A friend of mine in the US with permanent AF

Hi all,
I have friends in the US the lady half of whom has been in permanent AF for around 12 years now. It hit her hard at first but with rate control she has for the last 12 years lived a normal life horse-riding most days and travelling extensively etc. These guys are wealthy folks. When I was talking to this lady's husband a week or two ago when he was over here in the UK, I asked why she'd never contemplated an ablation - he was already aware of Cleveland Clinic's excellent reputation and when I told him about Natale he was interested to know more.
The thing it.... I'm almost loath to get/give them more info as she's doing well enough as it is. Her father had permanent AF from 50 to 90 years-old and it never bothered him much and I suspect that is why she's opting to live with it. I'd really not be very happy with myself if I encouraged her to get an ablation that for whatever reason made things worse rather than better....
That said, my question to you guys here is..... is 12 years too long in permanent AF to go start looking for an ablation - even with Natale??
Thanks in advance,
Mike F.

As an aside, when I need an ablation in due course as I surely will, I will more than likely be looking to Sabine Ernst to perform it. Would I be right in surmising that Ernst is now pretty much 'up there' with Haissaguerre and Jais in Bordeaux for a fairly straight forward paroxysmal AFr like me??

12 years of LSPAF or even permanent AF can be successfully ablated by the right electrophysiologist; however, the decision to seek treatment is a personal one and driven by the desire to reduce or be free from symptoms of AF. No one other than the patient can make this decision.

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mwcf
The thing it.... I'm almost loath to get/give them more info as she's doing well enough as it is. Her father had permanent AF from 50 to 90 years-old and it never bothered him much and I suspect that is why she's opting to live with it. I'd really not be very happy with myself if I encouraged her to get an ablation that for whatever reason made things worse rather than better....
That said, my question to you guys here is..... is 12 years too long in permanent AF to go start looking for an ablation - even with Natale??

No, it's not too long if the EP is someone like Natale. As I understand it, he has successfully ablated persistent afib of much longer duration than 12 years.

But mainly, I don't think it's your job to selectively withhold information from them. An ablation might not be the right course for her, even from Natale, but that's not your decision to make. Like Wolfpack said, only the patient gets to make that decision. You don't need to encourage or discourage them. Just give them the facts and let them decide.

I was in permanent AF for two years, at 140-160 BPM. After an ablation with Dr. Natale, which lasted about two hours, I have been AF free for six years and counting.

Great to hear from you Tom! And thanks for the update ... I remember well your AFIB saga and your connecting with Dr Natale to such good effect.

Glad to hear all is well with your ticker!

Mahalo nui,
Shannon



Edited 1 time(s). Last edit at 11/30/2017 12:05AM by Shannon.

MikeF,

I’ve personally witnessed Dr Natale convert a 68 yr old man who had endured 36 YEARS of symptomatic LSPAF to NSR is only 43 minutes of his index ablation.

The man did require one touch up of his LAA isolation ablations 8 months after his index LSPAF ablation, but he is enjoying very much life in normal rhythm now in spite of literally no other EPs he had consulted with over the years even venturing the possibility that he was an ablation candidate ... much less a very good one as it turns out when partnering with the right set of hands!

There is a big gulf in the vision and understanding of what is possible between those who rarely even offer persistent AFIB ablation (much less LSPAF ablation). And the elite operator who, like Natale, have total caseloads equalling 50% (to over 75% in the case of Dr Natale) of all their ablation patients being persistent and LSPAF cases they successfully treat every day!

The difference in vision, talent and outcomes is truly a huge gulf!

Shannon



Edited 2 time(s). Last edit at 11/30/2017 12:04AM by Shannon.

Many thanks to all of you guys for your input - much appreciated. I”ll recommend my friends organise a consult with Natale so he can review this lady’s circumstances and discuss/advise as required and then it’s up to her (with her husband) to decide.

Best to all,

Mike

Shannon, thank you for keeping this site well and alive. I remember the first time I ventured into this site, seeming without any hope for the future. After many trials and tribulations and doctors who had no ideal of how to solve the problem besides medication and electo-shock. I remember a doctor who told me, AF will not kill you just live with it. Yes, it was easy for him to say just live with it because he wasn't just living with it. Then there was that one doctor, you know him well, pretending he could do ablations at Queens. He almost killed me. Shannon, people will remember the great work you are doing for all of us. Thank You.

Amen to that Tom! And many congrats upon your own success after a rather rough time of it for sure.

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Tom in Hawaii
. I remember a doctor who told me, AF will not kill you just live with it.

I've heard that before, too. Shocking as it is when you first hear it, it's almost a blessing in disguise. I wish all doctors would reveal their own limitations so clearly.

Folks, if any of you ever hear these words they mean your physician is stuck in the Stone Age and it is time to move on.