PVI ablation with Dr. Natale Procedure Notes

Hello People,

Thought some of you might be interested in the procedure notes from my ablation on Oct 17th with Dr. Natale:
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Lab Staff: Andrea Natale, MD
Lab Fellow: George Joseph, MD (turns out this was the famous Dr. Lipitor who discharged me, was very cocky & I didn't like him at all)
EP Follow-up Physician: Andrea Natale, MD
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Procedure: Electrophysiology study and radiofrequency ablation
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Indications for Procedure: Evaluation of a patient with recurrent arrhythmia for possible ablative therapy
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Summay Findings:

CONTROL
1. Sinus node function was normal
2. AV nodal testing revealed normal function
3. Infranodal conduction was normal
4. Response to Carotid Sinus massage was normal

ABLATION
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Additional Comments:

The patient arrived to the EP laboratory in atrial fibrillation. After catheter placement, left atrial instrumentation was achieved with double transseptal access. The circular mapping catheter was placed in the PV's and the patient was cardioverted. Atrial fibrillation immediately restarted with firing from both left and right PV's. Isolation was started in atrial fibrillation. After isolation of the left PV's the patient spontaneously converted to sinus rhythm. Short self terminating episodes of atrial fibrillation from the right PV's were still seen and terminated after isolation of the right PV's. Following isolation catheters were moved back to the right atrium and the SVC was instrumented. No potientials were recorded at this site. The atrial flutter line(this was done in a previous ablation in 1999 at the Univ of Alabama) was reassessed and showed complete bidirectional block. The patient tolerated the procedure well.

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Patient History:

59y.o. WM with h/o paroxymal atrial fibrillation for 15 years. Patient has failed therapy with flecanide and rhythmol. Patient comes for a pulmonary vein isolation.
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Patient Profile:

Age:59
Gender: Male
Race: White
Cardiac Diagnosis: No structural heart disease
NYHA Class:II
LV function: ECHO: Ejection fraction 0.50
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Procedure Profile:

Fluoroscopic Time: 66.9 min

Sedative Drugs: Versed 10mg
Etomidate 8mg
Fentanyl 585 mcg
Anticoagulants: Heparin
Protamic (reversal agent)
Vascular Access: 8F sheath, right jugular vein
8F sheath, right femoral vein
8F sheath, right femoral vein
11F sheath, left femoral vein
Recording sites: Coronary Sinus
Intracardiac Echo was used:
with doppler to measure pulmonary blood flow pre and post
procedure
to assist with the transeptal puncture
to observe the catheter/tissue interface

Jim I had an experience with on patient who used the formulation which I talked with you about for atrial fibrillation, before and after having the ablation, which made him heal smoothly with less arrythmias, with no retouch ablations.

Jim,

I am astounded at how advanced the ablation procedure has become. A cure for AFIB today in most cases requires only a four hour painless procedure in the hands of Dr. Natale. Ten years ago the only cure was death.

We picked the right guy!

Newman

Hi Jim - Thanks for this - I'll be getting mine soon and will compare with your report.

Yep, Dr. Joseph was the discharge doc I had as well. In fact, the minute he came in I could sense from his body language he was the one you and Newman mentioned as "Mr. Personality." I tried my usual charm on him and he didn't falter.

However, I did get his interest up a bit when I asked if he would explain the physiology of what influence Lipitor has on the cells wrt the inflammation factor. He sort of explained it but then threw in a couple of large medical terms which he chewed up and spit out as he spoke so I didn't quite get it...but I understood enough to get that blood cholesterol in the vacinity of the PV ostea was irritating or caused the inflammation so they wanted to keep cholesterol low while the healing was taking place. I could tell he wanted me to know he knew everything and that I wouldn't understand it even if he explained it.

He was unable to make eye contact. He just couldn't look at me and talk and I'm not that difficult to look at!!

Poor guy, he's probably one of those brillian men who is a better plumber than a PR man but has drawn the short straw for some reason and has part of his duties doing discharge time. I'm sure he hates it. I also know he would never instill my confidence in him to do my ablation with his demeanor. I suppose he'll find that out as he gets into the real world.

Later on, I asked who he was and was told he was not on Dr. Natale's staff but was one of the EP fellows.

My procedure time must have been under 3 hours because I wasback in the holding area at 10 am having walked into the EP lab at almost 7:30.

Indeed, Newman, we did choose the right man. Bless Dr. Natale.

Jackie

Jim, Newman, Jackie:

Jim...Thanks for posting your procedure notes. It gives us more of an idea of the elements of the procedure. How/when did you get them? When I called to have them sent they said I would have to go thru the cardio. to whom they were sent here (who I had listed as local Dr.). The first set is free to the local attending physician; the next is $50. I would like to have them for future reference should I need to see someone else here. I don't believe, however, that after all we have paid! that there should be an extra charge.

I, too, had the same Dr. J / "Personality" (or lack thereof, for sure). In fact, he was the MD/Fellow who places the catheters prior to Dr. Natale doing the ablation. I hope he is better technically than socially. I asked for a prescription for lipitor and he walked off. The nurse ran after him. (He may not have heard me.) He was not there at my first visit in August. I couldn't be happier because I've been in sinus rhythm for almost two weeks now. May God bless Dr. Natale!

Char - so glad to hear from you and that your are in NSR. You've been on my mind ever since you went in. After you've been through so much for so long, it truly must be heaven for you.

I agree. God Bless Dr. Natale.

Strange about Dr. Joseph, though. Odd duck. As I said, he should stick to plumbing and skip the PR portion.

Thanks for your good news.Best regards, Jackie