Ablation Summary from July 2019

Back at the hotel after a fairly restful night.

Yesterday was a long day. Checked into St David's @ 0530. Was in the EP Lab @0600. As always the EP crew was upbeat and fun right up until the point I was out and woke to pleasant nurse in recovery. I really thought I would be able to get to sleep early last night but as usual that wasn't the case. I finally requested a sleep aid and was out shortly after.

My wait for a room was going to be a while so once I was fully awake she ordered me lunch and brought my family back to visit while I was waiting.
I can't say enough about the atmosphere at both TC&A or St. David's as the staffing is fabulous.

Dr Natale was very pleased with how things turned out. He confirmed all pulmonary veins were isolated from previous procedures. And successful isolation of posterior wall of the left atrium using roof and inferior posterior lines. He also ablated along the left atrial septum, floor of the left atrium, left atrial lateral wall and interior roof of the left atrium. He also isolated the coronary sinus and left atrial appendage.

For those that have been following along since last year you will remember that Dr Natale did work on my coronary sinus and LAA at that time as well. I also had an organic afib episode that originated in my LAA while he was working his craft on my coronary sinus. This was after he had already done some work on the LAA.

As you who are veterans to this process here will already know how difficult the LAA is to ablated due to its consistency and proximity to other vital organs. This limits the the time that he can spend there. So even though he had twice visited my LAA there was still a little work to be done.

Also, most benefit greatly from a single LAA procedure which may or may not completely isolate the LAA. The plus side to that is that not only does this eliminated Afib in some patients. It also increases the possibility that the LAA will still function properly eliminating the need for long term anticoagulants.

He did have some issues ablating my LAA as he normally uses a 15 mm lasso but it could not be engaged because the entrance to my laa is too small. So he just used the regular catheter and went into the left atrial appendage and isolated it that way by moving the the catheter around the interior.

When we talked this morning we went over everything that he did as well as possibilities for the future. Chances are at this point I will either be on long-term anticoagulants or we need to have the laa isolated with either of watchmen or a lariot sutcher approach. His concern at this point with a watchman would be sizing as there only two sizes and the fact that my laa entry is so small could be an issue. But that's all down the road.

He sent me home only on 25 mg metoprolol and 5mg Elequis twice a day. He does not want me taking the Flecainide unless I need it.

Outpacing Myself

Had another break through the other day. Came home from work and was helping with dinner when it happened. this one was the worst thus far. My heart rate reached 204 bpm which is by no means a record for me but its been a while since I have seen numbers that high. Ended up taking 200 mg of Flecanide and 7mg of Metoprolol and converted about 3 hours later.

This event really sapped it out of me. I was completely wiped out through the following day into the evening. So much so I took the elevator at work and did nothing when I got home from work. This is the issue with afib. It almost always gets worse instead of better. You may plateau but it will eventually take a stronger hold.

The Date Is Set

I took some recordings with my KARDIA and sent the best one to DR. Natale's nurse. She got back to me right away and we discussed when I was coming back for a touch-up ablation. I told her I was just waiting to hear back from his scheduler to set a date since I had passed on the last date that was offered to me. Things at that time did not seem that bad but after the other night I feel its time. His scheduler got in touch with me yesterday and I scheduled an appointment for July 18. That's 2 months away but that time will go quickly. It will also give me time to continue to regain some fitness before hand.

Monitoring My Every Move

My heart rate monitor arrived last week and its unlike any I have ever had in the past. Its called the ZIO Patch. It is the smallest monitor I have ever been prescribed by a doctor. It's pretty simple in design and has no wires. The only issue I have encountered is the adhesive does not tolerate showers and exercise real well. So I had to come up with and alternative to help hold it in place that has worked out real well. I have been using Kinesio Tape in addition to the manufactures adhesive and it is working out real well. The other issue with the patch is there is no way of knowing if it is actually working. It will flash orange if it come unattached, which it did when I removed it. I should have taken a photo of that as well as it is very noticeable when this occurs.

I have thought of some other design changes I would make as well that are geared to those wearing it who are more active. These ideas would also benefit those with skin sensitivity as it would allow for re-positioning of the device every couple days. I may send them a suggestion or two as this is what I used to do for a living at one point in my life. I also verified that my addition of the Kinesio tape was successful as when I removed the tape it basically fell off and started blinking orange. The Kinesio tape was also less irritating to my skin.


The time frame for me to wear it ended Wednesday. I will then send it back and the results will be sent to Dr. Natale for review. If all is well I will come off of the metoprolol and be scheduled for a return trip to Austin for a TEE (Trans-Esophageal Electrocardiography) to check the function of my left atrial appendage. If that is ok then I will be able to come off of the Elequis.

Cycling In Place

I finally got the trainer set up the other day. I also purchased a Smart TV and a Lightning HDMI adapter for my I-pad so I can mirror the screen to the TV. It makes Zwifting allot more entertaining. I'm not a huge Apple fan but I got the I-pad for free last year so I'll use it for now.

I' been sick now for the past several days so really haven't had much chance to use the new setup but I'm feeling better and should get back to it this week. I also start my seven day break this coming Wednesday so I'll have lots of time to focus on this as well as some other outstanding projects I have been neglecting lately.