First night after Lariat procedure

Thanks once again for the generous spirit so many of you have shared with me around my Lariat procedure.

I'm starting the recovery process now from Cardiac ICU at St. Davids in Austin after Drs Natale and Burkhardt successfully completed tying off my left atrial appendage this morning. Both Docs came in separately a bit earlier to give me the run down and both noted mine was quite a challenge to complete.

Apparently, I had an unusual vertical lobe extending upward from the proximal part of my LAA just before it attached to the left atrium itself and this made getting the suture over this bulbous like lobe difficult to pull off. Nevertheless, Drs Natale and Burkhardt did a bang up job of going for it and it paid off big time for me!

My chest is very sore at the moment from pericarditis due to all the work my Lariat took to fully snare the LAA. The vast majority of patients won't require that much effort and thus will have much less pericardial inflammation to deal with.

Ill keep you posted how it all plays out in the coming days. It looks like I may need to stay in the hospital a day or two longer than the typical two to three total days for most Lariats.i

Whatever it is, the great news is they got it done and assuming it stays tightly sealed at the next TEE test at 6 weeks as it very much should, then I will be able to stop all Coumadin for good and will have eliminated this major embolic stroke risk for the rest of my life and that is most definitely worth some temporary discomfort in these early days.

Shannon



Edited 2 time(s). Last edit at 08/07/2013 01:20AM by Shannon.

Congratulations on the successful outcome, Shannon! This is good to read. I can't believe you are feeling well enough to post! Please rest and take care of yourself.

Louise

So glad to hear the good news.

Good luck on a fast recovery after your successful procedure.

...ron

Congratulations on your success! It is wonderful news!

Betty

Great news !!!, That will be great, no more blood thinners in your future. Rest up and enjoy the wonderful care at St. Davids.

KenH

Hello Shannon - thanks for your news. So very pleased the procedure went well and you're now on the 'other side of all that'... The soreness will diminish as the inflammation subsides.

Just rest and heal.

Best to you,
Jackie

Congrats and wishing you a quick recovery.

Shannon,
Nice to hear your voice last night as I was at the same moment discussing your Lariat procedure with my cardiologist. Priceless!
Get well soon and a speedy recovery!

Best,
McHale



Edited 1 time(s). Last edit at 08/07/2013 11:05AM by McHale.

Shannon

Glad to hear you finally got that out of the way. Now you can look forward to life without anticoagulants. Got to be a great feeling.

Jim

Good healing to you, Shannon.

______________
Lone paroxysmal vagal atrial fibrillation. Age 62, female, no risk factors. Autonomic instability since severe Paxil withdrawal in 2004, including extreme sensitivity to neuro-active drugs, supplements, foods. Monthly tachycardia started 1/11, happened only at night, during sleep, or when waking, bouts of 5-15 hours. Changed to afib about a year ago, same pattern. Frequency increased over last 6 months, apparently with sensitivity to more triggers. Ablation 6/27/13 by Steven Hao.

So glad that the morning after news is so good, despite the sore chest. My husband and I are keeping you in or prayers.

Nancy M

Good to hear from you, glad they got it, make sure you rest up and good luck in your recovery

I much appreciate all the healing thoughts folks, its 1:30 pm Texas time on Wednesday the 7th as I type this update.

I didn't get a lot I'd sleep in ICU last night which is par for the course in such places the first night after a procedure like this. Quite a lot of chest pain yesterday and last night mostly in a circular pattern around the whole chest area with the sensatation of heavy cramps and spasm with even shallow breathes .. Typical pericarditis symptoms. What made this experience stronger than, for example, the kind of mild to moderate pericarditis from a solid ablation was the chest tube inserted into the pericardial space to drain any excess fluid and inflammation.

The tube was a ribbed metal tube a bit more than 1/8" diameter that was threaded about 10 inches into the chest under the xiphoid area up into the pericardium. What a relief when they pulled that tube out around 11:00am this morning 24 hours after the Lariat was completed! I still have some discomfort and tenderness upon breathing, but not nearly as significant as it was with the drain in place!

Before pulling the tube they did a trans-thoracic Echo to see if any pericardial effusion might be happening and when that was clear , I got the green light to have the tube removed.

Dr Natale came in an hour later in good spirits as usual and we had a nice visit reflecting on how far we've come over the years and how, for me, it seems surreal that this might really all be over for the long term...? I will have one more Echo done in the morning and if no excess fluid has accumulated in the pericardium overnight I will likely be discharged tomorrow, Thursday, a day or two earlier than I expected.

The good news is that if you should ever get a Lariat don't worry about the added pain the first night as much of it will dissipate as soon as the drain is pulled. Knowing that up front can really help make the time pass a little easier.

I still have to confirm the seal holds up one month to six weeks from now with another TEE and if it does, as is the case the vast majority of the time and well over 90% for those with an initial good seal, then it will be good and over with for life!

I can definitely see the light at the end if the tunnel and that's a very good feeling!

Take care, Shannon



Edited 2 time(s). Last edit at 08/19/2013 01:51AM by Shannon.

Wow, what a great outcome! May your freedom be absolute and lasting!
Tom

Wonderful News - Stay well Shannon!

Valli

Shannon - so good to hear from you and even better, to get such a good report! I'm glad you now have this behind you and other than some follow up tests, a very bright future in NSR and without blood thinners - yay!

Hopefully you will get a good night's sleep tonight and finally feel PEACE and freedom from Afib, once and for all!

Sending healing thoughts your way ~ Barb

Just finished a nice chat with Dr N and his very nice nurse practitioner Kay Zedlitz. I have one more echocardiogram .. A regular thoracic version so no need for anesthesia or sedation like with a TEE ... And if all is well with no added fluid build up in the pericardium as it seems will be the case then I get sprung shortly after lunch just over 48 hours post Lariat installation!

I feel much better today, really have since shortly after the chest tube was removed yesterday morning. Still have some modest discomfort in the chest on breathing but I can take much bigger breathes now before it starts to cramp a bit than before the tube was removed.

Also removal of the tube Wasnt bad at all. It looked like it might be rough as it is a ribbed metal tube that was help in place just under my solar plexus with a suture. Too bad I can't post a pix here as I took a few for those not faint at heart .

In any event, the approximately ten inches or so of metal drainage tube that were removed from the pericardial space and chest cavity slid out surprisingly smoothly and easily and was nothing remotely like the one nightmare event 27 years ago with a Foley catheter removal I recounted here a few months ago. Thank goodness! So nothing at all to worry about here with this step of the procedure at all.

Dr Natale said to take it easy the next 7 to 10 days with no lifting of anything over around 7 pounds during that time. And he said to go very easy with any really strenuous exercise for the next month. I am going to avoid anything challenging at all until the follow up TEE confirms my Lariat knot has not loosened any. Dr N said that after one month, if everything is still tight with no leaks as they expect to find, then its good for life as the endothelial tissue continues to grow and provide a permanent seal over the seam that once was the mouth of the LAA.

There have been some cases where the Lariat noose has loosened a bit in a process not yet fully understood, but its quite rare and well over 90% of the time when there is a good seal of the Lariat in the beginning like mine has been, that is how it remains for life. Certainly, long enough for the body to seal up the seam itself and resorb most all of the LAA tissue after which its a moot point what the suture does.

So, I have one more TEE in a month to six weeks now set for Sept 23 in San Fran, and then one final ultimate confirmation with a last TEE one year later.. This last TEE is mostly by protocol during these early months and first few years of experience with the Lariat and may someday be considered not necessary.

That's about it Folks! I should be back at the hotel here in Austin after lunch sometime and then fly back to Phoenix on Sunday for the drive home to Sedona. Hard to believe really, but I'm really starting to feel like I may well be on the other side of this very long fence now ... one step at a time!

Thanks again to you all for the great support and good wishes!

Cheers!
Shannon



Edited 2 time(s). Last edit at 08/19/2013 01:56AM by Shannon.

Awesome report, Shannon. I am relatively new to this site and since joining have gone back and read many, many of your wonderful, informative posts and am soooo glad you are doing well! We all look forward to the the day you go home and post from there! Best, Louise

That's great news Shannon. I may have to go through that in another four months. Hopefully not. Doesn't sound like much fun. It's been six weeks since my LAA ablation in Austin. Everything is going excellent. I'm doing about 2 hours of beach time at Hickam five days a week.

Tom in Hawaii

Shannon - not sure if we should think of you as the "Ever Ready bunny" or "Superman" or just a great guy who uses his own experiences to enlighten others and encourge them in their own journeys down this rocky road Probably all of the above.

Thank you for letting us know how you're doing, and educating us on what this is all about. I would imagine some on this Board might choose the Lariat option, largely due to your education and encouragement.

Wishing you a great view from the other side of that fence!

Best to you and your wife ~ Barb

Shannon,

What a wonderful report and great news for you!!!

Also kudos to you for preparing such thorough and detailed reports on what I assume is your iPhone!!!

George

It really is more than a little surreal taking it easy now propped up on pillows in my hotel room bed and only just over 48 hours after the Lariat! Very dream like.

I had no effusion at all on the last two Echo's so was good to go. They give you 0.6mg of Colchicine twice a day for the time in the hospital post Lariat and for seven days after release to help reduce any inflammation and lower the risk of a pericardial effusion which it apparently really helps to do. Also Ibuprofen at 600mg doses per every 6 hours for some days also helps a lot with the inflammation and now I can add some of my trusty herbal anti-inflammatories as well to help the cause.

So far very good indeed! Even going to try watching my beloved Broncos first preseason game against the 49ers tonight on the tube which I didn't imagine being able to do a couple days ago.

Also, the food was very good at St. Davids and all of their dishes including pastas etc come with gluten free ingredient options as well. Even better than I recall from five years ago.

You are welcome Louise and glad to see you found this forum as well as you too Barb! Yep George, it was just me and the trusty Iphone here so it took a little time which I had plenty of, considering.

Enjoy Hickam beach Tom, I know it well. Hope you don't have to have any more work done either but if you should the Lariat is a good option, There is also the Watchman and Atriclip and Im sure Dr Natale would discuss which of these he would recommend for your case, if you do wind up having too slow an LAA emptying flow rate, and would ratgher not take anti-coagulant drugs long term. Especially considering what you had to go through already after the aborted Hawaii ablation two years ago. Do you have an intact pericardium still after the valve replacement?

In any event the Lariat is a peice of cake compared to what you have already gone through and you have the best team going here to do which ever procedure that would fit your needs best .. if you should need any at all.

Also, I'd be remiss if I didn't emphasize how much I liked Dr J David Burkhardt as well. He does all the Lariats with Dr Horton at St Davids when Dr Natale is in San Fran or In NYC and people want to get the Lariat done ASAP. He's a very competent EP and has a very friendly open demeanor as well and from all reports is a superb ablationist in his own right and has worked with Natale for many years now. He knows his stuff for sure and Id have no hesitation at all recommending him strongly to anyone for an ablation, especially when Natale isn't available at the time you wish to have it done.

Take care, Shannon



Edited 4 time(s). Last edit at 08/12/2013 02:43AM by Shannon.

Shannon
We are glad you are doing so well!
Remember your words and take it easy
We send our prayers
Larry and Elena

Shannon, Tom in Charlotte NC...God bless you! thanks for all you did in support for me!

TP

Shannon,

I have no ideal if the pericardium is still intact. I doubt it. They had to go in twice to replace the mitral valve. They tried to seal it the first time and that failed. Is the pericardium important to seal the LAA?

Tom in Hawaii

Shannon, thanks for the detailed report on your procedure, so glad that you are progressing so well. I feel that thru your post, I have a better understanding of the procedures.

Once you have recovered and are back to near normal, I am in hopes that in a future post, you might tell us just what was needed to qualified for this procedure and just how hard it was to get to the head of the line. Just how does one get himself to the point of being accepted by the few doing this procedure or even for the watchman device? How soon will these procedures be commonly done ?

I think many would be willing to seek this way out of being on blood thinners for life but just are not sure of just what to do.

Thanks for your help and sharing of your knowledge.

...ron

Continued speedy recovery to ya!

Passing Comment: Don't think my GI could tolerate all that Ibuprofen.

/L

Hi Shannon, very happy to see your healing is going as everyone has hoped it would. hope it continues in a straight line to good health. Dennis

Shannon: Just to say, thinking of you and wishing you a speedy recovery.
Murray L

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.

Made it back to Sedona just now... We are very glad to be home in quiet Sedona and are a bit bushed for sure,and are ready for a quiet niight and a good while of taking it easy.. Thanks again everyone for all the kind words!

Will be back on soon in a day or two but Im very pleased with the way the whole thing has worked out to date.

Take care,
Shannon



Edited 1 time(s). Last edit at 08/12/2013 02:45AM by Shannon.

ron Wrote:
-------------------------------------------------------
> Shannon, thanks for the detailed report on your
> procedure, so glad that you are progressing so
> well. I feel that thru your post, I have a better
> understanding of the procedures.
>
> Once you have recovered and are back to near
> normal, I am in hopes that in a future post, you
> might tell us just what was needed to qualified
> for this procedure and just how hard it was to get
> to the head of the line. Just how does one get
> himself to the point of being accepted by the few
> doing this procedure or even for the watchman
> device? How soon will these procedures be
> commonly done ?
>
> I think many would be willing to seek this way out
> of being on blood thinners for life but just are
> not sure of just what to do.
>
> Thanks for your help and sharing of your
> knowledge.
>
> ...ron

Ron,
You won't qualify unless there's a reason you can't take Warfarin or any of the new anticoags when I talked to Dr Natale.
Shannon had a compromised emptying velocity from LAA so he was at a higher risk of stroke. He'll fill you in on the details I'm sure.

McHale Wrote:
---------------------------------------------
>
> Ron,
> You won't qualify unless there's a reason you
> can't take Warfarin or any of the new anticoags
> when I talked to Dr Natale.
> Shannon had a compromised emptying velocity from
> LAA so he was at a higher risk of stroke. He'll
> fill you in on the details I'm sure.


Thanks McHale. I was kinda thinking it might be a stretch to get Medicare and insurance to pay for this procedure for anyone wanting it. I hope someday (soon) they come up with a simple less expensive way of doing the same thing.


....ron

Hi Tom in Hawaii,

You'll have to confirm with Dr N, but I do think an intact pericardium is a prerequisite to be able to install the Lariat due to the epicardial phase with the Lariat suture system which all takes place inside that narrow pericardial space.

Even if so, should you even need and want to consider LAA exclusion, there are several other options, as you know, to get the job done well for you too. But that is a conversation only if it turns out your LAA velocity is too slow after the LAA isolation which you will find out at the 6 month mark post ablation.

For now just enjoy the NSR as it is!
Take care, Shannon

Shannon Wrote:
-------------------------------------------------------

> Even if so, should you even need and want to
> consider LAA exclusion, there are several other
> options, as you know, to get the job done well for
> you too. But that is a conversation only if it
> turns out your LAA velocity is too slow after the
> LAA isolation which you will find out at the 6
> month mark post ablation.


Shannon,

Let me get this straight. Are you saying that following an ablation of the LAA, some patients might require blood thinners for the rest of their lives, but others, with an even slower LAA velocity, will require an LAA exclusion, because blood thinners will not be sufficient in their situations to prevent clots?

Buster

Shannon! So glad to hear of the great news. Continuing to think of you and hoping for all the goodness you deserve after such a long battle and helping all of us out during very dark times. Thanks again for being there for all of us!!!

Buster - I think Shannon is saying that if the velocity is too low in the LAA (whether because of AF or caused by LAA isolation to get rid of the AF), there are now viable minimally invasive surgical choices in addition to life long anticoagulation. There are risks to life long anticoagulation and the surgical choices maybe the lower risk way to go for many. It probably depends how susceptible you are to bleeding incidents and somewhat on life expectancy. For example, I doubt my 91 year old father in law would be a good candidate for the Lariat. He has been to ER about once a year because of bleeding incidents.

Hi Buster,

Researcher has spelled out in his post above a general overview of what I was trying to convey. However, I also want to elaborate a bit more on your question as it is very important for you and others interested in this topic to have a broad view of this issue.

The main thing you need to digest is that the need to deal with life long anti-coagulation or choose one of the new minimally invasive mechanical procedures for either ligation or occlusion of the left atrial appendage is most often driven by the persons underlying progression of structural remodeling and fibrosis.

It is only in a much smaller number of more recent cases that an 'LAA isolation ablation' has become a possible, but not necessarily guaranteed, secondary factor in the need to address this long term anti-coagulation issue. In other words, long term structural remodeling can and does lead to LAA emptying velocities below the roughly safe level of 0.4m/sec in a fair number of people with advanced disease, and this happens often from years of poorly controlled AFIB/Flutter, from the genetic roll of the dice and/or accelerated aging .. and not infrequently from a healthy dose of too much procrastination as well in making the decision to deal effectively with your AFIB by which ever methods you adopt that work.

The rule of thumb on LAA Isolation is that you will not have such an LAA isolation preformed unless it is found to be a significant, even dominant, contributor to ongoing AFIB/Flutter and in most cases only after a first comprehensive ablation has failed to keep things quiet for the long term.

Neither Dr Natale, nor any other EP, will perform an LAA isolation unless they find that it is the only or best way to achieve long term control over your arrhythmia. In about 60% of the cases, the end result of such an LAA isolation can be a low enough LAA velocity to require life long anti-coagulation or, alternatively, a Lariat, Watchman, Atri-Clip, or perhaps surgical removal of the LAA. That means roughly 40% of those who do require a LAA isolation will still retain more than enough LAA mechanical function to be able to stop blood thinners for good after a TEE 6 months after the LAA isolation confirms the sufficient blood velocity through the appendage. As such, it is by no means a fait accompli that having an LAA ablation must equal life long blood thinners or one of these new Buck Rogers procedures.

At this point, you do not really have the choice many assume you do. If your AFIB/Flutter is being largely driven by your LAA, then avoiding addressing this with ablation will almost invariably lead to continued remodeling and on-going fibrosis leading inevitably to persistent AFIB and being stuck on AC drugs for life in any event .. plus you will be miserable with non stop flutter or AFIB that has not been controlled on top of it all! Its a totally false choice and a bad bargain for anyone to suggest that you should avoid isolation of the LAA, no matter what, even if it found to be your main driver.

Anyone who tells you that should not be your EP.

For the those who have had an LAA isolation and afterward the LAA velocity is too low to avoid the AC drugs, it is true that with careful monitoring to insure you maintain a therapeutic INR for four consecutive weeks straight, at all times, it is very unlikely you will ever form a clot and have an embolic stroke ... same could likely be extrapolated as true for those on constant Xeralto or Eliquis as well.

However, for those of us who also had significant degrees of LAA dysfunction even before it's full electrical isolation by ablation, it is possible for the emptying velocity to drop so low that you can remain with some latent degree of clot risk even with a therapeutic INR. his was my case with less than 0.1m/sec residual LAA velocity and thus my LAA was essentially non-functional, but I also had had confirmed delay in my LAA during the first ablation in 2008 and before Dr N had started any work on the LAA area.

This is likely what happens to those 8% or so of Coumadin users who stroke out even though on Coumadin and with a good INR and in spite of never having had an LAA isolation ablation... Just from too much cumulative damage over time.

Almost all of those folks likely had significantly dysfunctional LAAs not from an isolation ablation, but from too long a history of structural remodeling and scarring from ineffectively treated AFIB.

Its the nature of the beast and should encourage everyone to take as good a care of yourselves as possible and deal boldly with the disease when the time comes using the most skilled ablationist that you can find to buy you as much NSR time as possible in this life!

That is the bottom line. And for a relatively smaller number of us, a mechanical ligation or occlusion of the LAA will be the right choice and give us the best odds for a life free of stroke, and very well could offer a life free of future arrhythmia as well in the bargain.

Its important to understand the lay of the land here and not get too timid when it comes to going for long term NSR .. whatever it might take.

Shannon



Edited 3 time(s). Last edit at 08/14/2013 02:17PM by Shannon.

Hi Shannon -

So glad your procedure went well and that you got out of the hospital so quickly! I have been away in the back woods, so couldn't access the internet (no smart phone!). Just back and I have been thinking about you and wishing you well.

Nice description of the whole Lariat picture. Your experience is similar to mine. Yes, wasn't it easy to have the tube removed?

But since I failed the Lariat, I'll try the Watchman, and am scheduled to have it installed September 4 in Austin. I may cancel since my BP is very very high, and has crept up after each surgery in the last many months.

I hope that you are finished with dealing with afib! Such a change from life challenged by it. I look forward to more posts. Be well.

Cindy O

Thanks Cindy,
And good to hear from you too and that you at least have the Watchman set for Sept. 4. Please discuss with Dr N about the BP issue before deciding to postpone doing it now, if that is the only reason. He could well want to put in his two cents in a recommendation for you.

I'm feeling quite good actually, am taking it very easy too like I'm suppose to, though reminding myself not to lift anything more than 7 pounds for another 3 days, (10 days total) now that it has been 7 days since the Lariat procedure, has been a challenge as always for me after these things.

Glad you got away in the woods for some time. Take care and keep in touch. Let me know by PM what your thoughts are on the BP and Watchman as you get closer and perhaps I can help convey any ideas upstream if you wish..

Take care,
Shannon



Edited 1 time(s). Last edit at 08/14/2013 02:19PM by Shannon.

Hi Shannon,

Hope this finds you continuing to improve. I understand the function of the LAA is debated by some. Have you found a lack of pacing cells or lack of ANP hormone during your recovery? I know this was a significant problem with the extensive ablation you had.

Betty

Hi Betty,

Nope I haven't had the slightest evidence of lack of ANP production since my Lariat a little over two weeks ago. Have actually lost a couple pounds down to 181lbs from around 183.5 to 184lbs at 6 feet tall, which had been my steady weight for some time. That small lose of a couple pounds could well be from less exercise while I recover from the procedure. But had there been some ANP imbalance from no longer having whatever contribution the LAA makes toward total ANP production throughout the whole of both left and right atriums as well as in the right atrial appendage which I still have, I would have either gained some water wait as I did when I had all that burning of those ANP producing cells during my first ablation, and/or I would have been peeing up a storm had there been some paradoxical over production of ANP in an effort to rebalance the loss of production from the LAA and I have had neither effect at all!

All the docs who have insisted that the ANP loss concept as a concern was strictly hypothetical and is not a real world issue in actual experience in people with removed LAAs, have fortunately been right on the money I'm pleased to confirm.

Shannon



Edited 1 time(s). Last edit at 08/22/2013 04:25AM by Shannon.