, then I have to, but I was really hoping to take care of things with the ablation.
It's funny cause on any surgeon's website you go to, they always make it sound like most ppl that go there get their problem fixed for good, and that just a few will need a second touchup but after that second try 95% of ppl are "cured" blah blah blah. I say BS, to me it looks like only a tiny % is "cured", everyone else is told to come back for more and more and then eventually go back to meds lol.

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WhyMe
It's funny cause on any surgeon's website you go to, they always make it sound like most ppl that go there get their problem fixed for good, and that just a few will need a second touchup but after that second try 95% of ppl are "cured" blah blah blah. I say BS, to me it looks like only a tiny % is "cured", everyone else is told to come back for more and more and then eventually go back to meds lol.

That's what happens when people go to an average EP who does maybe a few ablations per month. Just because your EP is willing to do an ablation doesn't mean you should let them. I learned that lesson the hard way.

Across the industry of correcting arrhythmias globally, the rate of success for a first ablation runs about 70%. Give or take 5%. Second and subsequent attempts run about 80%. Success only means one full year free of AF. It doesn't mean a year free of new onset, or repeat, PACs. For some reason, the medical community seems reluctant to treat them unless they become quite burdensome to the patient.

You are correct, there is no real cure for AF. The process of ablation doesn't alter the underlying disordered electrical state of the heart and of its substrate. If you were to reverse the ablation and reverse the resulting lesions and scarring, your heart would immediately return to arrhythmic beats. And, since it is considered widely, in the literature, to be a progressive disorder, it should come as no surprise that a great many of us will have to make an office call to an EP at some point with a heart returned to active AF. It is disappointing, and I rue the day it happens to me...if/when it happens. One can hope that, in the meanwhile, advances in technique and in our understanding of the diseased heart will help to improve our responses to novel treatments.

I am very aware of your frustration. I hope at this point you have uncovered some answers. I developed AFIB at age 30. After all these years, no one has been able to tell me why. At this point the feedback I was given is likely some genetic flaw and just bad luck. And my current EP told me I will drive myself crazy trying to figure out the cause.

I am now 74. 40+ years ago, not as much information or treatment options were available. So lots of drug experimentation on me over the years. Fast forward and I have now had 2 procedures a MINI MAZE 16 years ago with LAA closure and a "touch up" 4 years ago when the AFIB came back. I am still plagued with PAC/PVC and occasional afib run. I have not been off of medication for all these years except for brief periods to determine burden. I have been and still see a EP's in a top center. I will likely need another "touch up" at some point. I too had hopes to be off all medications after each intervention, but so far that does not seem possible. However, even at my age, I am still hopeful that a solution will be found. I am mentioning all this because I have had a wonderful life, even on medications. Long career - traveled all over the world. Still active in the community and despite the AFIB, good health. Do not give up.