Heading for my 3rd ablation with Dr. Natale

My neverending story continues. This will be my 4th ablation, 3rd one with Dr. Natale. 44yr male, fit and active. In 2021 I had minimally invasive mitral valve repair surgery (successful, no more regurgitation) and I was also ablated (cryo maze) cause prior to the surgery I had 2 Afib episodes (one at a high HR 11 yrs ago, one at a normal HR a few yrs later).

Anyhow, no more Afib episodes, however I started developing 24/7 PACs (at a normal HR). Did Met+Flec for a while then decided to go to Dr. Natale in 2023. All good for 7 months, then bam!, PACs came back. Back on Met+Flec for 2 yrs.

Decided to go back last August. Again, amazing for 7 months...then bam!...but not PACs this time ...oh no, no no...this time a sudden increase to 110 BPM while I was sleeping (I have a sleep monitor so I saw exactly when it happened at 4am)....was at 110bpm all day til a walk with the doggie pushed me to a very scary 215bpm Atrial Flutter episode. Called 911, they injected me twice with Adenosine, did not work, finally Diltiazem did the trick (the 3 injections were not fun at all, literally feels like someone is squeezing your heart and trying to stop it for good). Finally at the hospital they gave me Met+Flec and things calmed down for good and was dismissed next day.

I informed Natale's team, they said he wants me back in Austin (I am in FL).

Now here's the scary part....the other morning I forgot my AM dosage of Met+Flec.....all it took was 6hrs (around 3pm) while I was driving for my heart to start acting up again, and once again I had an Atrial Flutter attack (around 150bpm). Scary as hell, this time I did the pill in the pocket thing, took 150 of flec and 50 of Met (the fast acting one), then sat down at home trying to not freak out and breathe slowly. Anyhow, finally after an hr the meds kicked in, but it felt like 10 hrs.

So now I am freaking out cause I know they will ask me to stop meds a few days before, but clearly my heart is not messing around, all it took was 6hr for it to come back with a vengence. I have my call with them on the 26th and will discuss of course.

Anyhow, that's my story...from AFIB, to PACS, and now to FLUTTER. Anything else left on the menu I haven't tried yet? All I can do is laugh cause the alternative is, literally, crying.

End of my rant...thanks for listening lol.

PS: ChatGPT says that most likely my mitral valve prolapse caused my atria to stretch through the yrs (prior to the repair), which messes up with the electrical system, making my situation tricky. Also apparantly the heart is pretty sneaky at finding new pathways after each ablation, kind of like dog biting its tail. Dr Natale did mention last time that due to my vavle repair, the area where he can intervene is somewhat smaller vs other ppl. Fun!



Edited 1 time(s). Last edit at 05/18/2026 04:31PM by WhyMe.

Do not assume they will ask you to hold meds, but you did the right thing putting in the call.

Give them as much detail as possible, including your current dosages, which dose you missed, when the flutter started, how long it lasted, what the rate was, what you took to stop it, and an ECG if you captured one.

That will not only help them decide about holding your meds, but it should also be helpful in how they approach the ablation itsefl.

Jim

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mjamesone
Do not assume they will ask you to hold meds, but you did the right thing putting in the call.

Give them as much detail as possible, including your current dosages, which dose you missed, when the flutter started, how long it lasted, what the rate was, what you took to stop it, and an ECG if you captured one.

That will not only help them decide about holding your meds, but it should also be helpful in how they approach the ablation itsefl.

Jim

Thanks Jim, yep I have it all documented and ready for them. Thing is, I gotta take a 3 hr flight to get there so I cannot even imagine being without any meds in my system and risking an attack mid air. That would be scary. This is all new for me cause in the past at least I was dealing with PACs at a normal HR so worst thing was some skipped beats. This thing is a total different beast, literally your whole chest is visibly shaking. Ugly stuff.

Thing is, I gotta take a 3 hr flight to get there so I cannot even imagine being without any meds in my system and risking an attack mid air.

I couldn't imagine it either and I'm sure Natale's team will not have you do it. If they still want you to hold meds, looks like arriving a few days earlier would be the plan with the "bonus" of having a potential episode within shouting distance of their team.

Good luck and try not to overstress the details. While unique and understanble terrifying to you, this is a situation they probably run into every day, so you will be well taken care of.

Jim

I appreciate the kind words. Will update once I speak to them on the 26th! Thanks.

WhyMe, Rootin for you. Good luck.

I would hope, for your sake, that you ARE in some difficulty with an arrhythmia so that, when it comes time to perform the ablation, your team will have much less trouble finding the focus/re-entrant....whatever it turns out to be. I don't wish the anxiety, worry, and distress your arrhythmia would mean while going to the hospital that morning, but I would think Natale will heave a sigh of relief. ???

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Mark
WhyMe, Rootin for you. Good luck.

Thank you!

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gloaming
I would hope, for your sake, that you ARE in some difficulty with an arrhythmia so that, when it comes time to perform the ablation, your team will have much less trouble finding the focus/re-entrant....whatever it turns out to be. I don't wish the anxiety, worry, and distress your arrhythmia would mean while going to the hospital that morning, but I would think Natale will heave a sigh of relief. ???

I know what you mean and I would agree, but as you pointed out, this particular beast is a different animal....I can tolerate regular HR PACs or even Afib very well, but when it's Atrial Flutter that pushes to the 200s BPM, it's very overwhelming, cause all you can really do is stay still. Any movements like walking etc ramps up the BPM even more, unfortunately. So yes, in a perfect world I want it to sync perfectly where I am in full swing Atrial Flutter mode as soon as I enter the OR lol, but unfortunately it does not work that way. Luckily, he knows where to look and has the tools to potentially initiate it from his end, and given how reactive I am right now after only 6hr of no meds the other day, I am optimistic/hopeful he won't have a hard time getting IT started. Also, according to Dr. ChatGPT, Atrial Flutters tend to be pretty localized and "easy" to ablate, compared to other conditions. We shall see......hopefully 3rd time's the charm!

We drove last August, around 1K + miles. I didn't want to fly with chance I'd go into an episode, I took no medications then or now except Eliquis. One night in hotel on way and two nights prior to Ablation Day & Night @ St. David's plus 3 more nearby nights after then travel home plus extra few leisure nights on way home. 2200 Miles and 11 days later finally home. Exhausting.

I'd be tempted to fly in 3-4 nights early IF that is sufficient on pre-surgery stopping medication. Easier than driving for sure. We flew next two visits with last visit being the TEE and slightly less than 24 hours from touch down to take off.

Best Wishes for your 3rd ablation with Dr. Natale~!!!

There is an option. I did it. Fly into Austin before you wean.

I lived 45 minutes from Los Robles hospital. I knew with my >190 flutter, once I wean I would need the ER to drug convert me. However 911 would only take me to a local ER and i didnt want to be stuck and miss my ablation. So a fellow on this board suggested an inexpensive hotel that was close to the hospital to guarantee if I did need the ER, an ambulance would take me to the hospital where the ablation was scheduled.

Actually I was calmer knowing I was close enough to the hospital if my flutter acted up. I never did need an ambulance but it was a good plan B. Especially if you are flying and don’t want an episode on the flight because of your weaning.

I don’t know about AirbNb prices, but perhaps check it out. Get a place with a kitchenette/microwave/fridge to save on eating out.

Good luck with your ablation!



Edited 1 time(s). Last edit at 05/22/2026 01:30AM by susan.d.

@WhyMe,

when is your appt. with Natale scheduled? I have some pertinent information to share and it may be applicable to you. In Feb of 2024 I had robotic Mitral Valve Surgery to repair my mitral valve, a Cryo-Maze, and my LAA sutured. Thankfully, the surgery was successful. After the surgery I maintained NSR for a short 5 days before going back and forth between Afib/Aflutter. I was told this was a possibility and to wait for the "blanking period" of 60-90 days. The "blanking period" came and went, and I never converted to NSR. Over the months that followed I had a few 12 lead EKGs, some of which showed A-Flutter and some of which showed A-Fib. During this time, my average rate was around 110bpm, and it rarely was over 130bpm, with the exception of 2 instances where I was over 200bpm Afib/RVR, for 15-30 minutes. Only 2 instances on 2 separate occasions was my rate ever that high post surgery.

I ended up having an ablation in Sept. of 2024 which was right sided and which was for a very small area. Once again, after the ablation I was in NSR. This time NSR lasted about 2 weeks before reverting back to Afib/Aflutter. I had several EKGs in the months to follow and some were classified as Afib and some Aflutter. I was once again alternating between the two. This lasted months so I decided to talk with Dr. Natale and schedule an Ablation with him in Texas in December of 2025. Throughout this time I used my Kardia several times a day to check my Rate/Rhythm. I was always in an arrhythmia anytime I checked. That was, until Sept 25th, 2025, when Kardia said I was in NSR! I actually knew it was going to be NSR because I could see the even R-R intervals and after looking at countless EKGs it's pretty easy to know when you're in NSR. I waited a few days and went to my PCP to have a 12 lead EKG done and sure enough NSR!

What is far more amazing is since Sept 25th, 2025, to today, June 4th, 2025, I have been in NSR, EVERY, SINGLE DAY without a single sign of ANY arrhythmia!! I don't even have a single PVC on ANY EKG i've taken the last few months! I waited a couple of months or so from Sept. to ask to speak to Dr. Natale on the phone and I was able to speak to Dr. Natale in mid November. When I told Dr. Natale about converting to NSR after 7 consecutive months of constantly being in an arrhythmia, he said that he has seen this and it can happen. We spoke about 10 minutes, but he said multiple times during that conversation that I had "A LOT OF THINGS DONE." He was referring to the Surgery for my Mitral Valve, the Cryo-Maze and the LAA suture. Because my most recent Echo was solid, he agreed to cancel the Ablation and just monitor my situation.

It's been just short of 9 consecutive months where I have been in NSR each and every single day without ANY sign of an arrhythmia. My current heart rate as i'm typing this is 63bpm. My average RHR is around 75 standing, 70 sitting, 90-95 walking regulary, and right around 60 lying down. This has been the case for the last 9 months! Also, like you my Left Atria became SEVERELY enlarged prior to my surgery and I had several doctors tell me that I would NEVER convert to NSR because of how severely enlarged my Left Atria was. Well, this is now the 3rd time I have converted, and by far and away this has been the longest consecutive time in NSR! Even prior to converting to NSR, my Echo WHILE in arrhythmias showed my Left Atria had remodeled to NORMAL, as did my Left Ventricle. In my case, my Severe Mitral Valve Regurgitation is what caused my Left Atria to get severely enlarged and which caused the Arrhtymias.

What is a little concerning is that it would of been VERY possible that I could of jumped into much earlier Ablation appointments and had at LEAST one other Ablation prior to giving more time to allow my heart and body to adjust. I am not holding my breath and I know that these Arrhythmias CAN come back but I am doing everything in my power to make sure they DON'T! Because of the nature of the severity of both of our surgeries, it seems the heart and body need MUCH more time to heal then a "90 day blanking period." I never once panicked, I always refused an electro cardioverstion as I believe for most that is temporary and I saw no good in it at all. And because my Echo is night and day prior to my surgery I wasn't even considering an electro cardioversion or rush to an ablation.

You read and hear all of these things about the longer you're in an arrhythmia, the less likely it is to get out of it naturally. That may be true for most, but it seems that having significant heart surgery is quite different then having ablations. To me what is MOST amazing is not just converting to NSR out of the clear blue, but NEVER having a single arrhythmia SINCE! It's literally been like a light switch to NSR has been turned on AND HAS STAYED on. With this, I still take it day by day and know anything can happen, but I am EXTREMELY thankful to be in NSR and feeling great every day.

@ WhyMe, how long has it been since you've had your Mitral Valve Repair and Cryo-Maze and how does your most recent Echo look?



Edited 1 time(s). Last edit at 06/04/2026 11:21PM by cornerbax.

I have read numerous personal accounts of people taking months and months to get to the point where their HR returns to a normal range, or to NSR itself after an ablation. But the point is, many who do have questionable blanking periods do eventually have this result...it just seems to take forever. And, it's very worrisome until it settles.

On both my ablations, I had AF or AFL within a few days after the procedure. The first ablation was obviously a failure, but I went two weeks after the second ablation before I had a four hour run of AF. They declined to cardiovert me at the ER because my history with cardioversions was extremely poor/unsuccessful. Then, after a metoprolol bolus, went home and it never came back again. 40 months clear now.

I think it is reasonable to question the conventional blanking period's length of 10-12 weeks, but I saw a recent paper suggesting that it really should be shorter. This is because so many people who develop a recurrent tachyarrhythmia past the 60 day mark have a poorer prognosis. So, empirically, you want any blips of AF/AFL to happen in the first five weeks....that's a good sign if they slow and then go away as the blanking period ends. If you go five-seven weeks in bliss, but then begin to have the odd run....that's not good. And I think it stands to reason: the lesions both heal and intersect as the first few weeks pass, meaning the odd small gap will get closed off in the 'ring' of lesions surrounding the pulmonary vein ostia. At least, that's the theory. If AF/AFL begins to crop up in Week 8, this means the voltage has a clear pathway to get out into the open endothelium.

@ gloaming,

it my case it was more then months, it was a year and a half! Because "WhyMe" had a similar surgery with their Mitral Valve and Cryo-Maze, I would think it's very possible they would need much more time then a 4-12 week blanking period. That's why I asked what their most recent Echo showed. In my situation, I was diagnosed with "Valvular" Afib and Afib as a direct result from my Severe Mitral Valve regurgitation. My Left Ventricle was enlarged and my Left Atria was Severely Enlarged prior to my surgery which I had in Feb/2024. What seems crazy is that even though I was in Afib or Aflutter most of the time post surgery, my echos continued to get BETTER! That/s because my Severe regurgitation was reduced to no regurgitation directly after surgery and trace regurgitation on all Echos since.

"WhyMe" may have different circumstances and may not of had Valvular Afib so our situations may not be identical, but our surgeries were very similiar. The ONLY issue I had (besides the arrhythmias after the surgery) was my EF dropped to 19%. This was fully expected by my cardiologist and my surgeon prior to surgery so I was expecting that drop as well. In the Echos since, my EF has increased to 45%. My most recent Echo was April of 2025, so it's been over a year. I am hoping for an even better Echo and EF when I get one in October.

I am really thinking that my arrhythmias were related to BOTH my Severely enlarged Left Atria and my Low EF. And each month post surgery both improved drastically allowing my heart to maintain NSR after 18 months. This is speculative on my part, but it would certainly make a lot of sense. I am thankful each and every day for NSR, but know not to get too confident or comfortable as things can change. I am praying I get to the 1 year mark of NSR and when that happens I wll make a post about my situation.



Edited 2 time(s). Last edit at 06/05/2026 09:20PM by cornerbax.