Dr. Natale

Re: Dr. Natale

MadMax — Wed, 20 Feb 2019 17:51:54 +0000

I have no experience with ablation or the doctors who do it. However, I just had a bit of a complicated procedure and want to weight in on specialized doctors.

When I found out I might have the surgery, I fully researched doctors, made my list in order of priority and sent my records off to the top three I picked.

My top pick has done over 10,000 open heart surgeries, and the hospital was incredibly impressive, and he agreed to take my case.

Two years later, my number was up, he cut me open and the procedure went amazingly well. Every aspect of it - family support, billing, nurses, information, and decision guidance.

I'm lucky and learned a lot.

Re: Dr. Natale

montos — Mon, 24 Dec 2018 08:17:51 +0000

Shannon,
Don’t forget Dr. Hocini. I would put her on par with Jaïs and Haissaguerre. Of course I’m somewhat biased since she performed my ablation.

Monty

Re: Dr. Natale

Shannon — Sun, 09 Dec 2018 20:57:46 +0000

FYI, mcwf

The approximate figures are close to the mark for Prof's Jais and Haissaguerre, though they should closer to around 9,000 each at this stage of their careers, while Dr Natale is easily above the 11,000+ mark by now as the single most experienced ablationist on the planet.

Though, off course, it goes without saying that anyone with approx 9,000 ablations under their belts obviously possess an elite level of experience. At these levels of elite experience, it is proof positive of an outstanding track record for success overall, hence the ability to earn the trust of so many referring physicians and patients, which is not at all easy to earn ... not at anything like these sky high levels!

Furthermore, Natale is significantly ahead of the curve in the shear percentage of his cases that are LSPAF or Persistent which equals over 75% of his total case load!! This is a truly Astounding percentage of the most challenging cases referred to him from not only around the US, but also world-wide. It is not possible to duplicate this level of trust and experience without essentially mirroring Natale's unprecedented career path.

Shannon

Re: Dr. Natale

SueChef — Thu, 22 Nov 2018 20:27:05 +0000

Thanks for this post and the interesting read! I'm always learning!
Sue

(oops! Edited because I forgot something!)

Re: Dr. Natale

rocketritch — Tue, 20 Nov 2018 17:07:09 +0000

Quote
wolfpack

I would suspect that when you request your local records to be sent to Dr Natale your local EP/Cardiologist will know of the request but should not challenge you as the patient making the request.

Unlikely he or she would even know of the request. It'll be handled by front office folks. Also, it'd be illegal for them (or any doctor in this country) to not honor the request. They are your records, by law, and you decide what happens to them in all cases and at all times.

I actually had to fill out paperwork to have my records released. My EP does not keep his at his office. However, He and his staff both helped to speed the process along. My cardiologist sent records same day.

Re: Dr. Natale

wolfpack — Tue, 20 Nov 2018 16:45:14 +0000

Quote
JakeL
I would suspect that when you request your local records to be sent to Dr Natale your local EP/Cardiologist will know of the request but should not challenge you as the patient making the request.

Unlikely he or she would even know of the request. It'll be handled by front office folks. Also, it'd be illegal for them (or any doctor in this country) to not honor the request. They are your records, by law, and you decide what happens to them in all cases and at all times.

Re: Dr. Natale

JakeL — Mon, 19 Nov 2018 04:40:15 +0000

Dr Natale will need your local records before giving approval for an ablation. I would suspect that when you request your local records to be sent to Dr Natale your local EP/Cardiologist will know of the request but should not challenge you as the patient making the request.

Dr Natale has approved me for a one-trip consult/procedure in Austin sometime next year. I have switched to a Medicare Advantage PPO plan during this fall 2018 enrollment period and see that I have been approved by Medicare to start this PPO plan on 1/1/2019.

When I get my new Medicare Advantage card (in 1-2 weeks) Dr Natale's office wants to have a copy (to verify that Dr Natale and the hospital will be paid) and then I can scheduled the procedure with them. I am expecting that my new PPO Medicare card will be marked with "Passport", which will give me In-Network pricing in Texas (we will see).

Re: Dr. Natale

GeorgeN — Fri, 16 Nov 2018 19:06:34 +0000

I believe Shannon said the probability of lifetime AC after LAA isolation was 58%, on the initial 6 month exam.

My friend from Houston was the first person Shannon had met who had more burn time than Shannon on his index ablation. Then he got LAA isolation on #2. It took 2? years, but my friend's parameters, which were not in the good range after the ablation improved enough that he is now off all meds (at 67).

This is a quote from Shannon to my friend in an email:

Quote
Shannon
Always good to hear and it’s true some LAA Isolation patients who are borderline during their initial 6 month post LAA-Isolation TEE scan, but miss the passing grade that is now 45cm/sec or greater, will go on to pass a future exam that shows all 3 metrics are passed:

1. LAA Emptying Velocity of: >/=45cm/sec
2. A consistently robust Doppler A-Wave into the Mitral Valve Inflow area measurement.
3. Complete absence of any ‘Smoke’ or SEC (Spontaneous Echo Contrast) in both the LA and within the LAA.

These three metrics much all earn a passing grade to earn the right to stop OAC for folks with LAA isolation ... and ONLY if the person’s systemic stroke risk score (CHADS-VASc score) is
If stroke risk score is greater than 2.0 most EPs will insist on either continued Eliquis and/or to go for LAA Closure and sometimes even then an OAC drug (possibly at half dose) might still be required for those with higher systemic (non-LAA/AFIB related) stroke risks.

About 58% of LAA isolation patient do not pass the initial post 6 month LAA-iso TEE test and thus need to stay with either OAC or LAA Closure. But that leaves ~42% of LAA-ISO patients who stand a great chance of stopping all blood thinners plus have all atrial arrhythmia out of your life long-term. The ultimate ‘win-win’!

That is WAY better odds of getting off a blood thinner than just avoiding LAA Isolation for those with LAA triggering their AFIB/AFlutter/ATachy. And which only insures 100% need for life long blood thinner for this class of patients who will also morph into Persistent/LSPAF, if they have not already!!

Re: Dr. Natale

Kleinkp — Fri, 16 Nov 2018 14:28:08 +0000

Not taking AC just on the flec/met daily.

Re: Dr. Natale

GeorgeN — Fri, 16 Nov 2018 02:20:31 +0000

Quote
Kleinkp

Norma precautioned me depending on where and the aggressive nature of the ablation. The possibility of being on blood thinners for long term after procedure. She said unlikely in my case but non the less she put that out there, which I appreciated the candidness.

If he has to isolate the left atrial appendage (LAA), which would likely be in a second procedure if needed, then you may need lifetime anti coagulation (AC) or another procedure to place a screen that the blood coming out of the LAA would go through - screening for clots. '

If you need AC now, then if you don't fix the afib, that will continue for life also.

Re: Dr. Natale

Kleinkp — Thu, 15 Nov 2018 21:41:04 +0000

Quote
Carey

I here of many stories of Dr. Natale treating patients that have failed ablations and tough cases. Will Paroxysmal AF with no failed ablation fall under his expertise?

Of course. He takes routine cases right along with the hard cases.

Spoke with Norma Dr. Natale nurse today!!

She was very candid and professional. She let me know this is not a cure and possibilities of needing future care for AF is likely.

Norma's having Dr. Natale review my record and see what he recommends. She said in the past he recommended the procedure when AF was stopping you from day today life and or fear of AF was greatly affecting your life. Now he's leaning towards sooner the better.

Norma precautioned me depending on where and the aggressive nature of the ablation. The possibility of being on blood thinners for long term after procedure. She said unlikely in my case but non the less she put that out there, which I appreciated the candidness.

Paraphrasing/translating in my layman's terms our conversation we had today:). Norma seems like a well informed very smart nurse and would hate to have misrepresented her information.

Any insight on this info would be appreciated.

Thanks,
Kevin

Re: Dr. Natale

wolfpack — Thu, 15 Nov 2018 20:19:12 +0000

Dr. Natale's technique, as I understand it from reading here, is to "glide" the catheters along the pulmonary vein antra so as to create a continuous lesion as opposed to burning the "dots" that most other EPs do (think of a complete circle versus a "connect-the-dots" circle). There's at least anecdotal evidence here to suggest this creates better and more durable vein isolation. Apart from that, he also excels in ablating areas outside the pulmonary veins such as the coronary sinus, posterior wall and left atrial appendage (LAA). I know less about this as I've never had those areas ablated myself. At least not yet anyway.

As far as telling your current EP that you wish to see another EP goes, that should not - or ever - be an issue. No professional healthcare provider (EP or not) should ever take umbrage at a patient telling him or her that they would like to see another provider. Should a doctor react poorly to that then it is an excellent indication that you made the right choice in moving on from him or her!

Re: Dr. Natale

Carey — Thu, 15 Nov 2018 19:48:04 +0000

Quote
Kleinkp
I here of many stories of Dr. Natale treating patients that have failed ablations and tough cases. Will Paroxysmal AF with no failed ablation fall under his expertise?

Of course. He takes routine cases right along with the hard cases.

Re: Dr. Natale

mwcf — Thu, 15 Nov 2018 16:59:01 +0000

Quote
Kleinkp
Haven't mentioned Dr. Natale, but he has said make sure if not him a high volume clinic.

I here of many stories of Dr. Natale treating patients that have failed ablations and tough cases. Will Paroxysmal AF with no failed ablation fall under his expertise?

Thanks,
Kevin

Heck yeah - you ought to be a walk in the park for Natale!

Re: Dr. Natale

Kleinkp — Thu, 15 Nov 2018 14:21:04 +0000

Haven't mentioned Dr. Natale, but he has said make sure if not him a high volume clinic.

I here of many stories of Dr. Natale treating patients that have failed ablations and tough cases. Will Paroxysmal AF with no failed ablation fall under his expertise?

Thanks,
Kevin

Re: Dr. Natale

rocketritch — Thu, 15 Nov 2018 14:14:35 +0000

Quote
Kleinkp
Dr. Natale in network and I'm blessed with $1600 max out of pocket annually then covered at 100%.

Is there any info/articles that explain his techniques that make him such an allstar.

Sure my local EP will understand and if not I'll have to go elsewhere to find local care.

Thanks,
Kevin

Have you mentioned Dr Natle to your EP?
When I mentioned that I was persuing having Dr Natale perform an ablation for me, my EP's exact words were that if I could have Dr Natale do the procedure that I should. My current EP had performed 2 ablations on me at that point felt he had done all he could or me.
I"m assuming from your post that this will be your first ablation so why not start with the best?

Re: Dr. Natale

Kleinkp — Thu, 15 Nov 2018 12:18:28 +0000

Dr. Natale in network and I'm blessed with $1600 max out of pocket annually then covered at 100%.

Is there any info/articles that explain his techniques that make him such an allstar.

Sure my local EP will understand and if not I'll have to go elsewhere to find local care.

Thanks,
Kevin

Re: Dr. Natale

mwcf — Thu, 15 Nov 2018 09:21:48 +0000

Quote
Joe
It's your body and you pick the best you can afford especially at your age.

Mentioned to my EP the success rate of Bordeaux ablation experts. He was aware of their work but said that it could not be replicated (their success rate) in other centers.
I brought up the idea that it is the operator (and not the method/technique)who makes the biggest difference and he agreed.

Best of luck!

Whilst good to read having recently been to Bordeaux myself, having been hanging around here on this forum for almost 20 years I think you can safely take it to the bank that Natale and a few others (eg Di Biase & Hongo) in the US are definitely on a par. And yes it's definitely operator experience that counts - both Jais (Bordeaux) and Natale (Austin) will have by now done in excess of 8000 AF ablation procedures each.

Re: Dr. Natale

Carey — Thu, 15 Nov 2018 06:36:30 +0000

Quote
Kleinkp
I feel alittle bad telling my local EP I'm going to another EP for the procedure.

Then don't. It's not like you need permission or he's your girlfriend or something. :)

I told mine in advance and he was fully supportive. I continue to see him today for follow-up visits because of that. He proved he was more interested in my health than his ego.

Re: Dr. Natale

Joe — Thu, 15 Nov 2018 04:04:10 +0000

It's your body and you pick the best you can afford especially at your age.

Mentioned to my EP the success rate of Bordeaux ablation experts. He was aware of their work but said that it could not be replicated (their success rate) in other centers.
I brought up the idea that it is the operator (and not the method/technique)who makes the biggest difference and he agreed.

Best of luck!

Dr. Natale

Kleinkp — Thu, 15 Nov 2018 03:26:44 +0000

38yrs old. Have had afib for 7+ years been on flecanide/met for last 4+ years. Works ok but few break through episodes a year seconds to as much as 60 hrs being the longest episode. Seems more frequent lately or they get to my psyche more with age.

That said I'd really like to know how Dr. Natale procedure,techniques differ from other EP.

Any insight would be much appreciated, I have a call out to his nurses to get on his list. I feel alittle bad telling my local EP I'm going to another EP for the procedure.

Thanks,
Kevin