Locked and Loaded with Dr Natale

Just met with the great Dr Natale and we decided to go ahead right now!
See you guys in NSR!

McHale

Just got a call from McHale while he was in the room with Dr Natale and since Dr N's schedule is particularly full tomorrow when McHale was scheduled for his ablation, and since he was there for his first meeting with Dr Natale and had been fasting for the CT Scan in any event, Dr N was able to fit him in right now so he is being prepped now as we speak, roughly 10am PST - 1pm EST for his 2pm ablation with the Maestro.

Lucky guy, with no time left for the mind to wander :-) ... Best wishes McHale for a lots of NSR in your future!

Shannon



Edited 3 time(s). Last edit at 05/28/2013 01:52PM by Shannon.

WOW - that's great service! Here's to a successful ablation and eventually no more blood thinners!

Thats the way to have it done - leave not time to prevaricate.

Shannon, you said that McHale was having a CT scan. I have the impression that not all Dr's require a CT scan before or after an ablation. Do you know if a refusal to have a CT scan would be a deal breaker with Dr Natale? Thanks, Dennis

Hi Dennis, not necessarily a deal breaker, depending on the degree of AFIB. If it looks like a simple PVI it may not be as big a deal.. It also helps give very accurate coordinates to coorelate your actual Left and right atrial anatomy with the Carto 3 real time imagining for even more precise location and burns for real time and anatomical triggers..

But not everyone that has a Natale ablation is requested to have one. And often these days they don't do the follow up CT six months after ablation to check for any possible stenosis unless a lot of extra work was required very near where that might be possible.

In my experience, Dr Natale is very flexible and adaptable ... and unless he feels something is very necessary he tends not to add things in unless he feels there is a completing reason for it.
Shannon

We met you today at Dr N
Our best to you
Let us know how it went

Elena

Shannon,

You seem to be very familiar with Dr. Natale. Do you work for him? The reason that I'm asking is that I want to schedule an appt with him for a potential ablation. I'm in CA so I can travel to Scripps in San Diego or Sutter Pacific in San Francisco. Does the facility where the ablation takes place make a difference or is it all about the doctor? I've had six failed ablations - I thought I'd give it one more shot with Dr Natale if he thinks it has a chance of being successful.

Thanks,

Bruce

Thanks for the update on McHale, Shannon. I spoke to him last week and he seemed in good spirits. If he has a smartphone he might get online soon and type in a few words. Anyway, good he went through with it.,

Hi Bruce,

Sorry to hear of your long ablation history without success as yet! Nope, I don't work for Dr. Natale, I'm just a very satisfied and grateful long-time customer and have gotten to know him well over the years spent in the trenches as he has greatly helped dig me out of a couple of deep holes. I had a pretty extreme case, and thus working through all that, coupled with my own interest in learning as much as I could about it all, made for a natural connection and that's about the size of it.

Plus he is very personable, warm and very easy to like as it is, whether he was an elite ablation master or not.

I do highly recommend you go see him after six failed ablations. It might take two or so more with him to put the genie back in the bottle for the long term, but perhaps he can get it done in one more as well. Jsut keep an open view and speak with him. I would recommend for a case like yours to stick with either Austin or San Francisco for now. Possibly Al Sabah in NYC will soon be ready for prime time too for such more challenging cases with their staff? I know he is a real stickler for having the best and most competent people around him where ever he goes.

But in Austin, they have the greatest volume of difficult cases passing through, though San Fran has a good number as well and is well set for that too. It is mostly the EP wielding the catheter, by far, that is the prime thing. But its also very nice and in your best interest to pair his expertise with his most experienced staffs as well, and currently that is at Austin first and San Fran second ... NYC will likely quickly move right up there as well.

You can always go see him for the consult in San Fran, if that is more convenient, and after reviewing your case ask him point blank if he would recommend you to go to Austin for the actual ablation and do follow-up visits in San Fran? He may very well say he is equally comfortable in both places since San Fran is a very experienced center now too.

I've had the rather rare experience of having my two ablations split between Austin for the big first one to end my persistent AFIB, and then 4 years later (last August) in San Fran for what turned out to be a left atrial appendage isolation ablation to end (to-date) the atypical flutter that became too active, starting after a period of blessed quiet for about 3 years after ending my persistent AFIB in 2008, as Dr N clearly predicted would happen in my case from the beginning.

I had excellent top notch experiences in both Austin and San Francisco. The main reason I might lean a little toward Austin is soley because he is there more often and thus if your ablation is scheduled near the beginning of one of his trips back to his home base there, then if you need any follow-up care with him while there for anything, unlikely as that might be, he will certainly be there. Plus, there are 9 other highly skilled EP ablationist working with him there as well who can fill-in for follow-up duties as needed immediately post ablation for that first few days. In San Fran he has two .. or now three ... well trained colleagues. In any event, he may say flip a coin and if you first see him in San Fran he will very likely recommend doing it there unless he sees a distinct advantage due to your long ablation history.

Keep in mind that after having six failed ablations, you have either had the misfortune of some not very skilled EPs, or it may well be a lot more likely he will find LAA involvement that everyone else so far has overlooked ( likely from not looking there at all!).

In any event, there is no one on the planet I would recommend you more to go too after 6 failed ablations than Dr Natale. He is one of the very few who can truly take care of business if the remaining problem really does lie within your LAA. He will discuss all the possibilities with you in any event and you can be sure you will know first hand what your real range of realistic options are, for sure, with Dr N reviewing your case.

If you can fly to Austin, you might try giving them a call and seeing how soon you can see him there and do the same with San Fran and then let it play out by where he can see you the soonest.

Best of Luck!
Shannon



Edited 2 time(s). Last edit at 05/28/2013 08:19PM by Shannon.

Shannon,

Thank you for the very detailed and helpful answer. I'll take your advice and see him in SF and ask if he would recommend Austin. SF is much more convenient, but I'll go where the chance of success is the greatest. Unfortunately, the first available consultation appt in SF isn't until July 16th - which probably means the procedure couldn't be done until Sept-Oct. Regarding the failed ablations, I assume it's a mixed bag of reasons. The first couple were done at Cedars Sinai way back in 2002 and I think it was the wild west days of ablations and they were taking a shot in the dark. I had a fellow who had observed the 2nd procedure recommend in confidence that I go elsewhere if I was going to have another ablation procedure. Generally a very unpleasant experience. Then Cedars referred me to a Dr.Nademanee who performed two procedures in 2003 and 2004. I then switched to my current cardiologist, Dr. Cannom, who performed ablations in 2007 and 2009 at Good Samaritan in Los Angeles. I'm very fond of Dr. Cannom, who is a past President of NASPE. Dr. Cannom thinks perhaps I should consult with Dr. Narayan regarding the FIRM procedure.

Maybe it's wishful thinking on my part but I can't help but think that primary aldosteronism wasn't a factor in my afib. After I was diagnosed with this condition due to a tumor on an adrenal gland I went back and looked at my blood tests and my potassium levels had always been low. The primary aldosteonism was fixed in 2011 by the removal of the adrenal gland and my potassium levels are now normal and my blood pressure is terrific. So perhaps the 7th ablation performed by Dr. Natale will be the charm.

Thanks again,

Bruce

Good news! Just heard everything went well with Mchales ablation. Surely he will fill us in tomorrow with the details when he is up to it and back online.
Shannon

You are Welcome Bruce,
Will try to reply more to your last post tomorrow. Its late here and am closing the computer. I'm surprised none of your prior EPs checked your hyperaldosteronism for a possible adrenal tumor and urged you to get that fixed! Doing so would have at least given a better chance for any half way decent ablation to work more effectively. With active hyperaldosteronism that could demand a near perfect ablation covering all trigger spots with complete transmurality of all ablation scars to keep you relatively quiet. Alas, the increasing fibrosis likely from continued chronic excessive aldosterone could well have undermined yor chances for success.

Time now to let the top expert in the world address your more complex case after the six failed ablations .. More later.
Shannon



Edited 4 time(s). Last edit at 05/29/2013 12:52PM by Shannon.

Hi Shannon,

I guess there are two NASPE's - Dr Cannom was the President of the North American Society of Pacing and Electrophysiology so I believe he is up to date with what is happening in the field. I think he felt bad for me and hence the recommendation to Narayan. He was up front and said the data is still preliminary but there were some positive initial results on the FIRM procedure. Primarily because of the skepticism of the FIRM procedure on this board and your and others belief in Dr. Natale I've decided to go that route.

I was also surprised/disappointed in the failure of prior Doctors to make the low potassium-hyperaldosterism link. I had volunteered for a study of a hybrid surgical/catheter ablation study at Stanford in 2011 and they pointed out my very low potassium and said I should get it checked. Thankfully, I didn't qualify for the study because I was in flutter and only afib patients qualified. Desperate, eh? Your depth of knowledge on this subject is impressive....considering the length of time I've been suffering and the number of procedures I've undergone, I should know more than I do.

Thanks again,

Bruce

McHale, Wishing you the best.

Hi Shannon,

So I guess the question for me to research and discuss with Dr Natale is what effect the fibrosis will have on the chances of a successful ablation.

Thanks,

Bruce

BruceS Wrote:
-------------------------------------------------------
> Hi Shannon,
>
> I guess there are two NASPE's - Dr Cannom was the
> President of the North American Society of Pacing
> and Electrophysiology so I believe he is up to
> date with what is happening in the field. I think
> he felt bad for me and hence the recommendation to
> Narayan. He was up front and said the data is
> still preliminary but there were some positive
> initial results on the FIRM procedure. Primarily
> because of the skepticism of the FIRM procedure on
> this board and your and others belief in Dr.
> Natale I've decided to go that route.
>
> I was also surprised/disappointed in the failure
> of prior Doctors to make the low
> potassium-hyperaldosterism link. I had
> volunteered for a study of a hybrid
> surgical/catheter ablation study at Stanford in
> 2011 and they pointed out my very low potassium
> and said I should get it checked. Thankfully, I
> didn't qualify for the study because I was in
> flutter and only afib patients qualified.
> Desperate, eh? Your depth of knowledge on this
> subject is impressive....considering the length of
> time I've been suffering and the number of
> procedures I've undergone, I should know more than
> I do.
>
> Thanks again,
>
> Bruce

Hi Bruce,

I'm not sure what happened to the bit longer reply to your prior post in this thread before the one you posted quoted above? Perhaps I erased it inadvertently when going back to make a spelling correction ? In any event, it seems like you were able to read it before it disappeared into the ether so that's fine.

The point I was making about some of the other EPs is that there can be a very big difference between what may be a very solid and very well informed doctor who is good to work with in an ongoing follow up role, and their ability to wield a catheter with elite skill and know just what, where, when and how to make those burns. The EP that Pam Walter had the misfortune to align with back many years ago at Johns Hopkins was, and still is in some circles, considered to be a leading expert on AFIB and ablation technology overall. However, that doesn't mean at all he is anywhere near a good choice when it comes to him actually doing the procedure.

So many people quite naturally will have a local or regional 'name' near where they live recommended to them do a procedure, even though an AFIB ablation is such a complex and skill dependent procedure, and too often such folks, through no fault of their own, wind up getting a compromised outcome, or worse.

The situation has gotten considerably better since your early ablations, no doubt, and it is a lot more likely to get a decent result with a much wider array of operators across the country now than even just 5 years ago. However, there is still a greater overall risk with a less experienced ablationist than with a true Maestro, and for anyone in your position after 6 ablations that still have not done the trick, you are very wise to hold out only for the very best and most experienced man possible in dealing with complex cases, and steer clear of unproven and questionable new idea such as FIRM, in your case, at least until it actually can show some consistent long term results with many top ablationists doing the procedure.

You are on the right track going to San Fran to see Dr N for a consult, and good luck to you.
Shannon

Just heard from McHale, he is home now and grateful to have it all over with. His I-phone ran out of charge at the hospital and since it was a surprise that he got the ablation yesterday instead of today in any event, he hadn't had the time to plan out such details like phone chargers etc.

Anyway, he said his is taking a good rest now while the phone charges. Had a bit of a residual headache and nausea from the anesthesia, but otherwise seems in good shape and no doubt will fill in the details here before long.

Shannon

Hey Guys,
I appreciate all the goodwill and well wishes!
I was dying to post last night but my brother didn't have time to bring back my ipad and Iphone. It's a long story when you walk in for a consultation and you get ablated 2 hours later!

I'm resting now in NSR but the anesthesia has made me a bit nauseous but feel much better now.

Bruce to answer your question about Shannon's passion about the good doctor I must say I was quite impressed and felt so at ease the minute he walked into the room.

Dr NATALE is just one a caring gentle compassionate humble down to earth regular guy I felt so at ease and truly it is my pleasure to say I got a NATALE ablation!

He was willing to stay Thursday to do my ablation even though he was flying out.! Wednesday would have been a challenge for him with 2 ablations before me and a meeting he had to attend.

So he asked me would you be willing to go today and I said YES!!!!!

Shannon Thank You so much for your guidance and support! I also want to thank many others who also reached out to me to move forward with this life altering decision!



Edited 2 time(s). Last edit at 05/29/2013 09:10PM by McHale.

Yay McHale!! So happy to hear of your good news and the speed at which you were able to get this done, once you decided to do it. I know you've been wrestling with this decision for awhile - as I have. How do you feel today? I'm hoping it all went smoothly and you barely felt a thing! I'm expecting you to say "why didn't I do this sooner?"

Keep us posted on your progress. We are all rooting for you!

Congratulations on your decision to be done with this ~ Barb

Hey Barb,
Right now I'm feeling great at midnight 30 hours later.
I would saw the anesthesia was the worse part but the nausea has finally dissipated. We both agonized over who to go with here in New York but now there was no more excuses for me. The level of confidence I had with Dr Natale was soothing and I actually smiled lots all thru the prep.
I saw him in the lounge right before I went into the Lab talking on the phone in Italian to someone and he smiled!
It's quite the experience you should try it sometime

That's comforting to hear, McHale. I have been waking up in Afib a little more often lately, and have been thinking it's TIME. Did it hurt? What did he say about what to expect? (probably 2nd ablation? pain? PAC'd?). How soon can you get back to your usual activities? I think the biggest fear I have is that it could possibly make matter worse. I read a few posts that said they were actually worse after their ablaton (I don't think they had Natale though)...and of course, any complications.

I am very happy for you. A tough decision but you faced the fear and did it!

Kudos to you & wishes for peaceful NSR forevermore ~ Barb

Hi Barb,

Your biggest fear that an ablation could possibly make things worse is extremely unlikely when you choose a true top tier highly experienced operator. That's why I continue to harp on that issue so strongly.

It can take two, to even three on occasion, procedures to get everything addressed for the long haul, but the less persistent your AFIB is the better your chances for a one and done are as well. Particularly with a maestro doing the work.

Shannon

Thanks Shannon. I know I'm a big chicken about this - I hate hospitals and shake like a leaf whenever I've had any procedure done in one. Can't imagine what I'll do in this case!

Do you happen to know Dr. Natale's phone number in NYC? I think it's TIME to talk to him...can't believe I'm saying this after 10 years of this, but...I think his practice now in NY is a sign...

Barb

So, McHale, how was your Foley



Edited 1 time(s). Last edit at 05/30/2013 04:44PM by afhound99.

Hey Buddy thanks for the pep talk!
The first thing I checked when I was in recovery was the
foley.....not too bad but not a small hose either. The nurse pulled it out around 2:30am not too painful but the first few times I went it burned. Not a deal breaker at all. The nurse shaved my groin area in the Lab before I went under but did it with dignity not exposing me to all the staff as some have complained. What happened afterwards maybe will make YouTube.......

Barb,
Yes I faced the fear and did it. But with a doctor like Natale it's your best chance at a cure and I knew I was in the best possible hands so the safety level gave me comfort. As for the second ablation he told me he was going to check the LAA appendage as he's seeing more repeat procedures are those with activity in that area. He found none Thank God. I had a lot of activity near the coronary sinus he said and he shut that down. I'm not sure of the details till I get my report as my memory is cloudy.I didn't have much fibrosis he told me. He did all four pulmonary veins, coronary sinus and and the Superior vena cava that can be triggered by my sleep apnea. About a 4 hour procedure.
That was also my fear that it can make matters worse but I couldn't take a chance anymore as my afib was progressing.I hated the way I was feeling as the Flec was failing me the last few months.
Natale's complication rate is pretty small considering the number of patients he ablates and most go to him after many failed ablations and are often older and sicker.
No it didn't really hurt at all except maybe from the Foley catheter and some pain from a sore throat where they inserted the temperature probe and incubation tube. My insertion sites in my groin are good with no bruising or hemotomas. The anesthesia was the worst part for me it just gave me a bad hangover. I have lots of sinus pressure and slight headaches but that could be from the allergies and anesthesia.
Not a show stopper at all!

Good to hear all is progressing along as expected McHale, as we discussed on the phone just chill the next week and go easy with the exercise the first month or so. Avoid drinking or eating cold liquids or ice cream while the inflammation in the LA is healing. Avoid laying on your left side as much as possible, don't forget the daily anti-inflammatory helpers we discussed, stock up on the Strategy goodies and enjoy the ride into NSR for the long term ...

Take it easy friend!
Shannon

Hi Barb.. to reach Dr Natale's scheduling nurse, Michele, at Al Sabah in NYC call: 212-523-2400. I posted this already in another thread but wanted to added it in this thread as well where you asked me for his NYC number.

Best wishes,
Shannon



Edited 1 time(s). Last edit at 05/30/2013 05:08PM by Shannon.



Edited 1 time(s). Last edit at 05/30/2013 08:11PM by Shannon.

Shannon
Can you be more specific about the anti inflammatory agents and the strategy goodies
We met McHale at Dr N office the day of his procedure
My husband was going for a consultation it looks like my husband will be done in Sep
We will appreciated all information
Elena

Elena

We are very happy everything is going so well
Keep updating your progress
Elena

Hi Elena, start with Jackie's 'The Strategy' and immediately after the ablation you can start with Han's Post ablation protocol, both of these resources and many more good tips and guidance can be found in the AFIB Resources link button on the top left of this Message Board as well.

Best of luck for you Husband .. you are definitely making the right choice of where and who to go to...
Shannon



Edited 1 time(s). Last edit at 05/31/2013 01:20AM by Shannon.

Shannon
Thank you for the information
I will give Larry all the information to read. He is not a computer person so I do all the research and give him the information
The first time I talk to Larsen was about 10 years ago but I have never posted until a few weeks ago
All of you have been my source of information for a long time and I'm very greatfull for it
Larry talk to Larsen a few weeks back and that help him to make the decision to go and see Dr.N
Elena

You are welcome Elena,

Larry is very fortunate that you are handy with a computer and found this place . Good too that Larry was able to connect with and speak to Hans who is always such a great resource. You have definitely helped Larry make the right choices in this often daunting field that can be so confusing without some solid guidance from people who have had to navigate all the twists and turns that living and dealing with AFIB brings to one's life. Take care.

Best wishes for both you and Larry,
Shannon

Hey, McHale! Glad to see you took the plunge. Do you know what your Left Atrium Size was going into the OR? I'm sitting at 55mm and Dr. Verma says that at that size my chances of a successful ablation are diminished; that I am on TIKOSYN and in 100%NSR with tolerable side effects, and my best bet is to hang in there until my LA shrinks, but there are no guarantees. My ejection fraction is 60% which is, apparently, nearly optimal for a 30 year old (1/2 my age) so it appears all the moving pieces are fitting well. It's just this darned LA enlargement that's holding off an ablation for me.

I'd like to find some other 60 year olds with 55mm Left Atriums who are happy with their ablation outcomes.

Anyway, if you are totally freaked about having the Foley removed get them to use some anasthaeic (topical or otherwise). They used some topical Zylocane when playing with mine (the FOley. The Foley.) and it was nothing... did not feel a thing, really.

Murray L

--------------------------------------------------------------------------
Tikosyn uptake Dec 2011 500ug b.i.d. NSR since!
Herein lies opinion, not professional advice, which all are well advised to seek.

Hey Murray,
Yes so glad I did it. There is no other way and in hindsight I probably had afib for 4-8-10 years who knows just speculating before being diagnosed 4 years ago but the episodes where mild and I never thought it was more than the minoxidil I was using.
After the ablation the next morning I asked Dr Natale what size my LA was and he said just mildly enlarged nothing to worry about and not too much Fibrosis.



Edited 1 time(s). Last edit at 06/04/2013 02:37PM by McHale.