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My Dr. Natale ablation and TCAI experience
Posted by AB Page
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My Dr. Natale ablation and TCAI experience June 13, 2017 06:13PM |
Registered: 6 years ago Posts: 232 |
I wanted to wite a post about my ablation, performed by Dr. Andrea Natale at the Texas Cardiac Arrhythmia Institute in Austin, TX on June 8th. I don’t have the medical knowledge that many of you do, but maybe this will help someone know a little better what to expect.
I am a 55 year old male, with technically paroxysmal afib, but it really had rapidly progressed to a persistent state following a failed FIRM ablation that lasted 8.5 hours on Feb 7th in Indianapolis. One of the leading proponents of the FIRM technique/mapping technology performed the first procedure, and it “failed” on March 25th. The FIRM ablation also introduced a flutter circuit that caused tachycardias up to 159 bpm, and on about the 3rd of April I had to be cardioverted in my city of residence. Post-conversion I settled into a near constant arrhythmia soup of afib and flutter with occasional brief bouts of NSR. My afib presented at least 10 years ago, and was never clinically diagnosed until August of last year, when I was started on diltiazem, then multaq, then sotalol and finally propafenone as a PIP. All the AA’s were ineffective, and I had lengthy pauses on sotalol and propafenone. I wore a heart monitor/recorder for 60 days, from Oct. 1 to the end of November ’16. I was started on eliquis back in August of ’16.
At this point I have to give my praise, thanks and gratitude to patient advocate Shannon Dickson, as well as to forum member Clay S., who introduced me to Shannon. Shannon is an amazing human being, one who is selfless in his giving to help others with this condition, and has made as big an impact on my life, at first a total stranger, as anyone ever has. I will forever be grateful to Shannon and Clay.
Next, I will climb the highest mountain (as soon as I’m out of the blanking period), and sing the praises of Dr. Andrea Natale and the entire staff at the Texas Cardiac Arrhythmia Institute and St. David’s Hospital in Austin. They set the bar for patient care and treatment. Every single interaction, whether it was via email, telephone or in person, exemplified professionalism, a level of knowledge and understanding of what the patient is going through, and a personal touch that provided an experience unlike any I have ever experienced in the American health care system. The facilities, as far as I can tell, are the best of the best. But we all know it’s the people at the heart of the institute that make it what it is. I am forever grateful and thankful for my care. No matter my outcome, if I need a touch-up or a watchman or whatever, I will always feel this way about my experience.
For anyone reading this, I’ll now try to create a timeline of my experience at TCAI, and I hope it’s helpful. Of course this is just my experience, tailored to my needs.
Sometime in April I began email discussions with a nurse educator, who helped me through the initial process of becoming accepted as a patient of Dr. Natale’s. Once I was contacted by the scheduling person and I had filled out and returned all of the paperwork digitally, I was officially accepted and my procedure was scheduled. I live several states away, and am fortunate to be in-network with the hospital and Dr. Natale.
Once all my medical records were obtained, I was also scheduled for a CT and a Dr. Natale consult the day before my procedure. I am not positive, but I am under the impression that because it is challenging to schedule a one-trip on the TCAI end, that they will now be requiring patients to make 2 trips – one for the consult and one for the procedure.
Next up I scheduled our flights and hotel. One thing I didn’t consider is providing extra time in-between connecting flights if you can’t fly direct to Austin, and consider flying in 2 days prior instead of one to allow for weather and other snafus. And on the return, if you have a connecting flight, schedule a wheelchair with the airlines to transport you from terminals/gates. We had 50 minutes to make our connection in Dallas, and we were very fortunate to not miss any flights. We stayed at the Crowne Plaza off of I-35, where the food was decent, and 2 very good restaurants adjacent to the hotel. We also used Uber to get back and forth from the hospital and airport, which worked out exceptionally well.
The morning of my consult I first met with my nurse educator as well as Dr. Natale’s nurse practitioner. In between those 2 visits, I met a research coordinator and signed papers for 2 studies I agreed to participate in, and started one with with a cognition test. Finally my nurse educator returned and Dr. Natale came in for the actual consult, which lasted only about 10 minutes. This was just fine as my nurse educator was always available to answer questions, help interpret AliveCor strips and just generally help me feel at ease. I should note I was plagued by fairly intense anxiety fed by or caused by the afib and flutter, and the folks at TCAI were very understanding. Dr. Natale has this innate ability to make a patient feel at ease, and he asked a few questions, and we reviewed what was to be expected. He exudes a quiet, understated confidence, and has a warm smile and makes eye contact. We talked about my FIRM experience, which was rather unpleasant, and how this would be different, including my not having to have a urinary catheter. At the end of the consult, my beautiful fiancé had lunch in the St. David’s cafeteria, while I watched as I was fasting for the CT. The St. David’s cafeteria is excellent, with a very nice salad bar, brick oven pizza, and a host of other options.
The facilities throughout are spotless and modern, and the walls are adorned with beautiful watercolor artwork depicting rural Texas landscapes. The waiting areas have cold water and coffee gratis, and of course television and wifi. The grounds are beautifully landscaped, and inside entranceways you’ll find touch screen monitors with interactive maps and directories that aid you in getting to the office or area you need to find.
My CT was performed that afternoon, and for the first time ever during the dye injection I had a brief episode of nausea that quickly passed. Just prior to my CT, I signed all of the admitting paperwork and was given the wrist band that would stay on until discharge the day after the procedure. Prior to the CT, blood was drawn in a private room and I also gave a urine sample.
My procedure was scheduled the next day at 12:30, and I was asked to report at St. David’s at 11. We arrived at 10, and I was promptly brought to the small private pre-op waiting room, where I changed into a gown and the IV was inserted, and I gave another blood and urine sample. They let me know that 2 units of blood were stored for me just in case. Very comforting, something I didn't know was done, but this place isn't just anyplace. I met with a nurse as well as the anesthesiologist supervisor. All of my questions were answered, and they returned periodically to update me on when I would be called. We watched an old Ronald Reagan western on TCM while we passed the time. A shared restroom was attached to the private waiting room.
A TCAI nurse came for me about 12:50, and my fiancé walked with us on the short journey to the EP lab, where she was directed to the waiting area. She was given a phone number to call if she needed, and told she would be called during the procedure with updates.
Outside of the lab I was stashed behind a curtain for about 5 minutes at most while final preparations were made. Upon being wheeled into the lab, Dr. Natale just happened to be in what I take was a common area, and he greeted me warmly, with a smile, and I had no fear. I was transferred to the table, and immediately a NASCAResque pit stop like group of folks began working. Everyone was gracious and professional, yet intensely focused. I saw maybe 10-12 folks doing their thing.
The procedure: I’ll be brief and to the point. I don’t understand this well beyond the basics. I believe this was a fairly intensive ablation. I presented in the lab in a steady 159 bpm flutter.
My PVI from February was still silent. The posterior wall regained conduction. Successful re-isolation of the posterior wall of the left atrium utilizing roof and infero-posterior lines. Ablation and isolation of the LAA. Ablated the left atrial septum, floor of the left atrium, left atrial lateral wall and anterior roof of the left atrium. Superior vena cava isolation and coronary sinus isolation. Total of 90 minutes of RF lesions delivered. About 3.5-4 hr total procedure.
When I awoke (4:30-5pm), the sheaths were removed soon after, and I was given a dose of dilaudid for pain. At some point relatively (30-45 mins?) soon after I was wheeled a short distance to my private room. I met my fiancé in the room, and my nurse and tech were there also. I was amazingly awake and free of pain and discomfort, especially in comparison to my post FIRM procedure in Indianapolis, where I developed a hematoma at a sheath site, severe, extreme bruising, a urinary infection and fever, post-anesthesia night sweats that lasted weeks and lasting chest discomfort and overall weakness. The difference in Austin was night and day, immediately. I ordered food about 7, and thanks to Clay S., I had a delicious slice of carrot cake to go with a turkey sandwich and coleslaw. At some point in the early evening Dr. Natale stopped by just to see how I was doing, something I wasn’t expecting.
About 10 pm I was administered via IV a diuretic whose effect was swift and unstoppable, and I had mild trouble starting a urine stream, but once I got going I was fine. I got out of bed about 12:30 a.m. after my 6 hour wait and used the bathroom and took a brief walk in the hallway. At some point overnight I asked for my CPAP machine and I also took a low dose of narco to help me sleep. I slept as well or poorly as anyone in a hospital, and the next morning I was weighed and the sheath site inspections continued. I felt great, with only mild chest discomfort that left within 2 days. That morning Dr. Natale’s nurse educator came in, as did the nurse practitioner and then Dr. Natale for a brief follow-up. My memory is vague of the overnight and morning. The nurse visits were spent going over post-medication rules, including the diuretic and potassium supplement prescriptions ordered pre-ablation and filled and brought with me to Austin.
I was discharged about 10:30 a.m., and when we returned to the Crowne Plaza, I ordered room service and had a nice 3 hour nap. The next day I continued rest and felt stronger, and we made it out for a fantastic dinner. I felt PVC’s or ectopic beats or extra heartbeats, whatever you want to call them, occasionally and briefly. They have continued, but have lessened to the point today, 5 days post, that I maybe experienced them twice so far for the briefest of moments. A wonderful start to my blanking period.
I’ll return to Austin in 6 months to have a look at what’s going on around my LAA and hopefully be able to stop the eliquis. I was placed on multaq for 2 months, and my metoprolol dose has been halved.
I have spoken with Shannon several times post-procedure, and I can’t emphasize enough what a caring, giving and genuine human being this man is. I am proud to now call him a friend, and I expect to stay in contact with him and Clay for life. Between Shannon’s advocacy and every single person at TCAI and St. David’s I feel extremely grateful, fortunate and thankful. Whether I need a touch-up or not I have no worries, for I know every future interaction with these folks will be wonderful. The way the health care system should be. I am fortunate.
Edited 1 time(s). Last edit at 06/13/2017 08:01PM by AB Page.
I am a 55 year old male, with technically paroxysmal afib, but it really had rapidly progressed to a persistent state following a failed FIRM ablation that lasted 8.5 hours on Feb 7th in Indianapolis. One of the leading proponents of the FIRM technique/mapping technology performed the first procedure, and it “failed” on March 25th. The FIRM ablation also introduced a flutter circuit that caused tachycardias up to 159 bpm, and on about the 3rd of April I had to be cardioverted in my city of residence. Post-conversion I settled into a near constant arrhythmia soup of afib and flutter with occasional brief bouts of NSR. My afib presented at least 10 years ago, and was never clinically diagnosed until August of last year, when I was started on diltiazem, then multaq, then sotalol and finally propafenone as a PIP. All the AA’s were ineffective, and I had lengthy pauses on sotalol and propafenone. I wore a heart monitor/recorder for 60 days, from Oct. 1 to the end of November ’16. I was started on eliquis back in August of ’16.
At this point I have to give my praise, thanks and gratitude to patient advocate Shannon Dickson, as well as to forum member Clay S., who introduced me to Shannon. Shannon is an amazing human being, one who is selfless in his giving to help others with this condition, and has made as big an impact on my life, at first a total stranger, as anyone ever has. I will forever be grateful to Shannon and Clay.
Next, I will climb the highest mountain (as soon as I’m out of the blanking period), and sing the praises of Dr. Andrea Natale and the entire staff at the Texas Cardiac Arrhythmia Institute and St. David’s Hospital in Austin. They set the bar for patient care and treatment. Every single interaction, whether it was via email, telephone or in person, exemplified professionalism, a level of knowledge and understanding of what the patient is going through, and a personal touch that provided an experience unlike any I have ever experienced in the American health care system. The facilities, as far as I can tell, are the best of the best. But we all know it’s the people at the heart of the institute that make it what it is. I am forever grateful and thankful for my care. No matter my outcome, if I need a touch-up or a watchman or whatever, I will always feel this way about my experience.
For anyone reading this, I’ll now try to create a timeline of my experience at TCAI, and I hope it’s helpful. Of course this is just my experience, tailored to my needs.
Sometime in April I began email discussions with a nurse educator, who helped me through the initial process of becoming accepted as a patient of Dr. Natale’s. Once I was contacted by the scheduling person and I had filled out and returned all of the paperwork digitally, I was officially accepted and my procedure was scheduled. I live several states away, and am fortunate to be in-network with the hospital and Dr. Natale.
Once all my medical records were obtained, I was also scheduled for a CT and a Dr. Natale consult the day before my procedure. I am not positive, but I am under the impression that because it is challenging to schedule a one-trip on the TCAI end, that they will now be requiring patients to make 2 trips – one for the consult and one for the procedure.
Next up I scheduled our flights and hotel. One thing I didn’t consider is providing extra time in-between connecting flights if you can’t fly direct to Austin, and consider flying in 2 days prior instead of one to allow for weather and other snafus. And on the return, if you have a connecting flight, schedule a wheelchair with the airlines to transport you from terminals/gates. We had 50 minutes to make our connection in Dallas, and we were very fortunate to not miss any flights. We stayed at the Crowne Plaza off of I-35, where the food was decent, and 2 very good restaurants adjacent to the hotel. We also used Uber to get back and forth from the hospital and airport, which worked out exceptionally well.
The morning of my consult I first met with my nurse educator as well as Dr. Natale’s nurse practitioner. In between those 2 visits, I met a research coordinator and signed papers for 2 studies I agreed to participate in, and started one with with a cognition test. Finally my nurse educator returned and Dr. Natale came in for the actual consult, which lasted only about 10 minutes. This was just fine as my nurse educator was always available to answer questions, help interpret AliveCor strips and just generally help me feel at ease. I should note I was plagued by fairly intense anxiety fed by or caused by the afib and flutter, and the folks at TCAI were very understanding. Dr. Natale has this innate ability to make a patient feel at ease, and he asked a few questions, and we reviewed what was to be expected. He exudes a quiet, understated confidence, and has a warm smile and makes eye contact. We talked about my FIRM experience, which was rather unpleasant, and how this would be different, including my not having to have a urinary catheter. At the end of the consult, my beautiful fiancé had lunch in the St. David’s cafeteria, while I watched as I was fasting for the CT. The St. David’s cafeteria is excellent, with a very nice salad bar, brick oven pizza, and a host of other options.
The facilities throughout are spotless and modern, and the walls are adorned with beautiful watercolor artwork depicting rural Texas landscapes. The waiting areas have cold water and coffee gratis, and of course television and wifi. The grounds are beautifully landscaped, and inside entranceways you’ll find touch screen monitors with interactive maps and directories that aid you in getting to the office or area you need to find.
My CT was performed that afternoon, and for the first time ever during the dye injection I had a brief episode of nausea that quickly passed. Just prior to my CT, I signed all of the admitting paperwork and was given the wrist band that would stay on until discharge the day after the procedure. Prior to the CT, blood was drawn in a private room and I also gave a urine sample.
My procedure was scheduled the next day at 12:30, and I was asked to report at St. David’s at 11. We arrived at 10, and I was promptly brought to the small private pre-op waiting room, where I changed into a gown and the IV was inserted, and I gave another blood and urine sample. They let me know that 2 units of blood were stored for me just in case. Very comforting, something I didn't know was done, but this place isn't just anyplace. I met with a nurse as well as the anesthesiologist supervisor. All of my questions were answered, and they returned periodically to update me on when I would be called. We watched an old Ronald Reagan western on TCM while we passed the time. A shared restroom was attached to the private waiting room.
A TCAI nurse came for me about 12:50, and my fiancé walked with us on the short journey to the EP lab, where she was directed to the waiting area. She was given a phone number to call if she needed, and told she would be called during the procedure with updates.
Outside of the lab I was stashed behind a curtain for about 5 minutes at most while final preparations were made. Upon being wheeled into the lab, Dr. Natale just happened to be in what I take was a common area, and he greeted me warmly, with a smile, and I had no fear. I was transferred to the table, and immediately a NASCAResque pit stop like group of folks began working. Everyone was gracious and professional, yet intensely focused. I saw maybe 10-12 folks doing their thing.
The procedure: I’ll be brief and to the point. I don’t understand this well beyond the basics. I believe this was a fairly intensive ablation. I presented in the lab in a steady 159 bpm flutter.
My PVI from February was still silent. The posterior wall regained conduction. Successful re-isolation of the posterior wall of the left atrium utilizing roof and infero-posterior lines. Ablation and isolation of the LAA. Ablated the left atrial septum, floor of the left atrium, left atrial lateral wall and anterior roof of the left atrium. Superior vena cava isolation and coronary sinus isolation. Total of 90 minutes of RF lesions delivered. About 3.5-4 hr total procedure.
When I awoke (4:30-5pm), the sheaths were removed soon after, and I was given a dose of dilaudid for pain. At some point relatively (30-45 mins?) soon after I was wheeled a short distance to my private room. I met my fiancé in the room, and my nurse and tech were there also. I was amazingly awake and free of pain and discomfort, especially in comparison to my post FIRM procedure in Indianapolis, where I developed a hematoma at a sheath site, severe, extreme bruising, a urinary infection and fever, post-anesthesia night sweats that lasted weeks and lasting chest discomfort and overall weakness. The difference in Austin was night and day, immediately. I ordered food about 7, and thanks to Clay S., I had a delicious slice of carrot cake to go with a turkey sandwich and coleslaw. At some point in the early evening Dr. Natale stopped by just to see how I was doing, something I wasn’t expecting.
About 10 pm I was administered via IV a diuretic whose effect was swift and unstoppable, and I had mild trouble starting a urine stream, but once I got going I was fine. I got out of bed about 12:30 a.m. after my 6 hour wait and used the bathroom and took a brief walk in the hallway. At some point overnight I asked for my CPAP machine and I also took a low dose of narco to help me sleep. I slept as well or poorly as anyone in a hospital, and the next morning I was weighed and the sheath site inspections continued. I felt great, with only mild chest discomfort that left within 2 days. That morning Dr. Natale’s nurse educator came in, as did the nurse practitioner and then Dr. Natale for a brief follow-up. My memory is vague of the overnight and morning. The nurse visits were spent going over post-medication rules, including the diuretic and potassium supplement prescriptions ordered pre-ablation and filled and brought with me to Austin.
I was discharged about 10:30 a.m., and when we returned to the Crowne Plaza, I ordered room service and had a nice 3 hour nap. The next day I continued rest and felt stronger, and we made it out for a fantastic dinner. I felt PVC’s or ectopic beats or extra heartbeats, whatever you want to call them, occasionally and briefly. They have continued, but have lessened to the point today, 5 days post, that I maybe experienced them twice so far for the briefest of moments. A wonderful start to my blanking period.
I’ll return to Austin in 6 months to have a look at what’s going on around my LAA and hopefully be able to stop the eliquis. I was placed on multaq for 2 months, and my metoprolol dose has been halved.
I have spoken with Shannon several times post-procedure, and I can’t emphasize enough what a caring, giving and genuine human being this man is. I am proud to now call him a friend, and I expect to stay in contact with him and Clay for life. Between Shannon’s advocacy and every single person at TCAI and St. David’s I feel extremely grateful, fortunate and thankful. Whether I need a touch-up or not I have no worries, for I know every future interaction with these folks will be wonderful. The way the health care system should be. I am fortunate.
Edited 1 time(s). Last edit at 06/13/2017 08:01PM by AB Page.
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Re: My Dr. Natale ablation and TCAI experience June 13, 2017 09:18PM |
Registered: 8 years ago Posts: 105 |
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Re: My Dr. Natale ablation and TCAI experience June 20, 2017 10:07PM |
Registered: 9 years ago Posts: 171 |
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Re: My Dr. Natale ablation and TCAI experience June 20, 2017 10:41PM |
Registered: 6 years ago Posts: 232 |
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Re: My Dr. Natale ablation and TCAI experience June 24, 2017 02:21PM |
Registered: 11 years ago Posts: 2 |
I will also sing the praises of Dr Natale. He gave me my life back and I am in a sinus rhythm. When I started my afib journey I was given no hope of ever being in a sinus rhythm because I was in permanent afib. It also runs in our family but I never gave up hope and now I am enjoying life again!
Dr Natale is a very caring man and I can't say enough about him! I have had one ablation and two touch up ablations. At the end of the third ablation when Dr Natale came in to see me post op he had a big smile on his face and told me I think you are going to like what I did. That was over a year ago and I am doing fine.
As I said before I can't stop singing the praises of Dr Natale!!!!!
EC
Dr Natale is a very caring man and I can't say enough about him! I have had one ablation and two touch up ablations. At the end of the third ablation when Dr Natale came in to see me post op he had a big smile on his face and told me I think you are going to like what I did. That was over a year ago and I am doing fine.
As I said before I can't stop singing the praises of Dr Natale!!!!!
EC
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Re: My Dr. Natale ablation and TCAI experience June 24, 2017 06:38PM |
Admin Registered: 11 years ago Posts: 2,779 |
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Re: My Dr. Natale ablation and TCAI experience November 17, 2017 06:04PM |
Registered: 6 years ago Posts: 27 |
This is my first post but I'm not new to this forum. I'm a 62 year old male who has undergone two failed PVI ablations at a well known hospital here in New Orleans. I have very recently, November 8th, had my third ablation procedure with Dr Natale at St Davids. After the second failed ablation and talking extensively to my New Orleans EPs who now classified me as a "challenging case", I came to the realization that while my New Orleans doctors were caring and well experienced in PVI procedures, they did not have the expertise to correct the more troublesome non- PV triggers causing my problems. Admittedly, I had a "now what" moment, and on the verge of despair and out of desperation, I contacted Shannon via email explaining my situation and asking him some general questions about how to go about possibly setting up an appointment with Dr Natale. Shannon called me the very next day! I can only echo the praises others have expressed of Dr Natale and the staff at St David's hospital, but I must give special thanks to Shannon for my well being, from his comforting phone calls to his extensive technical expertise explaining in layman's terms what transpired in my procedure.
I can't say what the future holds as we all know there is technically no cure. However, I am comforted knowing that I'm in the best possible hands going forward, and glad to be a patient of Dr Natale and Shannon Dickson!
I can't say what the future holds as we all know there is technically no cure. However, I am comforted knowing that I'm in the best possible hands going forward, and glad to be a patient of Dr Natale and Shannon Dickson!
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