statistics for Natale

Hi Everyone - I just had my appointment with my local EP in Calgary and he said I was a very good candidate for an ablation with low risk of stroke. But I don't like his statistics. He has done somewhere between 500 and 1000 over the past 7 years. There is no guarantee I would have this particular EP and I could have someone with much less experience and I would have zero control over it. They have a 50% success rate on the first ablation and says it could go up to 75% or maybe even 80% with the second and third. They have somewhere between a 4% and 6% (it changed during the conversation) risk of complications with a mortality rate of 1/1000.

I have the brochure from Bordeaux and their statistics seem to be much better. What I find curious is the Bordeaux brochure statistics are to October 2011, instead of current.

I am leaning towards Bordeaux, but would like to make sure they are not pumping sunshine and would like to compare to Dr. Natale. Does anyone have the statistics for him?

Also the local EP said the hospital stay was for one night. Very typical of our health care system where they want to rush patients out the door.

The hospital stay in Bordeaux is for 5 days, or possibly more if there are any complications.

What is the hospital stay with Natale?

Everything else was fairly typical mainstream medicine - "there is no proof supplements work and there are no lifestyle modifications recommended".

What was interesting is he said because of my Marked Sinus Bradycardia and low blood pressure, I am not a good candidate for antiarythmics and that the best first line of defense could very well be an ablation.

He also stated that because of my almost daily afib events I am not a good candidate for the PIP protocol.

Any information about Dr Natale would be most appreciated as would any other comments about the above.

Ron

What I've heard about the top U.S. EP's who've been visited on this list is overnight hospital stays as well, probably due to the extortionate cost of being in the hospital in the U.S. My guess is that would be true of Natale as well.

Ron,

I don't have the data, but I think comparing either Natale or the Bordeaux group to your local people is comparing apples and oranges. This is because the types of patients handled by either "name" has a much larger component of very difficult cases.

Unless you happen to have US insurance, I'm guessing Bordeaux will be much more cost effective for you. IMO with either "name" choice you are in the elite league and the differences in outcomes are not material.

George

I doubt Bordeaux would ever pump sunshine actually.

Ron - as far as the actual stay... it's typically an overnight stay assuming all goes well. When people travel to Dr. Natale and Bordeaux they've indicated that they are advised to stay for 5 days or so to be sure they are doing well and can travel without incident. Several of those going to Bordeaux have reported they added on a week or so and did some sightseeing. Several of those traveling to CA or TX for Dr. Natale have also commented about staying in the area for around 5 days.

I lived about 20 miles from the main campus of CCF where I had my ablation which was the first of the morning and discharged the following afternoon around 1 pm. While I felt astoundingly great, I'm not sure I would have wanted to endure the rigors of a lengthy road trip or being confined in an airplane so if you plan to go to Bordeaux from Canada, then I'd definitely add time after the procedure.

Jackie

Hi Ron,

What researcher said is most important to appreciate. The stats for Dr Natale for example or Drs. Haissaguerre/Jais are very strong just on the numbers alone, but they represent a vast real-world improvement over the kind of 500 to 1000 ablations in 7 years kind of experience level.

The majority of cases Dr Natale handles are among the most difficult ablations that are often referred to him from all over the world who have had failed ablations elsewhere, or were deemed too risky (such as I was) to attempt an ablation by the more typical EP ablationists you will find more often in your search. So Natale's very strong figures represent a large percentage of very difficult persistent or long standing complex paroxysmal cases with other co-morbidity's that complicate the picture.

For a run of the mill standard paroxysmal AFIB ablation with short duration episodes, those ablations for EPs like Natale and the stars of Bordeaux are a walk in the park. And thus, regardless of how difficult your case may be, if you really want to give yourself the very best odds for success, then the list of truly elite maestros is much narrower to choose from. And when it comes to your heart, who doesn't want to have the best chance they can possibly arrange for themselves??

Fortunately, there has been steady progress in the skill level and knowledge base among a growing list of EPs for doing the most straight forward PVI-only ablations, and it is now very possible .. and even very likely ... that you will get a good outcome even with less experienced operators these days than was true even just a couple of years ago.

However, its still a relative roll of the dice choosing anyone with less than 1,000 to 1,500 ablations under their belt, and if you or anyone you know has persistent AFIB or paroxysmal AFIB with episodes lasting longer than 24 hours or so, then by all means strongly urge them to move heaven and earth .. or whatever it takes ... to insure they put themselves in the hands of an elite-level ablationist with the most experience and solid track record in addressing such challenging cases that they can possibly arrange.

I have seen this wisdeo echoed close up so often, and not only in my own experience, but in so many others I have spoken with who have been fortunate enough to have had Dr. Natale as their EP, and the vast majority count their lucky stars even many years after that they made that wise choice.

The bottomline is, while there are growing number of excellent ablationists out there, you simply cant do any better than Natale or Bordeaux... those top guns remain the gold standard to which all others aspire.

Shannon



Edited 3 time(s). Last edit at 04/02/2013 05:59PM by Shannon.

Hi Ron, Are those Veenhuyzens stats you are quoting and why wouldn't he be the one to do your ablation? 50% success on 1st ablation, well I rolled that die once myself and still ended up with afib after my first ablation here in Edmonton with Pantano. My second ablation was with Lockwood who quoted me 60 % 1st ablation success. I ended up in aflutter after that one. Since my bordeaux ablation one year ago I have been in NSR with occasional pac's. Once I guzzled a very cold drink and went tachycardic for about ten seconds. Other then that its been 100% NSR. If money is not an issue I would most definitely go to bordeaux.

My wife accompanied me to Bordeaux and stayed in the same room with me for the 5 day stay. The first 2.5 days were spent in bed with a compression bandage wrapped around the catheter insertion site. The nurses would come in and clean and inspect a couple times a day. They were very clear on not moving around. I think another concern was the amount of fluid retention due to the ablation itself, irrigated catheter? For the first 2 days my urine output was measured to insure I was successfully eliminating the excess and then was allowed to walk the grounds that afternoon. Discharged on Friday morning and then we rented an apartment in central Bordeaux and enjoyed walking around the area and seeing the sites for the next nine days. Two wine tour excursions out of town and a rip to the Arcechon to climb Europe's biggest sand dune. Total cost was under $25000.

Adrian

I am from Calgary and had a ablation 2 years prior. The list in our city is extremely long. The notion of waiting a year when i went out of nowhere into persistent a-fib was not an alternative to me. I in the end had my ablation with Dr. Natale but really only went there because it was easier for my wife and I to go to San Fran versus France. The Calgary EP's are all trained at Bourdeaux and prefer that centre. I have been a-fib free since my ablation with Dr. Natale.

Adrian, those are the statistics that were provided verbally by Veenhyuzen and confirmed somewhat by a very thin brochure provided later. Dr V stated their mortality rate was 1:1000 whereas the brochure stated a mortality rate of 1:3000. Also during the conversation the complication rate was mentioned at various times at 4, 5 or 6%. Dr V is taking a leave soon so would not be available. Reading between the lines there may be something going on there.

Iorenzo, am I reading this right, that all of Calgary's EPs are trained in Bordeaux? Does this mean that Veenhuyzen was trained there?

What was the cost for you to see Natale?

I am fast progressing as well, and in afib at some point virtually every day, so I don't want to mess with it any longer. I can get into Bordeaux quite quickly but I have not looked into Natale because of the percieved huge price difference. I would love to hear your experience on this.
Ron

Yes, Vennhyuzen was trained at Bordeaux and if i saw him prior to seeing Natale. He knew i was not going to wait a year at age 46 so i went south. He did want me to go to Bordeuax as that is where he was trained. I do believe that all 3 EP's in Calgary are trained in France. I simply went to Natale because it was quicker to get an appointment and it was easier to get to then France. I did lots of analysis and determined both options would have been worth it. It cost me 35k not including travel costs for Natale. I am A-fib free to so hence am happy but i really think that the doctors at Bordeuax would have been successful as well. I hear that the best EP in Western Canada is Dr. Leather out of Victoria and their wait list is not unreasonable. In the end it was my heart and i wanted the best. Don't let anyone tell you it is a routine or simple procedure. The EP's in Canada just don't have the operating hours as Natale or the Bordeaux docs. happy to answer anything else.