Second Ablation with Dr. Natalie what to expect

Hello everyone. My name is Deniss ( Dennis in reality but it is a long story ) My Afib started almost 20 years ago ( in 1999) when i was 27 y/o. Now I will turn 47 in September.
Since then I battled with Afib as i could - diets, medications etc.. In March 2008 i had an ablation with Dr. Natalie and it was successful ablation and I was Afib free and off from all the medication for 10 years.
In March this year(2018) it made a comeback. Since March i had 3 episodes each lasting for 1,5 - 2 hours. What scares me is that I was told by dr. Natalie's Nurses that if he needs to ablate all around atrial appendage then I will be on a long term blood thinners which for me is a killer as I am active fisherman and kayaker. One of the Nurse said because I am still young and i am not in persistent afib it is unlikely but another nurse said that because it is a "redo" procedure it is highly likely that this is the case. Now i am scared a bit because the whole purpose of this procedure for me is to be meds free. Do any people here who had second ablation long after the first one went through it ? What was the experience like? Or I should not worry too much? All replays are welcome.

PS I have an appointment with Dr. Natalie on August 28 and procedure on August 29

Thanks alot
Deniss



Edited 2 time(s). Last edit at 06/25/2018 03:25PM by dartisskis.

I would imagine Jackie will pop in here shortly and answer. She had a second ablation with Natale many years after her first.

I have an isolated left atrial appendage (LAA) from an ablation with Dr. Natale last August. Yes, that means either anticoagulant for life or a LAA closure device such as a Watchman. I'll be in Austin a little over a month from now to have a Watchman inserted. That should allow me to stop my anticoagulant 45 days later and all drugs five months after that.

Incidentally, I think your fear of anticoagulants is overblown. I'm an avid cyclist, which I dare say involves a lot more risk of injury than fishing and kayaking, and I don't hesitate to ride or do anything differently in my life. There's no reason to curtail your life just because you're on an AC. Everybody fears uncontrolled bleeding from ACs but really that's a very rare event. Bleeding can almost always be stopped despite the AC. The only bleeding that's truly dangerous is bleeding within the brain since that's an enclosed space, and that's dangerous with or without ACs. What's far scarier and more dangerous are the strokes afib can cause. Strokes from afib are typically big and devastating, and the risk of stroke is much higher than the risk of a dangerous bleeding event.

Thanks a lot for your replay and input Carey. Just a question was it first procedure for you or it was a repeat ? And were you persistent or just paroxysmal as I am ?

Deniss

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dartisskis
Just a question was it first procedure for you or it was a repeat ? And were you persistent or just paroxysmal as I am ?

Ha ha.... Definitely not my first. Read this.

I was paroxysmal for many years, but around 2008 the episodes started becoming steadily more frequent. They went from 1-2 per year to monthly and finally to weekly. The trend was clear that I was headed for persistence, which is why I sought an ablation. I've now been 100% arrhythmia free for 10 months.

Wow. I read about your Odyssey and I should say mine was not as tough as yours. I also started from once a year and then deteriorated to once per two weeks. That is when I went for procedure. Which stopped it for 10 years. You are right I am a bit overblown by the possibilities of long term AC but somehow it is stuck in a back of my head. In your story you mentioned potassium and I should say that every time when i made a trip to ER and doctors did blood work my potassium levels were just couple of points below the lower border of the normal limits and nobody paid attention to it. My current episodes are short comparing to what i had before first ablation. I usually had episode lasting from 3 - 8 hours. Now it is 1 - 2 hours ( last 3 which i had). So i just hope Second procedure would address the issue and I would get another 10 - 15 years Afib free.

Hello Deniss - Carey's crystal ball is working. My initial ablation with Dr. Natale was in 2003 and the breakthrough AF came 11 years later. Now, let me begin by clarifying that I was much older than you at the initial onset... which began when I was 59. It's often observed that there is a genetic component to AF and with your young history, no doubt that's the case. I have no knowledge of any relatives then or now that developed AF. However, there is some interesting and relevant science about managing the expression of genes that, eventually, you will want to look into. More on that at another time.

As for the second ablation with Dr. Natale, it did involve isolating the LAA and after about 7 mos. later, I had more breakthrough and went back to Texas for #3. After that blanking period, I had another TEE assessment of the clearance velocity out of the LAA to see if I could stop the Eliquis... and although my numbers were good, Dr. Natale said it would be best for me to remain on a half dose for life based CHADS score - the female plus my age penalty.... errr... precaution.

You're young enough to escape the CHADs penalty box and I want to assure you that all three of my ablations have been amazing in that I had virtually no adverse after-effects such as pain or tiredness. After the second, I had my son (who lives in Austin) fly home with me "just in case". I flew home alone with #3. I did ask for transport help when changing concourses in Houston just to be on the safe side. And today, almost 3 years later, all remains blissfully calm.

If you haven't already done so, you should consider assessing your life-style risk management including diet with a focus on making sure your heart has the nutrients it needs to remain healthy and calm. There is a ton of info here on the topic and you can certainly send me a PM if and when you are ready to do that so you can help maintain the best possible nutritional support for your heart for the rest of your life.

Meanwhile, I wish you every success with your upcoming procedure. You've got the best with Dr. Natale and the TCAI experience at St. David's is just grand. I look forward to seeing your post-procedure report.

Best to you,
Jackie

Good Day Jackie, Thanks for the info. You are right my afib seems genetic in nature. Neither my mom or my father had Afib however I know my ( I am very bad at the hierarchy relation) grandmother's sister also had a daughter so she has Afib as well. To be honest I would be upset if this time because of my LAA I would need to be on AC for life. This is exactly because I am still young and it i really do not want to be dependent over any pills. I also was told that there is a possibility to close LAA surgically or via Watchman device the only challenge would be to prove that for me would be beneficial to do it instead of being lifelong on AC. Thanks a lot again for the info to both of you

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dartisskis
To be honest I would be upset if this time because of my LAA I would need to be on AC for life. This is exactly because I am still young and it i really do not want to be dependent over any pills. I also was told that there is a possibility to close LAA surgically or via Watchman device the only challenge would be to prove that for me would be beneficial to do it instead of being lifelong on AC.

Being 47 I completely understand why you want to avoid being dependent on any pills, but I'm afraid you probably need to start getting used to the idea. Pills are most likely going to be in your future one way or another as you age. ACs aren't the worst by any means -- trust me on that. Most people have no noticeable side effects from them. The other pills you might face in the future with afib such as antiarrhythmics and beta blockers are a whole different story. Those drugs come with a myriad of side effects for many people. You're probably not going to like them one bit. So just adjust your expectations going forward. ACs aren't the worst there is.

But getting coverage for a Watchman or similar device is a definite issue. As it stands now, you're not going to be covered by most insurance plans for such a device unless you can prove you can't tolerate ACs. I think that policy will change in the coming years, but right now that's how it is.

Hello Deniss,

I'm headed to texas mid July to have my third ablation done by Dr. Natale. My first two were done by a doctor at UPMC Shadyside in Pittsburgh. The first was in August of 2009 and teh second this past January after haveing breakthrough affib.

I too have some concerns about the possibility of having to remain on anticoagulants this time around as I am an avid cyclist. But the trade off for not having to deal with the affib outweighs that for me. I also have a few friends that are on anticoagulants for affib and other issues that are very active and it hasn't affected them in the least.

Best of luck to you.

Hello, rocketritch, thanks for replay. In my life i was always trying to stay away from meds. I took them only when i had no other choice. I admire Carey and his ability to accept the reality(and to be honest even envy) but the fact that it was my philosophy to avoid meds when ever possible is hard to overcome. Even more to be on meds for life is hard to comprehend But i guess if it happens i have to deal with it. I even have a thought that if it happens that I have to stay on AC I will try to go to Europe( like France or Germany) to close my LAA(I also have passport from one of the EU countries). Cost of such procedure is significantly less then in US and one can take a personal loan 10 - 25 K to cover for it.



Edited 2 time(s). Last edit at 06/26/2018 03:26PM by dartisskis.

What makes you think you'll need an LAA isolation other than brief conversation with the nurses? Recurrent AF after an index ablation can easily be caused by reconnection of the pulmonary veins. It's entirely possible Dr. Natale will only need to "re-do" the PVI lesion set and that's it. I assure you he won't isolate the LAA unless it's necessary. It's not something that's done prophylactically.

The good news on Eliquis is that the reversal agent is now available. If you're really worried about it, carry a medical bracelet or wallet card indicating your AC status. If you're young and active, as many of use are, then I can totally understand your worries about suffering trauma and bleeding while anti-coagulated. But, trust me, first responders and ER nurses know how to stop bleeding. In the unlikely event it happens, it WILL be stopped, regardless of AC drugs. You can also buy military grade quick clot packets at an outdoor sport store like Dick's and even Wal-Mart in some cases if you want to carry that with you. That stuff will clot heparinzed blood.

Well Your reply is really encouraging. I hope it is just a re-connection of PV. My episodes now are short comparing to what they were 10 years ago. So I keep my fingers crossed that this is the case

I have to ask another question. What is used right now as AC before and after the procedure? Is it still Warfarin or is it going to be Eliquis ir similar drug??

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dartisskis
I have to ask another question. What is used right now as AC before and after the procedure? Is it still Warfarin or is it going to be Eliquis ir similar drug??

Most likely Eliquis or one of the other NOACs. Warfarin has largely fallen out of favor except for certain patients who have other issues that require warfarin.

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Carey
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Most likely Eliquis or one of the other NOACs. Warfarin has largely fallen out of favor except for certain patients who have other issues that require warfarin.

Check out the many posts on the board regarding side effects, pros and cons, and then make your own decision. Many cardiovascular groups have warfarin clinics dedicated to monitoring your dosage. It's not a "one size fits all" medication (if indeed such a thing exists). Unlikely that warfarin will fall out of favor.

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jpeters
Unlikely that warfarin will fall out of favor.

It already has. Warfarin prescriptions in the US have declined 43% since 2010, with all of that decline being replaced by NOACs. I'm not saying it will go away completely -- it won't -- but it's rapidly falling out of favor. It may be cheap, but the testing requirements, length of time required to stabilize, and variability of effectiveness are big minuses when compared to NOACs, and that's why the plunging usage.

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Carey

Unlikely that warfarin will fall out of favor.

It already has. Warfarin prescriptions in the US have declined 43% since 2010, with all of that decline being replaced by NOACs. I'm not saying it will go away completely -- it won't -- but it's rapidly falling out of favor. It may be cheap, but the testing requirements, length of time required to stabilize, and variability of effectiveness are big minuses when compared to NOACs, and that's why the plunging usage.

.. and strokes are on the rise. I remain skeptical, especially given my own experience. There's a lot of money and advertising behind claims.

"Yet NOACs have not entirely fulfilled their promise, and have struggled in recent years due to concerns about complications and lawsuits against manufacturers."

[www.biopharmadive.com]

For what it's worth, I just had an angiogram. Arteries were completely clear.



Edited 1 time(s). Last edit at 07/11/2018 01:10PM by jpeters.

I seriously doubt that NOACs are the cause of a rise in strokes given that they've been repeatedly shown to be comparable or superior to warfarin in preventing strokes and superior to it in not causing bleeds. As for lawsuits, those are a dime a dozen for every new drug on the market. They mean nothing whatsoever.

Also, your choice of quotes was rather selective. You might want to consider the statement lower down that NOACs have become the standard of care. Not sure what you think is superior about warfarin. There's no scientific evidence to support that notion.

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Carey
I seriously doubt that NOACs are the cause of a rise in strokes given that they've been repeatedly shown to be comparable or superior to warfarin in preventing strokes and superior to it in not causing bleeds. As for lawsuits, those are a dime a dozen for every new drug on the market. They mean nothing whatsoever.

Also, your choice of quotes was rather selective. You might want to consider the statement lower down that NOACs have become the standard of care. Not sure what you think is superior about warfarin. There's no scientific evidence to support that notion.

Carey, we've had this discussion before.My cardiologist took me off Eliquis because it wasn't dissolving a clot. Warfarin took care of it quickly. Large sample studies find statistical group differences that don't always account for individual differences. There are large sample studies in Europe that failed to show NOAC's were any better than Warfarin. Lawsuits can be bogus, or they can have some validity...in this case, for failing to disclose risks and negative side effects. Anyway, nobody is telling you that Warfarin is superior to Eliquis. If it's working for you, by all means, pay the fees and enjoy.

Regarding Eliquis and clot formation

[www.medicaldaily.com]

[www.eliquis.bmscustomerconnect.com]

Hi, glad you had a good experience with Dr.Natale and best of luck with your continued recovery. I noticed you also had ablations at UPMC Shadyside. I'm scheduled for an ablation at UPMC, so thought I check with you on whether you were satisfied with your procedures there and whether there was any particular factors that lead you to go to Dr. Natale this time. Thanks.