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Justin from Surf City, USA

A-Fib Patient Story #54

A-Fib at 24—Five Years Later Gets Ablation by Dr. Natale

by Justin, 2011, update July 2013

My first A-Fib episode occurred in early 2005 when I was 24 years old.  I was startled awake at night by a commotion outside my apartment and noticed my heart pounding and beating out of rhythm. The A-Fib subsided within an hour, and I had no other side effects.  After that episode I started getting A-Fib every few months, usually after a late night out with little sleep.  Most times I would notice the A-Fib while lying in bed, and it would generally go away within an hour or so.  My A-Fib stayed like this for almost two years.

One night in late 2006 I experienced an extended A-Fib episode and went to the hospital for diagnosis.  An EKG confirmed A-Fib, and I was kept overnight until my heart naturally converted to normal sinus rhythm in the morning.  At this point I started seeing a cardiologist (of course I never got A-Fib during a checkup) and was frustrated with his advice which was always the same: “You’re young and the decision is up to you, either live with the A-Fib, go on meds or have an ablation.”  I felt that he left the decision up to me without providing solid information or professional guidance. Luckily I found Steve’s website and other helpful resources on the Internet.

At this point the A-Fib was still infrequent (once every few months), and I wasn’t excited about taking meds or having an ablation; so I just lived with it.  Over time my A-Fib progressed, and by 2010 I was experiencing episodes almost daily. My A-Fib would start and stop constantly and last anywhere from a few seconds to several hours.  I noticed if I lifted weights or did a long cardio workout, the A-Fib would go away during the exercise period and for several hours thereafter.  Physically I didn’t have any limitations and was never short of breath or tired. However, the effects were mentally draining as I began thinking about A-Fib all the time and was constantly worrying about my heart’s beating pattern.  The emotional toll was mounting, and I started making life and travel decisions because of the A-Fib.

Decision for Ablation

My quality of life was worsening, and it was time to do something about my A-Fib.  I was in my late 20s and didn’t want to go on meds the rest of my life.  I understood that eventually meds were likely to fail, and the toxicity of A-Fib drugs over decades is unknown.  I live a very active lifestyle with sports and exercise a focal point and wanted a permanent solution. An ablation was the only option that would allow me to live A-Fib free.

I started researching the procedure and met with a local electrophysiologist (EP) in Orange County, CA who specialized in catheter ablations.  He was informative and eased my concerns about the procedure, risks, likelihood of success, etc. So after two meetings with him I scheduled the ablation for about six months out due to the backlog of patients.  During the six month waiting period I continued researching and saw that Dr. Natale recently began performing ablations two days a month at Scripps Hospital in San Diego. Through my research I had repeatedly encountered his name and understood his remarkable standing within the EP field.  I scheduled an appointment and had a brief 15 minute consultation with Dr. Natale at Scripps Hospital.  He was very nice and strongly encouraged someone my age to have the ablation.  I cancelled my original procedure and scheduled an ablation with Dr. Natale.  I felt much more comfortable going to Dr. Natale given his proven track record and history of success.

About two months before my ablation I started taking Coumadin daily so that my blood was at a therapeutic level on the day of the ablation. This helps limit the risk of blood clots forming during the procedure.  I’m not sure all EPs do this as my original EP never mentioned this.  I would go in weekly and have a prick test done to measure the INR levels of my blood, and it took about six weeks to get my Coumadin dosage correct and blood at a consistently therapeutic level.  I also went in for a full heart mapping about two weeks before my ablation. This was so the doctors had a 3-D image of my heart’s structure during the ablation.  Dr. Natale performed my ablation in May 2011.

Procedure and Recovery

I was nervous about the procedure but confident Dr. Natale gave me the best chance for a successful and permanent outcome.  I checked into the hospital in the morning for blood work and to prep for the procedure which began in the early afternoon.  My ablation lasted about 3.5 hrs., and after waking up I felt really lucid within 45 minutes.  The ablation went much better and easier than I could have imagined (knock on wood). There was very little pain at all, the catheter insertion sites did not hurt much and really looked like small mosquito bites. I was expecting far worse.

A urinary catheter was inserted during the ablation to help flush the fluids that were pumped through me to keep the catheter tips cool. This urinary catheter was somewhat uncomfortable but not painful, and it was removed about six hours post procedure.  The neck catheter site was tender for a day or so.  I spent the night in the hospital, and my body was a bit sore after having to sit still for five hours post ablation while the insertion sites healed.  I checked out the next morning, and within 48 hours all the catheter insertion sites were pain free.  My chest was sore for a few days and felt heavy when I would lie down or breathe deeply, but that passed within a week.

Post Ablation

The biggest issue I dealt with immediately following the ablation was reprogramming my body which had become accustomed to constantly dealing with A-Fib. I would feel my body getting tense and ready to handle an A-Fib bout, but the A-Fib would never come.  Dr. Natale’s staff told me this was to be expected, but it still took a few months for my body and mind to get used to no more A-Fib. A few days after the procedure I started getting periodic palpitations, sometimes as many as six a minute which would last for a few hours.  I was told this could be expected as Dr. Natale doesn’t ablate the areas causing palpitations since they are harmless.  I was concerned but could feel the underlying heart rhythm was always in normal sinus rhythm.  I had a mobile rhythm transmitter that allowed me to record my heart rhythm over 30 second intervals, and I sent several recordings of palpitations to Dr. Natale’s nurse. Every time I was told it was just palpitations and not to worry (easier said than done).

Slowly over time the palpitations subsided and now (one year post ablation) I’ll get occasional palpitations every few weeks (usually more after a strenuous cardio workout or a night with limited sleep) that range from a few palpitations to some lasting on and off for a few hours.  The palpitations are lessening, and I don’t think about them much at all.

After the ablation my resting heart rate increased to about 80 beats per minute (from 60 pre-ablation) which can happen due to the burning of the nerve endings surrounding the pulmonary veins.  I don’t remember hearing about this beforehand, but I was told it’s temporary and subsides as the nerve endings regenerate.  Today my resting rate has come down to about 65-70 bpm, and I’m hoping it continues to drop back to 60 bpm.

Final Thoughts

I’m one year post procedure and feel 99% better.  My mental state is greatly improved as I’m not consumed worrying about A-Fib and frankly don’t think about it much anymore.  I’m actively working out and traveling without fear of my heart jumping out of rhythm.  I’m cautiously optimistic the procedure will remain a success. However if it does fail at some point I will definitely go back for a touch-up ablation.

I encourage any young person (and anyone in general) who is dealing with A-Fib on a regular basis to seriously consider an ablation.  In a matter of 3.5 hrs. Dr. Natale gave me back my life, free of the constant worry, restrictions and medications (I’m med free outside of a daily aspirin) that come with A-Fib.  I also suggest going to the best EP around. This is your heart. And while the procedure is fairly routine as far as heart procedures go, unexpected issues can always come up. Your A-Fib can come back if even tiny areas of the pulmonary veins are not properly ablated.

Please feel free to reach out to me directly. Steve has my contact information. Thanks.

“Surf City, USA

Update July 8, 2013

Justin wrote that it’s been more than 2 years post ablation, still free of A-Fib and feeling good!

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