Big News of Interest to Afibbers Forum ... Dr Natale & Salwa news!

It is my pleasure to announce that Salwa Beheiry, the long time Director of Cardiac EP and Arrhythmia Services at CPMC where she and Dr Natale have worked for so many years, today announced that she has accepted a key position at St Davids Medical Center, and thus will continue her long-term key association with Dr Natale in Austin at the ‘mothership’.

March 10th will mark the last day for both Salwa and Dr Natale at CPMC in San Fran! Anyone scheduled for a procedure with Dr Natale at CPMC past March 10th can Contact Salwa at CPMC for referral to either Austin or Los Robles Med Center in Thousand Oaks SoCal (though the coming months it is likely to be quicker for already prescheduled patients of Dr. Natale after March 10th at CPMC to switch via Salwa to St. Davids, as this will likely remain the quickest way to reset an ablation date with Dr Natale for the time being, if you already have a date set at CPMC past March 10th.

Los Robles Medical Center remains an option too for a few days a month for the time being as well, and possibly a longer time frame.

Also, Dr Natale will be returning for the same two day ablation visits per month as he did previously at Scripps Green Hospital. However, now he will be working at Scripps Memorial Med Center also in La Jolla California in order to further serve the large SoCal AFIB population with his peerless skills and unprecedented complex ablation experience while helping to train EPs in the area in the finer art of advanced catheter ablation techniques. Dr Natale’s first 2 day stint at Scripps Memorial will start the last two days of February and then each month he will spend that last two days at Scripps Memorial. His new NP at Scripps Memorial is named Kristy.

As so many of you know first hand, Salwa will be a big asset to St David’s already world class team and I was very happy to hear she will be continuing her work supporting Dr Natale’s passion for eliminating cardiac arrhythmias.

Cheers!
Shannon



Edited 5 time(s). Last edit at 01/24/2018 02:24PM by Shannon.

12 years ago Salwa shepherded my ablation procedure through Marin General Hospital with Dr. Natale. He was there before he went to CPMC. It was her efforts almost alone that got and kept Dr. Natale in the Sutter Health system bureaucracy. Drs. Hao and Hongo were both in training with him at that time.

I have been in NSR for the past 12 years but if I ever need another ablation the first call i make will be to Salwa and it well may be the last call I need to make as Salwa knows all the ropes and is a makes things happen person.

Gordon Held

Does Dr Natale have a preference where he does his most complicated cases? I ask because I have a consultation with him in San Diego on February 27th.

This is great news for us who saw Dr Natale at Scripps!
Thanks for the news Shannon.
Don

Thanks. Good to know for CA folks.

Along the same topic, I want to rant a little about a hospital mailer I just received yesterday from Memorial Healthcare (LA/OC areas). I get this along with others monthly because of a highly competitive market where I live. This specific mailer was clearly targeted at the planned retirement community near the Saddleback Memorial hospital. In it, they were advertising their expertise in placing TAVRs and new generation small pacemakers. There is nothing wrong with that. what I found disturbing was that the pacemaker article stated that that was the way to go for elderly AF patients. The example they used was an actual 80 yr old woman (she was on the cover with her daughter). No discussion on other options, no discussion of the fact that pacemaking does zilch for her AF, no discussion on implant risk and maintenance risk. The TAVR article wasn't much better in terms of framing of the diagnosis and referral.

It is a jungle out there.

May I ask what the maintenance risk is on pacemakers?

@Researcher, my conversations with cardiologists suggests that they are not necessarily misinformed about the role of pacemakers here. They are apparently used for sick sinus family of disorders, and/or where drugs are chosen to control afib leading to a depressed heart rate when not in afib. There may be valid reasons for avoiding ablation in some spectrum of elderly patients, especially those with comorbidities or generally weakened condition, and hence the drug treatment.

I think the primary risk is with the leads. There are now leadless pacemakers if you only need single chamber (RV for example) pacing. The majority will need BiVent. There you are seeing ~4% per year complication rate depending on how active one is. If you are immobile and have bradycardia, then complications are lower than those that are younger and active. The risks are dislodgement, bad placement, lead failure, infections. Even if those are ok, there will be scar buildup around the lead tips and those can cause surgical issues (had a friend that almost died on the table because of this issue during removal and replacement). Depending on longevity, there will be need for battery replacement every ~6 years or so.

safib - I get that. The article would be fine if it was written as you had explained. It wasn't. It was done to cast a wide net. "Have AF? Come see us for the simple procedure" type of deal. Terrible.

Researcher:

I have a pacemaker put in the year 1998, I had a first degree heart block caused by taking a beta blocker. It is mainly for when I convert to sinus rhythm from an AF episode, before the pacer my heart rate would almost flat line, it is set at the low of 50. I don't use it very much as the batteries lasted until about 4 years ago, that is about 15 years of battery life.

" The risks are dislodgement, bad placement, lead failure, infections. Even if those are ok, there will be scar buildup around the lead tips and those can cause surgical issues (had a friend that almost died on the table because of this issue during removal and replacement). Depending on longevity, there will be need for battery replacement every ~6 years or so"

I have been very active all those years of having my pacer--I use a heavy duty roto tiller, I spray my fruit trees, mow my over an acre of lawn etc. etc. never dislodged the pacer, never had any problems, what you have said is scary but how many people have problems like you have illustrated? There are people that have died because of having an ablation, taking blood thinner drugs, probably more so than people with pacers.

Liz

Liz, good for you and continued luck with your pacemaker. You will still need anticoagulation to take care of the stroke risk as pacing doesn't rid you of AF episodes. The friend I spoke of played tennis tournaments so a lot of rotation movements of the chest and stretching of the shoulders. In that setting, the last surgery I referred to was the sixth in 20 years. Mostly for battery replacements, once for infection, the last for lead failure.and the surgeon decided to remove old leads because of the risk of infection. 4% per year is based on registry data available from pubmed. So getting 15 yrs out of your device is excellent and reflects well on the doctor and hospital that you used. PS friend no longer plays tennis and sad about it.