More Good News From My Visit with My Local EP

This is part two of my update about my visits with two highly respected EPs. In part one, I detailed my appointment with Dr. Natale. In this update I’ll detail my appointment with my local EPs, one of the best EPs you’ll find in the Twin Cities metro area in Minnesota.

My Visit with My Local EP

You might be wondering why I had an appointment with yet another EP since I just had an appointment with Dr. Natale. The reason is simple. I needed to find a LOCAL EP I could trust and that I could turn to for any of the “small stuff” or emergency situations that might come up in the future. By small stuff I mean prescribing medications, providing heart monitoring services if needed, and answering any questions that might come up regarding my atrial fibrillation or any other heart issues I might come down with.

Dr. Natale is one of the best EPs in the country, if not THE best, but since he’s half way across the country from me and beyond busy, it wasn’t realistic to continue to rely on him for my day-to-day care. I needed someone local for that. If my atrial fibrillation comes roaring back, I’ll be on Dr. Natale’s operating table faster than you can say afib! I won’t let any doctor touch my heart but Dr. Natale but for the “other stuff” I needed to find a local EP.

With that in mind, the purpose of my meeting with my local EP was to re-establish a relationship with him. I had gone to him a couple times in the past and even contemplated having him do my ablation (before I learned about Dr. Natale). I dragged my feet committing to him as my “local EP,” however, because at the time I was also seeing another local EP who was more readily accessible and at the time seemed like a better fit for me.

As things changed over the past couple years, the other local EP I was seeing wasn’t such a good fit for me anymore. I realized that this EP was in fact the best doctor for me locally so I wanted to re-establish ties with him and commit to him as my primary EP here in Minnesota.

My Local EP Confirmed Everything Dr. Natale Told Me

I talked to my local EP about my recent appointment with Dr. Natale and he agreed with everything Dr. Natale told me. He was very sympathetic to how crappy I feel at times when my PVCs and PACs are out of control but as did Dr. Natale, he assured me they were benign and nothing to worry about.

He also looked at the results of the echo I had done down in Austin and he said it looked great. He also assured me that the “mild mitral valve regurgitation” and “mild tricuspid valve regurgitation” shown on my echo was absolutely nothing to worry about. Just as Dr. Natale said, he said almost everyone will show some trace, or mild, regurgitation on their echos.

He said he spoke to someone that does echos and he said to the person there has to be a time when you do an echo and you don’t see any regurgitation. The technician/nurse said, “No, we see regurgitation in every echo we do.” Apparently, everyone’s valves “leak” a little. No valve closes perfectly.

It wasn’t until this conversation that I finally stopped worrying about the damn regurgitation findings on my echo! Sometimes is just takes more than one person, or something stated differently that makes a difference and puts your mind at ease. For some, Dr. Natale’s words alone would have been enough. For me, I had to have things reconfirmed by another expert and my local EP just explained it in a way that made more sense to me.

I posted my official echo report in my previous update but I’ll post it here again:

(click on the images to view the pages)

I Finally Understand What Parts of My Heart Were Burned

As odd as this might sound, up until my appointment with my local EP, I never fully understood what parts of my heart were burned during my ablation. For some reason I never asked Dr. Natale. I guess I didn’t care as my recovery was picture perfect and the afib was gone.

I figured now would be a good time to get a full grasp on exactly what parts of my heart were ablated. It turns out, my ablation was indeed more extensive than I even realized. My case was more complex given my eight year history with afib and the genetic ties I had with afib (my dad had afib and so did a couple other members of my extended family).

In the near future I will provide a graphic that will show exactly what parts of my heart were ablated but sufficed it to say, I had more done than just the extended PVI index ablation. Meaning, after Dr. Natale ablated around the four pulmonary veins, I was still having afib so he had to “keep burning” other areas beyond the pulmonary veins until he found the source of my afib.

If my atrial fibrillation returns and I end up needing a second ablation, Dr. Natale will likely need to ablate additional areas of my heart, including possibly the left atrial appendage. Although, there is also a chance the afib might be come from some of the sources that were already ablated so some touch ups might also be required.

As my local EP told me, that’s the frustrating thing with afib. Until we know the precise cause and sources of afib, we’re purely speculating. Granted, that speculation has gotten better and better over the years but we still don’t have a cure. Unfortunately, my local EP believes we are still “years away” from knowing the cause of afib.

My Local EP’s Take on PVCs and PACs – and How Possibly to Treat Them

My local EP did a wonderful job explaining to me what causes PVCs and PACs and what exactly is going on when you experience them. I’ll do my best to try to explain what he said.

He said we have billions of cells in our hands and heart. The cells in our hands and heart are very similar in their genetic makeup. The key difference between the two is that the cells in our hands cannot operate on their own. They need a signal from our brain to contract and move.

The cells in our heart don’t need the brain. Each cell can (and does) contract and move on their own. That’s how your heart is able to pump and contract without thinking about it. If those cells required a signal from the brain to contract, we’d be in trouble!

While it’s great that those cells can operate on their own, it can also be a problem at times. All it takes is one cell, or groups of cells, to “go rogue” and you can have PVCs and PACs. In fact, PVCs and PACs are just that – a rogue or defective cell (or group of cells) firing when they’re not supposed to. Instead of firing when they are supposed to, or taking their turn, they fire prematurely. This throws everything off and gives you those nasty heart palpitations you feel when you’re having PVCs and PACs.

Interestingly, the pauses or hard thumps you feel when you have PVCs and PACs (i.e. the palpitations), aren’t the actual PVCs and PACs that you’re feeling. You’re actually feeling the after effects of the PVCs and PACs. When you feel that hard pause or thump, the actual PVC or PAC occurred seconds ago.

He explained why that was, but to be honest I don’t think I can do his explanation justice. He said something to the effect that when you have a PVC or PAC, there is a slight pause, which then causes your heart to fill up with more blood. Because your heart has slightly more blood in it than normal, it pumps harder to get all the blood out, thus the hard thump you feel. Both the pause and the hard thump come after the PVC and PAC have occurred.

I thought his explanation was brilliant, but how do we get rid of these damn things? He said 50% of the time these rogue, or defective cells, will eventually die or repair themselves over time. It may take up to a year for that to happen. And in some cases, they never die and they never repair themselves. In addition, a defective cell my die or repair itself but then you can get another defective cell, or cells, and the process can repeat itself.

How To Treat PVCs and PACs

He said there is one thing I can do that might be highly effective in knocking out the PVCs and PACs, however. He recommended a small dose of Flecainide. He said he has had great success with his patients taking Flecainide to treat PVCs and PACs.

He said taking just 50mg of Flecainide either “as needed” or even once or twice daily can be effective in keeping these PVCs and PACs at bay. As a result, he gave me a month’s worth of 50mg Flecainide tablets.

If you’ve been an avid reader of my blog, you know how I’m leery of prescription drugs and will only take them if absolutely necessarily – or if I know they are absolutely safe to take. Flecainide has been a Godsend for me to knock out my afib episodes (I only take it when I’m having an episode). However, I’m not comfortable getting in the habit of taking it daily to prevent PVCs and PACs, nor am I comfortable relying on them to knock them out whenever they get bad.

Until my PVCs and PACs get to the point where they are debilitating or make my life completely miserable, I will reserve the Flecainide for afib episodes only. I didn’t discuss this with Dr. Katsiyiannis, but the reason I won’t be taking it for PVCs and PACs is that I’m fearful that if I start taking it daily, the drug may make things worse over the long term as Flecainide does have the potential to be a pro-arrythmia drug. Meaning, it can cause various heart arrhythmias. Second, there is the potential to build a tolerance to the drug if you take it daily, making it ineffective over time. I need my Flecainide to be 100% effective as it has been so that if I have an afib episode it will hopefully knock it out.

Still, though, it’s good to know that if I do have a really bad day of PVCs and PACs, I can “safely” take a small dose of Flecainide and I might feel better. But I will reserve my use of Flecainide only for those days. Let’s just knock on wood that I never have days like that in the first place!

My Local EP – The Best Supporting Local EP (and How You Can Find One Too)

When I say “supporting EP” I don’t mean supporting in the sense that he supports me through my afib and other heart related issues, although he certainly does that. What I am referring to here when I say “supporting” is that he’s the perfect EP to support what I’m also doing with Dr. Natale. He’s perfecting willing (and obviously capable) to support whatever treatment protocols I’m doing with Dr. Natale – specifically ablations.

At the end of my lengthy appointment with my local EP, I told him point blank I wanted him to be my local EP moving forward. He literally said he was “honored” to be my local EP. That was the first green light that this was a great doctor. Who doesn’t want a doctor that is “honored” to treat you? In my entire life I’ve never had a doctor tell me he’s honored to be my doctor. That says a lot about his character and how much he values his patients.

I also told him that I would only let Dr. Natale operate on my heart. If I needed another ablation or anything else done to my heart surgically, Dr. Natale “was my guy.” This was the key test and my local EP passed with flying colors.

For some doctors if you said that to them they would feel slighted, angry, jealous or whatever. They wouldn’t exactly be thrilled. You might get the old, “Well, if you’re more comfortable with Dr. Natale then you should see him exclusively, or “Well, if you’re going to work with me then I’d prefer if I was handling any future ablations or procedures.” And so on and so forth.

What was my local EP’s response? He smiled and said, “Absolutely continue to work with Dr. Natale and I’ll play whatever role you want me to play. Either way, I’m here for you.” He went on to say that it was great I found a doctor I had such faith and trust in. He said that was very important.

He also said that he’d be a pretty crummy doctor if he was offended that I wanted to work with another doctor besides himself. As a doctor, he said it’s his role to support whatever decisions his patients make in their care. He said if I ever talk to a doctor and they get offended or angry that I’m working with other doctors as well, I should run, not walk out of that doctor’s office!

There is something to learn here so that you too can find that perfect “local supporting EP” if you’re also working with other maestros like Dr. Natale. As you talk to local EPs, aside from their experience as a doctor, ask yourself, are they optimistic, easy to talk to, and genuinely interested in being your doctor? If the answer is no to any of those, move on.

The biggest test is, are they willing to play a supportive role to another doctor? If the answer is yes, then you’ve found the perfect supporting EP! As my local EP said so eloquently, if a doctor gets offended or angry that you are also seeing another doctor, run, don’t walk out of the office! A doctor should be secure enough to not get upset if you’re working with another doctor. He should be willing to support your care however possible.

Next Steps

Now that my appointments are over and I finally have some peace of mind about things, I will do my best to just “live life” and enjoy it. As I write this, I continue to have terrible PVCs and PACs but I hope there will be a day soon when they will be totally gone or at least not nearly as noticeable. I continue to have good days and bad days but I have yet to have a “perfect day.” Even on my good days I’ll still have some pretty bad runs of PVCs and PACs from time-to-time.

Both doctors have assured me my heart is strong and healthy and that unless something comes up or things get worse, I won’t need to see either one until next year. I’m knocking on wood that I won’t be seeing either one any time soon! But in the meantime, please dear God, put these PVCs and PACs to rest already!

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