Ablation guaranteed for Life?

I was talking to a friend last night, who's brother has asymptomatic LAF, as I do. He is in permanent afib. I believe he is in his mid-60's, and other than LAF he has no other health issues. She told me he was having an ablation and that his doctor told him he would never have to worry about it again for the rest of his life. We are in southern California and I do not know who the doctor is, but after being on this site for several months, that seems to me to be a pretty gutsy guaranty. Thoughts? Is it because of the type of afib?

Louise

Think the phrase: "would never have to worry about it again for the rest of his life" needs to be defined.

But there's a bridge in Brooklyn I'd be willing to sell to this doc for the price he's charging for an ablation in CA.

Would you pass this on for me, L? ;>)

Thanks!

/L

Louise

I wouldn't believe him. I had my ablation (for permanent afib) almost 11 years ago and am still in normal rhythm, but when I ask the EP about the long term he says "You ARE the long term".

Nobody knows how long an ablation will last because the procedure is too new.

Gill

Gill, congratulations! 11 years is a long time without an event; so maybe he's right!

LarryG - my thoughts were the same as yours! No one can really say "the rest of your life" until you die!

Louise

Hi Louise,


Tell your friend to tell his brother to run for the hills!! Any EP that would make such a statement in this day and age should be tarred and feathered out behind the barn!

To tell a permanent afibber that a single ablation will end his entire affair with AFIB for the rest of his life is being beyond disingenuous! This type of AFIB can be the most challenging to get good long term results with and it depends too on the degree of fibrosis/scarring in the left atrium as well as left atrial diameter , both of which tend to be less favorable for people with long-standing permanent AFIB.

This group of afibbers can indeed be helped, in most cases, and your friend's brother may well be able to achieve a very worthwhile freedom from AFIB, but depending on how long he has been in permanent AFIB and considering if he is really purely asymptomatic, it might be better for him to just go for a Lariat Procedure first to dramatically minimize any chance of an AFIB related stroke as well as achieve both electrical and mechanical left atrial appendage isolation in the process. A secondary benefit from a successful Lariat procedure too is him being able to stop all blood thinner medication for life as well.

It's even possible that after a successful Lariat, if his main trigger source still driving his AFIB has shifted over time from increasingly more scarred and thus less electrically active areas within the left atrium and even around the PVs (which may have been the location of the main drivers earlier in his disease process) then if the vast majority (or possibly even all) the triggering has slowly migrated to the LAA ... which is not at all uncommon in such long standing afibbers ... its even possible that simply by getting the Lariat done and thus shutting down the LAA entirely that way just might convert his AFIB to NSR as well. Conceivably, without any ablation at all.

If he still had some triggering after a successful Lariat, then a highly skilled EP with much experience in ablating these more challenging long term persistent or permanent cases, could then go in with a more typical first ablation protocol and isolate the PVs and address any other areas they find active within the LA and RA, all the while knowing that the left atrial appendage issue has already been taken care of.

Tell your friend's brother to forget this other guy promising the moon and go see Dr Natale up the coast in San Fran... He might even be able to see him when he comes occasionally to Scripps in La Jolla a bit closer to LA, but that might require an even longer wait for that first consult. However, if he is asymptomatic and has been in permanent AFIB such a long time already, he can afford to wait for the right man for this kind of job.

And since this is concerning an asymptomatic permanent afibber, I would be more inclined to go for this 'Lariat first, ablation second' staging just to see if he might be able to kill two birds with one stone, and then determine after the Lariat is done and successful if any additional work in the form of an ablation might be worthwhile, or if the better part of valor at that point might just be to leave it as is having eliminated all AFIB related stroke risk and done away with the anti-coagulation issue as well?

Plus, San Fran is an easy flight from LA where he could go for a good consult with Dr Natale, and this is one EP who would know very well exactly what to do for him and who also has all the skill and experience required to pull it off with great success over a possible multi-step process. And one thing for sure, your friend's brother would not be mislead with wild unfounded promises about a guaranteed single ablation life-time cure!

Shannon



Edited 2 time(s). Last edit at 10/19/2013 04:02PM by Shannon.

Louise,

I have done two surveys to determine the longevity of afib ablations. You can find them here:

[www.afibbers.org]
[www.afibbers.org]

I am working on the 2013 ablation/maze survey which will extend the timeframe for determining longevity to 10-12 years.

I agree with Shannon. An EP who would promise life-long freedom from AF after an ablation for permanent afib should not be trusted.

Hans

Thank you all -- I have forwarded your messages to my friend in hopes her brother will take note and also join the site.

Louise

I will put in my 2 cents. Ablation is not the highest priority for someone who is asymptomatic, stoke prevention is. I think rate control combined with something like the Lariat or Watchman could be a way forward. BTW, I don't see Natale's name prominently display in Scripps SD website anymore. Burkhardt is still available on occasion and he would be an excellent choice if your friend insist on pursuing ablation. There is also Nademanee in LA. I doubt either of them will recommend ablation for an asymptomatic patient.

Perhaps the EP told your brother's friend he *might* be free from afib for the rest of his life after an ablation, and when this report finally got to you, the qualifier was lost?

______________
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.

Hi researcher,

Dr Natale still does ablations at Scripps but only at the Scripps Green Hospital near La Jolla. His Nurse Practitioner at Scripps is Linda Couts and his secretary is named Dorie. The general phone number for Scripps Green Hospital is 858-554-9100 for those who might wish to set up a consult with Dr N during one of his periodic visits there.

Since he was hired as Executive Director at Al Sabah in NYC, there is only so much time and different places he can carve out of a year's schedule and his commitment to the NYC center is a big one so he is in La Jolla less frequently for sure.

Nevertheless, Louise's friend's brother being in LA, its not too far at all for a visit to San Fran to discuss his options with one of the few who can address all his possible options effectively, including doing no ablation, a process of one or two ablations, a possible hybrid option and just going first for the Lariat procedure ... or possibly Watchman as a second but less desirable in this particular case for a long standing persistent Afibber ... and leaving it at that. The Watchman would only be the best choice between the Lariat and Watchman if the person couldn't quality anatomically for the Lariat, for while it can get rid of the stroke risk and blood thinner when successfully installed, it does not provide full electrical and structural isolation of the LAA as does the Lariat. Nevertheless, it would definitely be worth considering if the person didn't qualify for the Lariat.

Natale would very likely strongly suggest the Lariat to him as a good option in his case, as he has recommended that for my sister with long standing persistent and for several other similar scenarios I've discussed with him, but its always best for the prospective patient to first visit with him and go through all the options in each case as there may be individual variables that might lead to a different recommendation.

What I have seen is that EPs will tend to recommend only .. or at least mostly ... what they are most familiar, comfortable and skilled in doing themselves. And, as such, it's in everyone's best interest to go to someone who has done all of the options above many times with great success in an effort to get the most clear and realistic recommendation, and thus be most confident you are getting the full skinny from which to make your choice.

Shannon



Edited 1 time(s). Last edit at 10/20/2013 09:15PM by Shannon.

Shannon, thanks for clarifying about situation in San Diego. Between all the different locations and conference demands, Natale is spread pretty thin. I don't know how he does it, and he spends time giving detailed replies to email questions too. I see he made the "dream team" (see dreamteamatwork.com)

Hi researcher,
I still think they must have at least one clone of him running around ..

The thing is, Dr N at 52 years old is in the prime of his stellar career and is utterly dedicated and passionate about this field and strongly feels this is the time, with knowledge about AFIB exploding, to really help make his major contribution for everyone's benefit.

The thing that amazes me too is how easy going his persona and energy remains even in the midst of his very busy and widely flung schedule. At some point, in some years ahead, he will surely ease up on the activity to some degree, but he said he feels fine and is able to maintain his 450 plus ablations a year schedule ( which is already a bit reduced from when he was mostly just at CC some years a ago, and still fit in the various conferences he is often a major speaker at around the world too.

I've had the good fortune to meet and work with a number of very accomplished and unique individuals in my life and Andrea Natale is definitely right at the top in being among the most impressive all around.

He really seems to have mastered rolling with the present moment from what I have observed and just get flustered much at all with all the demands.

It helps too that he truly loves what he is doing and is incredibly skilled at it as well, no doubt.

Shannon

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Edited 1 time(s). Last edit at 04/21/2014 05:06PM by Louise.

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Edited 1 time(s). Last edit at 04/18/2014 07:15PM by Louise.