3 Weeks Since Self-Converting to NSR - How?

Hi All, it's been 21 days since self-converting to NSR, and as happy as I am, I am also equally as baffled. I was in NSR for 7 consecutive months and went back into AFIB/AFLUTTER. I was in both Afib and Aflutter daily for about 3 months. Sometimes it was flutter sometimes it was AFIB. I have 2 different 12 lead EKGs over that 3 month period, one of which shows AFIB the other AFLUTTER. Dr. Natale viewed both of those EKG's as well as several others from my Kardia and confirmed both AFIB/AFLUTTER. After my 1st week back in the arrhythmias I was put on a high dose (800mg daily) of Amiodarone for 2 weeks. Actually, the 2nd week I was taken down to 400mg daily. Amiodarone did nothing, I was told no other anti-arrhythmia medication would work as Amiodarone is the most potent and I would either need a cardioversion or ablation.

I decided on the Ablation and set it up with Dr. Natale for December of this year. For about 3 straight months I alternated daily between AFIB/AFLUTTER until Flutter took over completely the last 2 months. As Carey mentioned the heart tends to follow the fastest pacemaker. So for 5 months I was in these arrhythmias and out of the blue, like magic and a miracle, I converted to NSR on September 25th and have maintained NSR for 21 consecutive days. I had my annual physical today and my EKG (i've attached here) shows Normal. No signs of PACS OR PVCS and in NSR. My PCP also said my chest x-ray looked great.

As excited and happy as I am, I know that it's possible the Arrhythmias can come back. What I don't understand is how this is possible. From everything i've read or been told, the longer the heart is in an arrhythmia, the higher the chance it will stay in that arrhythmia as it's learned those electrical pathways. My EP also told me after the Amiodarone didn't work the first 2 weeks of getting back into the Arrhythmias, that converting to NSR on my own is close to 0%. I've also read anything over 7 days consecutively in arrhythmias is considered persistent and self-converting doesn't happen without intervention such as a cardioversion or ablation.

Can anyone explain how this makes any sense? The only other thing I can mention is that I was put on Jardiance and Entresto to help with my Ejection Fraction post Mitral Valve Surgery. After surgery my EF dropped to 19%. I was completely asymptomatic so my surgeon and EP weren't overly concerned, they just monitored me and had me do regular Echos. After about 6 months on both Jardiance and Entresto my EF increased (Thankfully) to about 50%. The last Echo I had was earlier this year. I am thinking maybe it's possible my EF is even higher now and that could possibly be a factor in getting back into NSR? Or maybe the Entresto raised my Potassium consistently for so long that that was a factor?

The last thing to mention is that prior to my Mitral Valve Repair Surgery my left Ventricle was moderately enlarged and my left Atria was severely enlarged. Since the surgery both my left ventricle and left atria have remodeled to normal size. My EP was very happy about this and thought there was a better then good chance I wouldn't even get back into any arrhythmias because my Left Atria remodeled to normal size. Does anyone have ANY idea how I could of just converted to NSR like Magic? Are there any other cases like this on this forum where someone converted to NSR after months and maintained NSR every day for weeks or longer without any arrhythmias being present?



Edited 1 time(s). Last edit at 10/15/2025 10:07PM by cornerbax.

Persistent Afib simply means you are in Afib continuously for seven or more days. It does not mean you cannot self-convert. I know someone who self-converted (no interventions) after being in Afib for over six months. So while your case may not be typical, it is far from rare. And unfortunately, these types of remissions tend not to last, although you never know.

As to why you converted, it's just conjecture. Not even an EP knows how Afib really works; they just know how to treat it. So your theory is a good as any other, but it also could have been the meds they gave you, or even the insult of the repair procedure itself. Because what puts you into Afib, very often, is the same thing that gets you out of Afib.

Jim

Arrhythmia's are more likely to manifest if someone has something mechanically wrong with their heart, have a low EF, or are coming off a surgery. Your success is not unheard off, but you are fortunate. It could be a combination of things, but it sounds like a recover from surgery, and improved EF may be the primary contributor to success in getting out of AFIB.

Thanks for the responses. I have an echo scheduled in a couple of weeks so we'll see how that looks. I think what's more intriguing to me is not just self-converting out of the blue from what was both Afib and Flutter but the fact that I haven't had an episode of either since converting.

James, when your friend self converted from Afib how long were they in NSR and during that time they converted did they have any episodes of Afib in between being in NSR? What ended up ultimately happening to them? Did they revert to Afib and get an ablation?

The only other thing to mention is before my Mittal valve surgery I was diagnosed with VALVILAR AFIB. My cardiologist said in my case the AFIB was caused by the severe regurgitation and my severely enlarged Left Atria at the time. As mentioned, within a year post mitral valve surgery both my left atria and left ventricle remodeled to normal size and my EF weren't from 19% to 50% over that time as well. I'm interested to see what this Echo shows in the next couple of weeks.



Edited 1 time(s). Last edit at 10/16/2025 02:33PM by cornerbax.

He was incidentally diagnosed with Afib by a doctor friend who was visiting, not sure why the pulse was taken. Because he had Afib. normal rate and was more or less asymptomatic. Saw an EP, ran the usual, and they told him best he take a thinner and that was that. He was in his 80s and active and continued to be. About six to eight months after I heard the story from the doctor involved, I heard he had spontaneously converted back to normal rhythm recently. I don't know anything more.

But that story aside, I really don't see your situation as all that unusual in the Afib world. It can come and go, and often with big gaps in between. Someone wiser than myself said that the search for Afib triggers is the road to madness, and I think that also applies to why we come out of it as well. It does what it does, and at the end of the day, all we can do is treat it as best as we and our doctors know how.

Jim

Quote
mjamesone
the search for Afib triggers is the road to madness

Thank you for providing the words I've been looking for, for a very long time.

Unfortunately, spoken from experience, I racked up too many miles on that road before
finally getting an ablation.

Jim, that's interesting on your friend. When you say you don't see my situation is all that unusual in the Afib world what are you basing that off of? I haven't found any other posts on something like this and my EP who has done thousands of ablations said I had close to a 0% chance of self converting after two weeks when Amiodarone did nothing. He said to get an electric cardioversion and if that didn't hold an ablation.

Believe me I don't think I'm special.... Lol. I have already acknowledged I'm aware I may have the arrhythmias return and it wouldn't affect me at all. As I mentioned in a previous post I've come to the realization of that possibility. I think being asymptomatic helps me a lot too. Whether it was Afib or Flutter I felt nothing. Rates up to 130 or so feel the same to me as a rate of 60. Another thing to mention is my diet is not great and I haven't exercised in a long time. I recently signed up for a gym membership but this was after self converting. I'm also on the same medications for the last year and a half. I'm mentioning all of this because had I changed my diet or exercised regularly I would THINK that is what got me in NSR and what is keeping me there.

So in my case I changed absolutely nothing and in a way I'm happy about that because I would definitely of attributed that as the reason I converted. I will wait another week and hopefully still be maintaining NSR. In another week that will make a month and I will each out to Dr. Natale and see what he thinks as I still have an ablation scheduled in December with him.

When you say you don't see my situation is all that unusual in the Afib world what are you basing that off of?

My friend's example was one case where someone naturally converted after being in Afib for many months. I've also read other stories, on various Afib forums, where people have also naturally converted after some period of time. Again, there doesn't seem to be a rhyme or reason.

As to your doc saying you have "a zero chance of converting...". If I had a dollar every time I heard a doctor tell me I had a zero chance of this or that, I'd be a very rich man. It seems to be their go-to line whenever they want to sell you on something. And medical forums are full of stories where this type of definitive diagnosis or statement was later proved wrong.

But I think it's all academic, because no one can give you an answer. If I were you, based on your history and the progressive nature of Afib, I'd go ahead with your ablation.

Alternatively, you could ride your NSR out, and maybe something uniquely important did happen in your case, which might give you several years or longer of normal rhythm, before you have to do something. And ablation technology may even improve by then.

I believe the odds are against this, but it's not a wrong decision.

Jim



Edited 1 time(s). Last edit at 10/17/2025 04:30PM by mjamesone.

Thanks Jim that is great info and makes sense. You're also right on the 0% thing from doctors. I was told by 3 different doctors (1 was a primary care physician the other 2 were cardiologists) that I would not ever get back into sinus rhythm and that my Left Atria being severely enlarged would never reduce to normal size. They said it may reduce a little but not back to normal. For 5 days after my mitral valve surgery I went back in NSR and a year after my surgery my left Atria reduced to normal size. And of course I have now been in NSR Over three weeks. So those 3 doctors were all wrong....Thankfully.

I am really wondering if the mitral valve surgery with the cryo maze and left atria appendage closure stressed my body out to the point of those regular arrhythmias. For many months after I had some weird symptoms but they all went away over the last year and my surgery was a year and a half ago. I wouldn't think it being that long since the surgery would have any bearing on me being in NSR but who knows. Hooefully I maintain NSR for a long time but if not I won't stress over it.

You mentioned mitral valve surgery before, but not the "cryo maze", but maybe I missed it. That might change things, depending on the timing, etc. I assume your Cryo maze was successful, and then it wasn't, so you saw Natale?

What did your surgeon say? Could it be that the Cryo maze was successful, with one blip when you went into Afib, and the reason you've been in NSR for so long is because of the maze?

If that's the case, then maybe the Maze did work. So, in that case, a wait-and-see attitude regarding ablation might be a better plan than going ahead with a catheter ablation now. Then, if the Afib comes back, reevaluate.


Jim

Quote
mjamesone
the search for Afib triggers is the road to madness
...
Unfortunately, spoken from experience, I racked up too many miles on that road before
finally getting an ablation.

Quote
Carey
Thank you for providing the words I've been looking for, for a very long time.

While I can relate to the frustration, I've also been fortunate to identify triggers, though it sometimes took quite a while.

Initially, the identification was from the literature. I hypothensized that excessive endurance exercise was likely a trigger after reading a number of studies on this and knowing my lifestyle. I also hypothesized that elctrolytes were also likely part of the equation. In 2004, the EP, in the midst of what turned out to be a 2.5 month episode, suggested I stay out of rhythm as he didn't like the meds or ablation (then) and my afib heart rate was under 100 BPM. I proposed a "Plan B" which included revising my training, supplementing with electrolytes and having him prescribe flecainide on-demand to convert me to NSR (the on-demand flec paper had recently been published in 2004). Thankfully he agreed and I've been following this plan roughly since. I subsequently proved to myslef that the exercise hypothesis and absences of supplemental electrolytes were triggers a number of times. I later learned, around 2012-2013 that excess calcium consumption, from diet (and much later supplements) created a situation such that triggers were not required for afib to occur. In my thinking, excess calcium "lowered the bar" for triggers such that "no trigger" afib was possible and common. It took me over a year to figure this out, both from reading the literature and from experimentation.

After taking CV19 vaxxes, I found these also created a "no trigger" afib environement for me. I also learned I needed to be at least 8 months in time removed from a vax such that I did not require daily consuimption of low dose flec to keep me in NSR.

Then, somewhat later, I found that calcium that I did not realize was in a vitamin C supplement was causing me "no trigger" afib. Not seeing any cause for the afib, led me to contact Dr. Natale's office and start the process for an ablation. As I've self-directed my afib care since 2004, this was a bit more involved. However during this process, I discovered the calcium, removed it from my intake and my control reverted to its normal excellent status, leading me to put the ablation on hold though asking to be kept in the system, having make the effort to comply with all that was required for me to be on the approved list. Then later I was expermineting with a mild proxoidant protocol for a non-afib purpose. For the protocol, I had the option of reacting 3 drops of a 22.5% sodium chlorite solution with either 3 drops of 50% citric acid or 3 drops of 4% hydrocholric acid. I initially used citric acid as I already had it on the shelf. I found out, after a few trials that it created a strong vagal effect and which would also lead to no-trigger afib. After switching to using 4% HCl, I've had hundreds of doses with no afib (not saying this protocol prevents afib, only that using HCl as the acid does not create the no-trigger afib environment).



Edited 2 time(s). Last edit at 10/18/2025 11:26PM by GeorgeN.

@ Jim, In February of 2024 I had the Robotic Mitral Valve Repair Surgery, the Cryo-Maze and the Left Atrial Appendage suture. I was in NSR for 5 days post-surgery and then went into Atrial Flutter at a rate of about 138bpm which I was asymptomatic of. I was in Flutter at that rate for nearly 7 months prior to having the Flutter Ablation on the right side, end of September of 2024. I've been mostly asymptomatic to everything from 19% EF to Flutter, to Afib. The ONLY thing I was never asymptomatic too were the couple of episodes of Afib with RVR and rates 200+.

From my understanding, a common occurrence from Open Heart Surgery is Atrial Flutter. Because of this it wasn't a surprise to anyone that I went into Flutter which I had ablated on my right side in September of 2024. Since the Ablation for Flutter I was in NSR for most of 7 months with the exception of 1 or 2 episodes of AFIB. And then all of a sudden after 7 months in April of this year I went into Atrial Flutter which alternated with AFIB. I would be in BOTH daily, either one or the other. After about 2 months of that I went into 100% Atrial Flutter. This time the Atrial Flutter was right at 107bpm, nearly 30bpm less than the nearly 140bpm I had when I had the Flutter Ablated. In short, it was 5 consecutive months of Afib/Flutter until I converted to NSR out of the blue on September 25th. I've been in NSR every day since with not a single episode of Afib or Aflutter. My average RHR is about 67bpm, and when laying down it's about 57bpm.

I wouldn't think it would take a year and a half to heal from the Cryo Maze Procedure, but who knows. Something 100% changed and it isn't anything I do in my daily life that's for sure.



Edited 3 time(s). Last edit at 10/19/2025 12:13AM by cornerbax.

I wouldn't think it would take a year and a half to heal from the Cryo Maze Procedure, but who knows. Something 100% changed, and it isn't anything I do in my daily life, that's for sure.

Yes, "but who knows". And while not typical. That could explain your gut feeling why your NSR is so unusual, couldn't it?

So I changed my opinion, and in your shoes. Because it's no longer just trying to figure out triggers, it may be more about the healing process of the heart after a major procedure like Maze. So personally. I'd wait some more to see if the NSR holds before having another ablation.

Not as dramatic, but I had a single Sfib episode six months after my catheter ablation and nothing in the year since, so the healing process can be very individual, and with everything done to you, it just may have taken a little longer.

As to OHS or mini maze causing flutter, I think your case was the exception, not the norm in terms of persistence. For example, with the Wolf Mini Maze, flutter does arise in a small percentage of cases, but is almost always resolved by a single cardioversion, and no flutter ablation is needed.

Jim



Edited 1 time(s). Last edit at 10/19/2025 01:46PM by mjamesone.

I agree at this point, who knows. After the surgery I had some pretty significant body pain off and on for MONTHS. Around a month after the surgery I went back to the ER for what was really significant pain, somewhere between a 6-7 out of a 10. My entire body felt swollen and in pain and I couldn't lay down or sleep it was so bad. I went to the ER and they said my heart wasn't inflamed so it wasn't endocarditis or anything relating to the heart. They never gave me a firm answer on what it was but they did prescribe colchicine and pain medication.

With the robotic surgery they went in through the right side (underneath my arm with a few small incisions) and to the heart. I am sure the process itself going all the way from the right side to the heart caused a lot of stress on my body in general. After being released I still had pain off and on for a total of 3 months or so and then it just went away and it's been fine since. Next week will make 1 month in NSR and assuming nothing changes I'll reach out to Dr. Natale at that point and give him the details and see what he thinks and go from there.

Thanks again for the great info in this thread.

It will be interesting to see what Natale says, but unfortunately, it's often like going to a carpenter and asking if you need new cabinets!

More important, might be the opinion of the surgeon who did your Maze. And most important of all, what is your gut telling you, and what do you really have to lose by waiting and seeing if the Maze holds? The procedure you had after is close to the gold standard, and after going through all that trauma, why not see it through for at least a few more months?

Good luck in whatever you decide and please let us know.

Jim

Jim, I appreciate all the input and insight. On some of my more previous posts i've essentially said "I'M OVER IT" and wasn't sure if I was going to go through with the ablation anyway. At least not at this time. When I say I'm over it I mean I feel like being asymptomatic and all of the other surgeries/procedures, I just was fine not being in NSR.

Another thing I said but wasn't overly specific is that even going into Atrial Flutter 5 days after my surgery (and my heart rate at close to 140bpm daily, non-stop,) my Left Atria and Left Ventricle STILL REDUCED tremendously. My Left Atria went from Severely Englarged to Moderately Enlarged and my Left Ventricle went from Moderately Enlarged to slightly over the NORMAL Range. This is all by being in Flutter daily at a rate of nearly 140bpm, and for 7 MONTHS!

Once I had the Flutter Ablation, my Echo about 3 months later showed BOTH A NORMAL SIZED LEFT ATRIA AND NORMAL SIZED LEFT VENTRICLE. So being in NSR appears to of helped even more but my Heart remodeled/reduced in size EVEN IN FLUTTER daily for 7 months. This shows how bad my Severe Regurgitation was and having the Surgery was an absolute must. I will reach out to Dr. Natale next week. Hopefully I'll continue to maintain NSR, and I don't want to keep my place in his schedule when he can fit someone else in my spot right now. I am sure there will be plenty of people he can fill in and I will definitely keep the forum updated. Thank you again.

Good luck with your NSR. Taking care of that severe regurgitation was a big one. Let us know what happens after you speak to Natale. Just don't let him talk you into going in and "just looking around" . You know what that means with surgeons lol

Jim

Thanks, Jim. Today is a month in which i've been in NSR daily without a single episode of AFIB or AFLUTTER since self-converting September 25th. I'm still as amazed as I was when I converted. I will reach out to Dr. Natale and/or Norma next week and let them know I am going to hold off on the ablation. I will also ask (for my own knowledge) how often they've seen something like this and if they have any thoughts on what may of been the most likely scenario as to why I converted out of the blue.

I definitely am not going to be talked out of this decision. We'll see what the future continues to bring but as I mentioned on a previous post, I have no expectations. I still can't wrap my head around the fact that I just converted out of the absolute clear blue from Flutter of all things but even more so haven't had a SINGLE EPISODE of any arrhythmia in a month on top of it. I truly do hope it continues, but once again, if it doesn't, at least I know i CAN maintain NSR even after all of the fib/flutter so that in and of itself has to be pretty good.

I've had a number of times in my afib "career" where I mentally thought the game was up and it was time for an ablation. However, each time I figured something out and got my afib "control" back to a good state and didn't follow through. The most recent one was in the Spring of 2024 and went so far as to get on Dr. Natale's list and then took myself off the list, though asked to be kept in the system, as I posted here: [www.afibbers.org]

When you ask the question, context is very important. For example, when you first asked it here, you omitted or buried the very important fact that you are still in the healing period from your mini-maze. If you remember, without that context, I advised you to stop thinking about how unusual this was and just get an ablation. However, with the context, I changed my mind completely and suggested holding off on the ablation.

So the only question that makes sense to ask is whether it's unusual to have Afib and/or flutter episodes during the six months or so following mini-maze. And in all due respect to Dr. Natale and Norma, they don't do Mini-maze, so I doubt they would have anything useful to say. But if curious, why don't you ask whoever did the mini-maze?

In any event, happy that you are at peace with the decision to hold off. Sounds like the right decision for now.

Jim

@ George, that is amazing and I am very glad you were able to get your AFIB under control on your own. That is incredible and you definitely were very calculated with everything the same way I have been through all of this.

@Jim, My Surgery was February of 2024, it's been 20 months since my surgery, not 6 months. Are you saying you still believe I was healing from the surgery nearly 2 years later?

Thanks for the correction. I still think your case isn't that rare, because Afib often has no rhyme or reason. Healing 20 months after mini-maze, less likely than six months, but I would not discount it altogether, as you did have a lot of work done. In any event, I think at this point should be moving ahead with a plan, rather than trying to figure out what happened, because no one will ever be able to tell you with certainty the "whys" you're asking about, not me, Natale or Norma, but the closest might be the person who did your mini-maze, since hopefully they follow their patients. Your plan now seems to be watchful waiting, which you seem more comfortable with and is as reasonable as anything else. You can always have an ablation at a later date, if needed.

Jim

I agree with you on focusing on a plan to get a healthier lifestyle overall as that's just good in general. I'm not dwelling on the "whys" I just obviously wanted any input in my specific scenario that may of indicated a cause. It's like a light switch that was on for so long out of the blue just went off and has stayed off for over a month. My Surgeon reached out for 3 months post-surgery and since my cardiologist is at the same hospital, my follow ups after the 3 months have been with them. The info I relay to my cardiologist will get to my surgeon and if I ever need to reach out to my surgeon I can.

I have a follow up Mid November and i'll share this info with them during my follow-up. I have not let my surgeon or cardiologist know I converted to NSR and have maintained it for a month. I will let them know on my follow-up. I will have an ECHO and EKG done during the follow-up as well. Hopefully all looks great and I'll need to follow up even less next year. Thanks again for all the great information, and yes, if I ever need to I can follow up with Dr. Natale and an ablation at a later date.