Atrial Fibrillation Forum - AFIBBERS FORUM

Atrial Fibrillation Forum - AFIBBERS FORUM A forum for sharing experiences regarding atrial fibrillation and other atrial tachy-arrhythmias. https://www.afibbers.org/forum/list.php?9 Thu, 10 Sep 2026 13:13:02 +0000 Phorum 5.2.23 https://www.afibbers.org/forum/read.php?9,201631,201888#msg-201888 Re: Kardia interference https://www.afibbers.org/forum/read.php?9,201631,201888#msg-201888 WildHare AFIBBERS FORUM Wed, 09 Sep 2026 04:20:33 +0000 https://www.afibbers.org/forum/read.php?9,201884,201887#msg-201887 Re: trigger finding https://www.afibbers.org/forum/read.php?9,201884,201887#msg-201887
And if you're on traditional Medicare with a decent Medigap policy, you shouldn't be paying a single dime for anything once you've met your plan B deductible, which is $283 for 2026. If you're paying more than that, I recommend reviewing your coverage choices.]]> Carey AFIBBERS FORUM Tue, 08 Sep 2026 03:04:00 +0000 https://www.afibbers.org/forum/read.php?9,201884,201886#msg-201886 Re: trigger finding https://www.afibbers.org/forum/read.php?9,201884,201886#msg-201886 stahoo AFIBBERS FORUM Mon, 07 Sep 2026 17:15:04 +0000 https://www.afibbers.org/forum/read.php?9,201884,201885#msg-201885 Re: trigger finding https://www.afibbers.org/forum/read.php?9,201884,201885#msg-201885
The two big risks for afib are stroke and cardiomyopathy. A blood thinner would reduce the stroke risk. Cardiomyopathy comes from having your heart rate too high for too long,. My recollection is this for many days and weeks, not hours. The Metoprolol would reduce this risk, but it seems like a) you know when you are in afib and b) your episodes aren't too long, the longest being 13 hours and c) you can convert any epidodes now quickly. Many docs are worred that a person is in afib and does not know it, hence they could be with a high heart rate for long periods of time and at risk for cardiomyopathy (from your story, this does not seem like you). I presume that is your doc's logic for wanting the monitor - to see how much you are in afib and what your heart rate is doing.]]> GeorgeN AFIBBERS FORUM Mon, 07 Sep 2026 15:51:09 +0000 https://www.afibbers.org/forum/read.php?9,201884,201884#msg-201884 trigger finding https://www.afibbers.org/forum/read.php?9,201884,201884#msg-201884 stahoo AFIBBERS FORUM Mon, 07 Sep 2026 14:47:11 +0000 https://www.afibbers.org/forum/read.php?9,201852,201883#msg-201883 Re: Starting new thread on Isolating LAA topic https://www.afibbers.org/forum/read.php?9,201852,201883#msg-201883 how would one find one of these elite EPs who get good results converting persistent A-fib without isolating the LAA?

I would start by looking for EPs at the top ten-rated cardiac hospitals such as Johns Hopkins, Mayo Clinic, Mount Sinai, and Penn Medicine.

Alternatively, in complicated cases, or where past catheter ablations have failed, consider surgical ablation such as the hybrid convergent or the Wolf procedure, where success rates are at least comparable to LAA isolation, but with the added benefit of clipping the LAA, so patients can often stop taking anticoagulants entirely vs anticoagulation for life and/or Watchman for LAA isolation.

It’s unfortunate that when you spoke to Natale, not only didn’t you know about LAA isolation, but he never brought it up.

But it’s not limited to Natale. Many EPs assume you’re leaving it all up to them, which is an option many seem comfortable with.

But personally, I like to do as much research in advance as possible so I can better ask questions and better analyze how well their approach aligns with what I want.

Treatment philosophies vary from EP to EP. So in the end, the best EP for one person may not be the best for someone else.

Jim]]> mjamesone AFIBBERS FORUM Sun, 06 Sep 2026 18:29:10 +0000 https://www.afibbers.org/forum/read.php?9,201852,201882#msg-201882 Re: Starting new thread on Isolating LAA topic https://www.afibbers.org/forum/read.php?9,201852,201882#msg-201882
I was told the hope was to get off Eliquis entirely if my atria shrink back down to normal size. I was told the chances of that were on the order of 60%. But the response to Qwackertoo's thread about reverse remodeling was not real encouraging.

So for the benefit of others who have not committed yet, how would one find one of these elite EPs who get good results converting persistent A-fib without isolating the LAA? Dr. Natale's name comes up here repeatedly, but what are the names of the doctors who follow the different school of thought?

Lastly, I have trouble having faith in cardioversions long term. The one I had prior to my ablation did not last a week. Prior to that cardioversion, my Cardiologist put on the happy face that one jolt my revert me to NSR permanently. But when she read the EKG saying I was back in A-fib, her demeanor gave her away that this was what she expected all along.

Plus, I read where others have had dozens of cardioversions. But that does not mean that one may not do the trick after most of the pathways for spurious signals have been ablated.

Other than the risks involved every time one has a procedure, it seems logical that a person would not get the LAA ablated on the first ablation. But a surgeon with a lot of experience is going to feel qualified to use their best judgement while in the operating room. It is a discussion I wish I could have had ahead of time, but I didn't know to ask.]]> nonthumper AFIBBERS FORUM Sun, 06 Sep 2026 01:44:52 +0000 https://www.afibbers.org/forum/read.php?9,201852,201881#msg-201881 Re: Starting new thread on Isolating LAA topic https://www.afibbers.org/forum/read.php?9,201852,201881#msg-201881 fter 24 months, about 76% of patients who had the LAA isolation procedure stayed free of irregular heart rhythms.

George, that 76% includes repeat ablations. The single procedure success rate in the BELIEF trial was 56%

Natale was listed as an investigator in both trials. I don' know how many of the ablations he himself performed. And even if he did incrementally better because of his elite skill set, I think we are starting to deviate from the main subject. Which is whether a higher success rate is justified by increasing the thrombotic rate from LAA isolation. That's something everyone has to decide for themselves, and I think we've had a good discussion on that.

Jim]]> mjamesone AFIBBERS FORUM Sat, 05 Sep 2026 16:20:12 +0000 https://www.afibbers.org/forum/read.php?9,201852,201880#msg-201880 Re: Starting new thread on Isolating LAA topic https://www.afibbers.org/forum/read.php?9,201852,201880#msg-201880

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mjamesone
Jim: I get 56% and 63.5%. Sources: BELIEF and ADVANTAGE AF trials.

Looking at BELIEF from Gemini AI summary:
Higher Success Rate: After 24 months, about 76% of patients who had the LAA isolation procedure stayed free of irregular heart rhythms.
Standard Comparison: Only 56% of patients who received standard ablation without LAA isolation remained free of abnormal heart rhythms.

These data are for all EP's in study, not limited to AN.]]> GeorgeN AFIBBERS FORUM Sat, 05 Sep 2026 12:14:42 +0000 https://www.afibbers.org/forum/read.php?9,201852,201879#msg-201879 Re: Starting new thread on Isolating LAA topic https://www.afibbers.org/forum/read.php?9,201852,201879#msg-201879 : Last time I saw (Dr. Natale’s) published numbers, his success rates for LSPAF are a little over 90%.

I get 56% and 63.5%. Sources: BELIEF and ADVANTAGE AF trials.

As to LAA isolation increasing thrombotic risk. No one, even Natale. disagrees. That’s why his safety profile includes anticoagulation for life and/or Watchman. It's a trade off. Personally, I wouldn't take it and if it came down needing it, I'd go with a surgical ablation such as the Wolf Procedure with AtriClip. Also better results for LSPAF, but no anticogulation needed after.

Jim]]> mjamesone AFIBBERS FORUM Sat, 05 Sep 2026 01:31:35 +0000 https://www.afibbers.org/forum/read.php?9,201852,201878#msg-201878 Re: Starting new thread on Isolating LAA topic https://www.afibbers.org/forum/read.php?9,201852,201878#msg-201878

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mjamesone
I doubt he even does better than other elite EPs at high volume centers do with PAF. And dispute he does better with LSPAF than other elite EP does with PAF. He may do better than other eltes comparng LSPAF with LSPAF, but again the trade off might be a higher thrombotic risk.

I wasn't comparing him to other elites. I was comparing him to the widely published success rates for EPs across the profession, which run about 75% for PAF and 45-50% for LSPAF. Last time I saw published numbers, his success rates for LSPAF are a little over 90%.

As for thrombotic risk, if he created more thrombotic risk than other EPs, that would show up in his data and it doesn't. Unlike most EPs, he actually publishes his numbers.

Also, if you look at the attendees list at ISLAA, you'll find most of those elites are on it. I suspect you underestimate how many EPs do LAA isolation these days, particularly with LSPAF. And the ones who do are pretty much all elites.]]> Carey AFIBBERS FORUM Fri, 04 Sep 2026 22:26:26 +0000 https://www.afibbers.org/forum/read.php?9,201859,201877#msg-201877 Re: Strenuous exercise after PFA https://www.afibbers.org/forum/read.php?9,201859,201877#msg-201877
As you age, bumps in the road will occur more and more frequently. Meaning, sitting out for a period of time while things heal will become more common. I just missed three golf outing over the last 10 days while surgery on my upper back to remove a basal cell cancer is healing. I also missed three weigh work outs (just upper body) as well. You will find that your level of fitness fades much quicker as you age, so any interruption is a bummer.]]> Ken AFIBBERS FORUM Fri, 04 Sep 2026 12:38:58 +0000 https://www.afibbers.org/forum/read.php?9,201859,201875#msg-201875 Re: Strenuous exercise after PFA https://www.afibbers.org/forum/read.php?9,201859,201875#msg-201875 Jeff W AFIBBERS FORUM Thu, 03 Sep 2026 21:17:51 +0000 https://www.afibbers.org/forum/read.php?9,201829,201874#msg-201874 Re: 0 Chads vasc score and cardioversion https://www.afibbers.org/forum/read.php?9,201829,201874#msg-201874 susan.d AFIBBERS FORUM Thu, 03 Sep 2026 17:00:22 +0000 https://www.afibbers.org/forum/read.php?9,201859,201873#msg-201873 Re: Strenuous exercise after PFA https://www.afibbers.org/forum/read.php?9,201859,201873#msg-201873 P K AFIBBERS FORUM Thu, 03 Sep 2026 15:22:34 +0000 https://www.afibbers.org/forum/read.php?9,201859,201871#msg-201871 Re: Strenuous exercise after PFA https://www.afibbers.org/forum/read.php?9,201859,201871#msg-201871 JDfiB AFIBBERS FORUM Thu, 03 Sep 2026 01:02:16 +0000 https://www.afibbers.org/forum/read.php?9,201859,201870#msg-201870 Re: Strenuous exercise after PFA https://www.afibbers.org/forum/read.php?9,201859,201870#msg-201870
The organist at our church is an avid kayaker on the open ocean and hiker....he and his missus. He told me he was out on the water 48 hour after his ablation. He was 77 at the time.]]> gloaming AFIBBERS FORUM Thu, 03 Sep 2026 00:39:44 +0000 https://www.afibbers.org/forum/read.php?9,201859,201869#msg-201869 Re: Strenuous exercise after PFA https://www.afibbers.org/forum/read.php?9,201859,201869#msg-201869 nonthumper AFIBBERS FORUM Thu, 03 Sep 2026 00:32:40 +0000 https://www.afibbers.org/forum/read.php?9,201852,201868#msg-201868 Re: Starting new thread on Isolating LAA topic https://www.afibbers.org/forum/read.php?9,201852,201868#msg-201868 He really doesn't ablate much of anything empirically.

We both seem to agree that he does for persistent, which involves many of us, including myself and the Mayo poster who had successful ablations without the isolation,

Carey:
But here's the thing: I'm aware there are EPs who disagree with him on this, but I'm unaware of any EPs who can match his success rates with LSPAF. He does better with LSPAF than EPs as a whole do with paroxysmal, which is quite an achievement. I find it very difficult to argue with superior results.

I doubt he even does better than other elite EPs at high volume centers do with PAF. And dispute he does better with LSPAF than other elite EP does with PAF. He may do better than other eltes comparng LSPAF with LSPAF, but again the trade off might be a higher thrombotic risk.

Jim]]> mjamesone AFIBBERS FORUM Thu, 03 Sep 2026 00:09:00 +0000 https://www.afibbers.org/forum/read.php?9,201858,201867#msg-201867 Re: Interatrial septum healimg https://www.afibbers.org/forum/read.php?9,201858,201867#msg-201867
Ever heard the term patent foramen ovale? We're all born with a hole in our septum that's quite a bit larger than that needle poke. In most people, it closes naturally within a few months after birth. But in some people it doesn't fully close and they live their entire lives with a hole in their septum that they don't even know about. For the vast majority, it's no problem and nothing needs to be done about it. That itty bitty little needle hole really is of no concern.]]> Carey AFIBBERS FORUM Wed, 02 Sep 2026 23:42:03 +0000 https://www.afibbers.org/forum/read.php?9,201859,201866#msg-201866 Re: Strenuous exercise after PFA https://www.afibbers.org/forum/read.php?9,201859,201866#msg-201866
That said, I have never had any EP tell me to restrict my physical activities other than no heavy lifting for one week. However, I did receive blessings from one EP to do a 50-mile bike ride in hilly terrain 3 days after an ablation. The other EPs I've dealt with had the same opinion: no lifting but otherwise no restrictions.

So my advice to PK would be check with your EP and if they're fine with it, do what you want. You won't hurt yourself.]]> Carey AFIBBERS FORUM Wed, 02 Sep 2026 23:32:32 +0000 https://www.afibbers.org/forum/read.php?9,201852,201865#msg-201865 Re: Starting new thread on Isolating LAA topic https://www.afibbers.org/forum/read.php?9,201852,201865#msg-201865

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mjamesone
The fact that LAA isolation was the step that terminated your AF doesn’t necessarily mean it was necessary for success. The alternative wasn’t going home in AF, as they could have cardioverted you. That’s what they did with me, and I have been AF free since.

He isolated the LAA because he mapped afib signals originating there. I know this because I've read a couple of dozen afib procedure reports from Natale patients, I've heard him speak at conferences, and I know he does that routinely. He really doesn't ablate much of anything empirically. He's all about mapping and generally does it more extensively than most EPs. He's also about challenging the afib when he thinks the procedure is complete. He often spends an additional 20+ minutes doing that using isoproterenol and pulsed electrical stimulation. If he provokes an arrhythmia, he maps that and ablates it. Sometimes that mapping happens to point to the LAA.]]> Carey AFIBBERS FORUM Wed, 02 Sep 2026 23:24:51 +0000 https://www.afibbers.org/forum/read.php?9,201852,201864#msg-201864 Re: Starting new thread on Isolating LAA topic https://www.afibbers.org/forum/read.php?9,201852,201864#msg-201864

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mjamesone
From a Natale authored paper in 2020:

[www.jacc.org]

'We feel that in patients with non-paroxysmal AF, especially longstanding persistent AF, LAA should be isolated (no focal ablation) without evidence of triggers "

I'm aware of that statement but the important words are with non-paroxysmal AF, especially longstanding persistent AF. Specifically, he does not do empiric LAA isolations with paroxysmal afib.

But here's the thing: I'm aware there are EPs who disagree with him on this, but I'm unaware of any EPs who can match his success rates with LSPAF. He does better with LSPAF than EPs as a whole do with paroxysmal, which is quite an achievement. I find it very difficult to argue with superior results.]]> Carey AFIBBERS FORUM Wed, 02 Sep 2026 23:09:11 +0000 https://www.afibbers.org/forum/read.php?9,201852,201863#msg-201863 Re: Starting new thread on Isolating LAA topic https://www.afibbers.org/forum/read.php?9,201852,201863#msg-201863 Natale only isolated my LAA when I remained in A-fib after he ablated the "safer" areas. Once he isolated my LAA, I converted to NSR.
So that would make it appear Natale did no more than he had to.

Not really. It just shows his approach is different.

The fact that LAA isolation was the step that terminated your AF doesn’t necessarily mean it was necessary for success. The alternative wasn’t going home in AF, as they could have cardioverted you. That’s what they did with me, and I have been AF free since.

See the randomized CAPT-AF trial. It compares stopping after a predefined lesion set and then cardioverting versus additional lesion sets. No significant improvement in the primary arrhythmia-free endpoint with the termination strategy.

Now that doesn't mean isolating your LAA didn't give you a better chance, we really don't know, but what we do know is that it came at the expense of a greater thrombotic risk.

[www.heartrhythmjournal.com]]]> mjamesone AFIBBERS FORUM Wed, 02 Sep 2026 19:24:23 +0000 https://www.afibbers.org/forum/read.php?9,201859,201862#msg-201862 Re: Strenuous exercise after PFA https://www.afibbers.org/forum/read.php?9,201859,201862#msg-201862 seeing the recent post about the young soccer player returning in 6 weeks

He's 25, makes $150,000 a game and his PFA sounds like a right-sided SVT without a septum puncture. I would not decide on what so and so does, or the callendar, but by how you feel and what the doctor says. Personally, I'd err on the conservative side to give the ablation its best chance of holding.

Jim]]> mjamesone AFIBBERS FORUM Wed, 02 Sep 2026 17:10:08 +0000 https://www.afibbers.org/forum/read.php?9,201859,201861#msg-201861 Re: Strenuous exercise after PFA https://www.afibbers.org/forum/read.php?9,201859,201861#msg-201861 GeorgeN AFIBBERS FORUM Wed, 02 Sep 2026 16:51:41 +0000 https://www.afibbers.org/forum/read.php?9,201858,201860#msg-201860 Re: Interatrial septum healimg https://www.afibbers.org/forum/read.php?9,201858,201860#msg-201860 gloaming AFIBBERS FORUM Wed, 02 Sep 2026 16:28:23 +0000 https://www.afibbers.org/forum/read.php?9,201859,201859#msg-201859 Strenuous exercise after PFA https://www.afibbers.org/forum/read.php?9,201859,201859#msg-201859 P K AFIBBERS FORUM Wed, 02 Sep 2026 16:27:20 +0000 https://www.afibbers.org/forum/read.php?9,201858,201858#msg-201858 Interatrial septum healimg https://www.afibbers.org/forum/read.php?9,201858,201858#msg-201858 P K AFIBBERS FORUM Wed, 02 Sep 2026 16:14:32 +0000 https://www.afibbers.org/forum/read.php?9,201774,201857#msg-201857 Re: Ablation EP - Toronto https://www.afibbers.org/forum/read.php?9,201774,201857#msg-201857 second; he does not induce AFIB if I am in NSR at time of ablation. He said that with PFA he can get to it..

This is standard for an initial PVI ablation and study data backs this as the best approach weighing benefits and risks.

In general, no proven benefit inducing AF and chasing additional targets beyond the pulmonary veins on first ablation for paroxysmal, and in fact doing more can add unecessary burn lines and potentially even create new arrythhmias. Plus studies have shown that inducing an arrythmia in the lab does not mean that the arrhthmia would be induced in real life.There are exceptions of course, such as significant atrial scarring.

I had a successful PVI three years ago. I was also in NSR at the time, which my EP prefers. They did not try and induce. Very happy with the outcome and hopefully you will be as well,

Jim]]> mjamesone AFIBBERS FORUM Wed, 02 Sep 2026 16:08:08 +0000