Wait for Natale (and "remodel") or use a different EP?

I went from 5% "burden" on diagnosis w afib 9 months ago (based on 2 week Zio patch) to nearly full-time flutter and a fib as of the flu I caught this Christmas. I was cardioverted three weeks ago and it went great -- until I went back into flutter the next day. I have called Natale's office 2x in SF and received no return calls (since last Tuesday). I have a cardiologist in LA who will do an ablation (probably "both" aflutter (right atrium) and fib (left)). I have an appointment to get a second opinion from Doshi in Santa Monica --- but the appt is not until March. (I am on the cancellation list). I am worried about several things: 1. Since this persistent problems are a new phenomenon, should I wait and see if I revert to something closer to the 5% burden of last April? 2. Assuming I eventually get an appt. with Natale (and assuming it is six months from now), am I "remodeling" my heart in the meantime and thus diminishing the chances of a successful outcome? Should I look for other causes of the aflutter/afib than the current belief -- "lone/paroxysmal"? Who is the best "operator" in California? Thanks for insights. PS: Back in March I had a stress test echo and they saw nothing unusual. I am having a CT of my hear this week.



Edited 2 time(s). Last edit at 02/05/2017 03:23PM by Gobears.

Absolutely wait for Natale Gobears!

You are still relatively early in your AFiB History and progression now toward persistent AFIB is also very early. Plus, you can easily get an ablation set with Dr Natale in San Fran or Austin in well less than 6 months time! Send me a PM above with your cell number and we can discuss your options.

The worst mistake you could make now is to let an ongoing AFIB episode, or the unfounded fear of being 'too late' for Dr Natale to help you if you do not rush into just getting an ablation by anyone who can do it pronto! Do NOT let anxiety, which we all understand, force you into making a compromising choice on the ablationist you partner with!

If you never listen to anything else I, or anyone else here says, please take this to heart! It is well worth waiting for the most experienced persistent AFIB ablation expert you can possibly arrange for yourself. And since you can access Dr Natale, who is the single most experienced persistent AF ablation expert on the planet, your initial instincts were already your best decision by far. Just don't let your mind force a potential mistake here.

It's not that other EPs cannot help you, but if, and when, you have the opportunity for partnering with the most experienced EP in the world who does more persistent and LSPAF (long standing persistent AF) cases than anyone else on the planet, it does not at all increase your odds for long term success to back out on that connection for a more expedient choice, simply out the of fear of 'remodeling' making it impossible to get fixed. And certainly not based on not getting a return call from some scheduler for Dr Natale's San Fran office within one weeks time.

So many here can second this reality I'm suggesting to you. Any ablation EP that is really good at all will require a wait of at least two to three months, and with some guidance you can get set with Dr Natale, as well, within that same general time frame either in San Fran or Austin.

Just don't be shy about traveling, and I don't think you are, for a 5 day period for the entire index consult and ablation process, including two days of recovery in a local hotel after discharge from the hospital the day after the procedure before flying home.

The single most important decision you will ever make, Goobers, in your AFIB career is choosing the most experienced EP you can possible arrange for yourself, and you have already done that. All you have to do it follow through and not be sidetracked by a minor delay in getting a date set..

In your case, being diagnosed with AFIB less than a full year ago, and right when you are moving into more persistent AFIB, it is even more imperative NOT to get antsy and just jump for an EP that can offer you an ablation the soonest, simply because you might have to wait a few more months to access the most experienced EP with ablation of persistent AFIB.

Again, its not that Dr. Natale is the only EP who can do the job, its just that by making the choice for experience in persistent AFIB ablations significantly ups one's odds .. up front ... of gaining durable freedom from AFIB in the least amount of overall work being required to achieved that prime goal for us all. Something that so many here can validate over many years of experience.

Ive seen, in person, Dr. Natale convert to NSR in just 43 minutes, a 68 year old man who had endured unbroken 24/7 symptomatic LSPAF for THIRTY-SIX YEARS! I literally know of no other EP anywhere who would have even offered an ablation to such a person with so long a history of LSPAF!

Just let that sink in, and offer some perspective to the sense of urgency you feel, and which we all also fully understand Gobears, and to counter your concern that your current progression might make it seem to you like it might be too late for Dr Natale to restore you to durable freedom from the beast if you wait any longer at all to get that ablation.

Your sense is right not to drag this out by any more long term procrastination now that you are moving pretty quickly to persistent AFIB, but even over the next 6 to 9 months you are not going to appreciably make your condition significantly worse structurally. And in any event, the prime consideration now is making sure your put your hearts care in the right hands whatever that takes!

Best wishes on sticking with your initial decision Goobers, be patient too as all this plays itself out and keep your eye on the big picture!

Shannon



Edited 1 time(s). Last edit at 02/05/2017 05:20PM by Shannon.

Gobears,

Shannon can work wonders, he got me a slot with Dr. Natale much sooner than I expected. PM him, and hang in there - all the best to you!

Clay



Edited 1 time(s). Last edit at 02/05/2017 10:32PM by ClayS.

Thanks so much Shannon (the amazing editor of this website) for the insights and help. Thanks, Clay, for the support. I have an ablation scheduled with Dr. Natale. I have also been in NSR most of the last week so things are looking up. I am just taking metropolol but, when I'm in sinus rhythm I feel like it's not helpful, but then if I go into flutter I'm at 150bpm and it takes many hours to reduce the rate under 100. But, again, I seem to be slowly returning to more NSR than afib/flutter.