Back from Austin

Just a quick note to let everyone know I was first in line for Dr. Natale at St. Davids on the 24th, and all seems to have gone well so far.

My plan was to get there before things got complicated. Dr. Natale said my procedure was fairly standard, but it still sounds pretty complex to me. He isolated my PV's, left atrium posterior wall using roof and infero-posterior lines, ablated electrograms along the left atrial septum, floor of the left atrium, and anterior roof of the left atrium, isolated my superior vena cava and then on the way out fixed my failed flutter ablation ("Successful cavotricuspid isthmus ablation with persistent bi-directional isthmus conduction block obtained"), a total of 42 minutes of ablation time. And then the Isuprel challenge for 10 minutes. Total procedure time was 2 hours. What I found interesting was that even though I was still paroxysmal I had triggers beyond the PV's, so a typical index procedure would have missed those other electrograms.

St. Davids was great. One of the treats for me was that all the medical staff knew a lot about ablations and wanted to talk about them. I had a few great conversations with my nurses, one on the Oasis trial, one on some of the celebs who flow through on the sly, and several regarding Dr. Natale's expertise and record. I feel much better when everyone on the team is informed and experienced, not just the doc.

The only nuts and bolts things that stand out are that they gave me an option on the urinary catheter so of course I declined and fortunately made it through the 6 hours on my back without having to try to pee in the plastic urinal jug - that would've been some classic comedy! They removed the sheaths when I was quasi conscious and I remember it but not well so it couldn't have been too uncomfortable. I picked up 6 lbs of water weight from the catheter, had dropped it by Monday. And they kept telling me I was young (I'm 58)!! I gave them a very high survey score.

Its early yet but I'm very glad I went this route. There was a little leap of faith involved but thanks to Shannon and everyone on the forum it was a pretty well informed leap of faith.

I'm still a little bit in shock that its over. Huge thanks to Shannon for all of his help - and a huge thanks to all the forum members for their support and knowledge.

Thanks and NSR to all,

Clay


P.S. A few Austin restaurant suggestions for the pilgrimage: Black's Barbecue (the only bbq I've ever had that I could eat without sauce, OMG) , Torchy's Tacos (simple, really good, cheap), and the flagship Whole Foods which has like 5 restaurants in it and the worlds most incredible salad bar and desserts (great for nervous patients the night before who want to keep bobbing and weaving while they sort of eat).



Edited 1 time(s). Last edit at 03/31/2017 06:43AM by ClayS.

Thanks for the report, Clay. Sounds like you're on your way. Our experiences were almost identical. And thanks for your encouragement.

Kevin

Hi Clay,

At some time during last night, I made the decision to make arrangements to get in touch with Dr. Natale. Since finding this forum earlier this week, and reading about the experiences of various members, it seemed like the logical thing to do. I wanted to go the natural remedy route, but haven't come up with a solution following that line of thinking.

Now, after reading about your experience, I am even more certain that this is the route to take. I've checked with my Medicare insurance carrier, and Dr Natale is a participating physician. You've clinched it for me, and I sincerely thank you for your account.

Irma

Irma,

This site has helped me tremendously on this journey, glad to have helped in any way.

I don't think you'll regret your decision. My perspective from this side of my first ablation is that I'm glad I did it when I did, and wish I had had the guts to do it sooner, just because with someone like Dr. Natale, when the potentials are only in the PV's, the chances of one time success are very good - very, very good.

I would still encourage you to pursue lifestyle changes and the supplement strategy (search for "The Strategy") on this site. I tried a lot of things and while they didn't prevent all episodes I feel like it reduced them and took some of the burden off. Plus, it helps you handle the procedure and post-ablation as well.

Keep us posted - all the best,

C

Kevin - I got a message that you were asking about me when I got back to my room, thanks for that, kind of crazy that our procedures were only a few days apart!

Thanks for the update and the Austin team sounds wonderful. I recently had my second ablation in San Francisco on March 15 with Dr Natale and am so blessed that I did. He found that the first one I had last August with other doctors in MN did not hold and he was able to fix everything and more and I am feeling much better than before and look forward to total health and that wondrous NSR! So far so good.

I did natural remedies as often as possible to try and control it, eat mostly plant based and watch gluten and dairy, and take my nutrients yet still had multiple episodes in a day some lasting hours and some shorter and sometimes for days at a time even after the first ablation by an EP I really liked. After ending up the week after the first ablation back in the hospital and having to be tested for Tikosyn to control the arrhythmia my disappointment was tremendous. Needless to say, after many more months, I knew another ablation was going to be needed and also knew that I wanted to pursue having Dr Natale do the work based on what I had learned from talking with Travis via his blog and emails and doing my own research.

Thanks to Travis for connecting me to Shannon and to Shannon for being there every step of the way as a mentor and coach as I began the journey with Dr Natale that they both helped me begin. The difference in the way I am feeling and the support I have received from the team at CPMC, Dr Natale, Travis and Shannon are much appreciated.

I will keep you updated as I continue the healing and look forward to days and nights of NSR!! Carol

Clay, welcome back! It's good to hear things are going so well. Your report of The Maestro's work is very comprehensive and, as with mine, I would like to read just out of plain old curiosity, a report on a patient like you or I done by a clinical, fellowship trained EP.

Jay,

Great to hear from you and hope you're doing well!!

Your support and perspective were a great help - many thanks,

C

Carol - that's fantastic. All the best and NSR!

C

Hey Clay,
Glad you're on the other side finally.
It's a cakewalk with the Maestro......Dr Natale.
Yep even with paroxysmal afib its not usually confined to the PV's if you wait too long.

Best,

McHale

McHale and Clay are right and highlight an important point!

Even for many who are still in garden variety Paroxysmal AFIB when they appear for their index ablation, it is not uncommon at all to find at least a few Non-PV triggers too ... at least assuming the EP even looks for them!

The majority of the ablation reports I read from such patients done by advanced EPs who know how to detect and address non-PV triggers as well as the standard anatomical-only PVAI/PVI, Posterior wall isolation and Superior Vena Cava isolation (the last two areas that are including in better quality PAF ablations in addition to the core PVAI) ... also show, like Clay mentioned above, at least a few Non-PV triggers along the inter-atrial-septal wall, the roof or floor of the LA, and RA focal sources too at times.

So with 85% of all ablation EPs who rarely, if ever, go looking for Non-PV triggers and usually end the ablation after the a bi-directional block is achieved around the 4 PVs alone, and who do not even look in most cases for any such remaining Non-PV triggers, it will almost certainly guarantees repeat work being required, even for those who have not progressed to persistent or LSPAF.

All the more reason to always discriminate and choose with care the EP you will start ... and finish ... your 'expert ablation process' with who can truly address what ever source of triggers your heart may present, and make sure it is an elite ablationist who is actively looking for all areas of possible activation and can address whereever those sources appear in any patients heart. That is the key to minimizing the total amount of work that will be required to bring one back to durable NSR, regardless of how advanced and challenging a given case may be.

I'm so pleased to hear GoBears, Clay and Carol are all doing well as expected!

Shannon



Edited 1 time(s). Last edit at 04/02/2017 04:44PM by Shannon.

McHale - great to hear from you, hope you're doing well! Yes, it took a failed flutter ablation to get the ball rolling, but very glad I went this route. He's an amazing man, very fortunate to have access to him.

All the best,

C

Thanks for the shout-out, Shannon. Feeling great, just like Carol and Clay.

I do have an occasional dream where I have a run of tachycardia -- but I'm (pretty) sure it's just a dream!

Hello.

I have had paroxysmal afib for 3-4 years and I am 52. Get it almost daily now. I just started sotalol a month ago and it doesn't seem like it is that effective.

I am seriously considering ablation. Can someone tell me how you were able to find a good EP and have it covered on you plan? I really don't know where to start with this. Can't afford to pay for such a procedure out-of-pocket. And how do you find truly stellar EPs? I am in Ohio, and would hope there are some in my state who are in the same league as the Dr. mentioned here.

Thanks for any help.

Hi GaryS and welcome to Afibbers Forum!

Ive sent you a 'PM' (private message) you will find the links to above in the upper right hand corner of this forum page. Perhaps we help can short cut your journey toward return of durable NSR. Look forward to discussing some options with you.

Be well,
Shannon