Welcome to the Afibber’s Forum
Serving Afibbers worldwide since 1999
Moderated by Shannon and Carey
 |
 |
 |
 |
 |
 |
Home
>
AFIBBERS FORUM
>
Topic
Newbie with AFIB
Posted by smackman
|
Newbie with AFIB December 03, 2013 03:21PM |
Registered: 10 years ago Posts: 836 |
Hello to all. I am a 55 year old man who has Persistent AFIB. I went for a routine physical in Dec. 2011 and was in the Hospital 2 hours later with AFIB. My Heart rate was 95 sitting bouncing above 200 when I stood up. I had no idea I was having issues.
After testing and 4 weeks of Pradaxa, I had a stent put in around my Heart on Jan. 12 2012. Approx. One month later I had my 1st Electrical Cardioversion; It was successful They tried to convert it chemically with Amiodarone and Cardizam but it would not convert. I took Amiodarone for 10 months as preventive maint. but requested to be taken off of it due to its toxicity. After one year, I was taken off Pradaxa.
After 18 months and then I went into AFIB after a stressful event. I went back on Pradaxa and put on multaq this time. I was in the hospital 4 days. One month later, I had another Electrical Cardioversion; It lasted one month before AFIB attacked me again; I had my 3rd Cardioversion. This was 3 weeks ago. It was sucessfull and continues to be.
Currently, I am scheduled for a Cather Ablation in Jan 2014 in Shreveport, LA. Dr. Sherman Wiggins is the EP. My primary Cardiologist in Monroe , Louisiana sent me to him.
Currently, I am doing good. I feel confident Anxiety triggered my last 2 episodes of AFIB. After reading this forum, I am questioning whether it is the right move to have cather ablation this soon.
I am looking for any suggestions/help etc.
Thanks in advance.
5 mg Valium a day as needed.
20 mg Prozac daily
15 mg Prevacid a day
60 cc shot of Testosterone Cypionate every 10 days. Testosterone is low due to schedule two narcotics.
.5 mg Arimidex 2x a week to keep Estrogen levels in check. T shots can cause rise in Estrogen.
100 mg Metoprolol ER 1x a day
25 mg HydroDiuril fluid pill 1x a day every 2 days.
Neurontin 900mg a day (for Neuropathic pain IC/CPPS)
800 mg of Magnesium daily . Different types
81 mg aspirin 1X a day. Heart Doctor order due to stent installed in Jan. 2012.
2.5 mg Eliquis 2X a day
Miralax 1x a day for constipation issues. I have tried so many different methods for Constipation since 2008. Fiber is in my diet but to much Fiber really Constipates me.
25 mg/hcr Fentanyl.patch changed every 2 days
1st ablation done Feb. 27, 2014 for Long term persistent AFIB Dr. Natale
2nd Ablation done June 16,2016 Dr. Natale LAA isolated
After testing and 4 weeks of Pradaxa, I had a stent put in around my Heart on Jan. 12 2012. Approx. One month later I had my 1st Electrical Cardioversion; It was successful They tried to convert it chemically with Amiodarone and Cardizam but it would not convert. I took Amiodarone for 10 months as preventive maint. but requested to be taken off of it due to its toxicity. After one year, I was taken off Pradaxa.
After 18 months and then I went into AFIB after a stressful event. I went back on Pradaxa and put on multaq this time. I was in the hospital 4 days. One month later, I had another Electrical Cardioversion; It lasted one month before AFIB attacked me again; I had my 3rd Cardioversion. This was 3 weeks ago. It was sucessfull and continues to be.
Currently, I am scheduled for a Cather Ablation in Jan 2014 in Shreveport, LA. Dr. Sherman Wiggins is the EP. My primary Cardiologist in Monroe , Louisiana sent me to him.
Currently, I am doing good. I feel confident Anxiety triggered my last 2 episodes of AFIB. After reading this forum, I am questioning whether it is the right move to have cather ablation this soon.
I am looking for any suggestions/help etc.
Thanks in advance.
5 mg Valium a day as needed.
20 mg Prozac daily
15 mg Prevacid a day
60 cc shot of Testosterone Cypionate every 10 days. Testosterone is low due to schedule two narcotics.
.5 mg Arimidex 2x a week to keep Estrogen levels in check. T shots can cause rise in Estrogen.
100 mg Metoprolol ER 1x a day
25 mg HydroDiuril fluid pill 1x a day every 2 days.
Neurontin 900mg a day (for Neuropathic pain IC/CPPS)
800 mg of Magnesium daily . Different types
81 mg aspirin 1X a day. Heart Doctor order due to stent installed in Jan. 2012.
2.5 mg Eliquis 2X a day
Miralax 1x a day for constipation issues. I have tried so many different methods for Constipation since 2008. Fiber is in my diet but to much Fiber really Constipates me.
25 mg/hcr Fentanyl.patch changed every 2 days
1st ablation done Feb. 27, 2014 for Long term persistent AFIB Dr. Natale
2nd Ablation done June 16,2016 Dr. Natale LAA isolated
|
Re: Newbie with AFIB December 03, 2013 05:22PM |
Admin Registered: 11 years ago Posts: 2,779 |
Welcome Smackman,
With your persistent AFIB, your first order of business is being very discriminating about which EP does your ablation, once you've made the decision to go for an ablation. Do not go ahead with the EP you mention 'only' or even mostly based on the recommendation of a local Cardiologist, no matter how well meaning and friendly they are and no matter how great a doc they have been to you. In this case you have to make very sure what you are getting into, so if you do decide to go to him, do so only after fully checking things out and satisfying yourself that you are in excellent hands for the kind of procedure you will likely need.
Paroxysmal AFIB ablation has a much bigger window of acceptable ablationists to choose from, but for a successful outcome with long standing persistent AFIB, it's a big red flag to do your research and choose the very best and most experience EP ablationist you can possibly access who has a proven track record of consistent success over an ablation process typically requiring two procedures to get the job fully and well done.
If you don't want to go through all the research yourself, then just drive to your next door state of Texas and see Dr. Andrea Natale in Austin at Texas Cardiac Arrythmia operating at St David's Medical Center in Austin. Dr Natale has, far and away, the most experience with outstanding track record with these most difficult forms of persistent AFIB of anyone in the world. So he's a very safe bet, and a no brainer really, if your goal is the best possible outcome from this process.
I haven't heard anything about Dr Wiggins, and Shreveport is certainly not known as a bastion of ablation excellence in the wider world. However, it's possible he may be a fully competent EP in ablating these kind of more challenging cases, and yet you definitely need to be on alert and do your homework and know that the odds are VERY high that he is not among the most experienced you could have access too in that general regional area (including Texas) at doing these kind of demanding ablations.
Who you choose for your index procedure and any follow-up ablation ( if needed) for these kind of long-standing persistent cases is of utmost importance!! This is the only decision you will make that will have the biggest impact on your outcome and your experience of life with AFIB going forward. So be sure to take the time and make the right choice here. No matter how trustworthy and well-meaning your local cardio is who recommended this local area EP for such an ablation, do not just accept that recommendation on face value without making sure Dr Wiggin's has at least several thousand AFIB ablations under his belt and at least 750 to 1,000 of those as persistent AFIB cases. Otherwise, you are taking a much bigger risk than I would certainly want to make and all just to get it done a couple months quicker and save just a half a day drive to Austin.
For regular Paroxysmal AFIB the requirements are generally less stringent for doing a basic PVI (pulmonary vein isolation) or PVAI ( pulmonary vein antrum isolation) ablation. Then you could set say 1,000 to 1,500 AFIB ablations as a prudent minimum before letting the doctor work on his learning curve with your case. But for long-standing persistent , you seriously want to shoot for the very best you can find.
You'll have to wait three to four months for Dr Natale, but you've waited a long time already in silent AFIB so a few more months is well worth it for dramatically increasing your odds for a successful ablation process in, at most, two procedures.
If you go to an EP who is still getting his feet wet with these more complex cases, the numbers of ablations you might need could well climb beyond four or more and still may not get the job satisfactorily done. It happens all too frequently from just this sort of well-meaning recommendations by a local Cardiologist or GP to an local area EP who may be a very good doctor overall, but simply lacks the kind of long track record in the trenches you would want for this kind of persistent AFIB ablation process. Even a lot of Cardiologist don't make much of a distinction between paroxysmal AFIB and persistent AFIB when it comes to referral to an ablationist and so the simply default to the best guy they can think of within shouting distance from your neck of the woods. That may be okay for many medical referrals but its is woefully inadequate for long-standing persistent AFIB ablation referrals!
Find out how many AFIB ablations Dr Wiggins has done in his career, and how many of those were persistent AFIB cases and what has been his success rate with ablating long standing persistent AFIB?? If he is not doing at least 250 to 300 ablations a year, at a minimum, be very very skeptical that he is your best choice.
Do you know your left atrial diameter is? if its 50cm or more then all the more reason to demand the best. And you are lucky you live so relatively close to Austin. Many of us have flown from all over the country and world to put our hearts in the best hands possible and are very glad we did!
Best of luck to you, whatever you choose.
Shannon
Edited 5 time(s). Last edit at 12/03/2013 10:01PM by Shannon.
With your persistent AFIB, your first order of business is being very discriminating about which EP does your ablation, once you've made the decision to go for an ablation. Do not go ahead with the EP you mention 'only' or even mostly based on the recommendation of a local Cardiologist, no matter how well meaning and friendly they are and no matter how great a doc they have been to you. In this case you have to make very sure what you are getting into, so if you do decide to go to him, do so only after fully checking things out and satisfying yourself that you are in excellent hands for the kind of procedure you will likely need.
Paroxysmal AFIB ablation has a much bigger window of acceptable ablationists to choose from, but for a successful outcome with long standing persistent AFIB, it's a big red flag to do your research and choose the very best and most experience EP ablationist you can possibly access who has a proven track record of consistent success over an ablation process typically requiring two procedures to get the job fully and well done.
If you don't want to go through all the research yourself, then just drive to your next door state of Texas and see Dr. Andrea Natale in Austin at Texas Cardiac Arrythmia operating at St David's Medical Center in Austin. Dr Natale has, far and away, the most experience with outstanding track record with these most difficult forms of persistent AFIB of anyone in the world. So he's a very safe bet, and a no brainer really, if your goal is the best possible outcome from this process.
I haven't heard anything about Dr Wiggins, and Shreveport is certainly not known as a bastion of ablation excellence in the wider world. However, it's possible he may be a fully competent EP in ablating these kind of more challenging cases, and yet you definitely need to be on alert and do your homework and know that the odds are VERY high that he is not among the most experienced you could have access too in that general regional area (including Texas) at doing these kind of demanding ablations.
Who you choose for your index procedure and any follow-up ablation ( if needed) for these kind of long-standing persistent cases is of utmost importance!! This is the only decision you will make that will have the biggest impact on your outcome and your experience of life with AFIB going forward. So be sure to take the time and make the right choice here. No matter how trustworthy and well-meaning your local cardio is who recommended this local area EP for such an ablation, do not just accept that recommendation on face value without making sure Dr Wiggin's has at least several thousand AFIB ablations under his belt and at least 750 to 1,000 of those as persistent AFIB cases. Otherwise, you are taking a much bigger risk than I would certainly want to make and all just to get it done a couple months quicker and save just a half a day drive to Austin.
For regular Paroxysmal AFIB the requirements are generally less stringent for doing a basic PVI (pulmonary vein isolation) or PVAI ( pulmonary vein antrum isolation) ablation. Then you could set say 1,000 to 1,500 AFIB ablations as a prudent minimum before letting the doctor work on his learning curve with your case. But for long-standing persistent , you seriously want to shoot for the very best you can find.
You'll have to wait three to four months for Dr Natale, but you've waited a long time already in silent AFIB so a few more months is well worth it for dramatically increasing your odds for a successful ablation process in, at most, two procedures.
If you go to an EP who is still getting his feet wet with these more complex cases, the numbers of ablations you might need could well climb beyond four or more and still may not get the job satisfactorily done. It happens all too frequently from just this sort of well-meaning recommendations by a local Cardiologist or GP to an local area EP who may be a very good doctor overall, but simply lacks the kind of long track record in the trenches you would want for this kind of persistent AFIB ablation process. Even a lot of Cardiologist don't make much of a distinction between paroxysmal AFIB and persistent AFIB when it comes to referral to an ablationist and so the simply default to the best guy they can think of within shouting distance from your neck of the woods. That may be okay for many medical referrals but its is woefully inadequate for long-standing persistent AFIB ablation referrals!
Find out how many AFIB ablations Dr Wiggins has done in his career, and how many of those were persistent AFIB cases and what has been his success rate with ablating long standing persistent AFIB?? If he is not doing at least 250 to 300 ablations a year, at a minimum, be very very skeptical that he is your best choice.
Do you know your left atrial diameter is? if its 50cm or more then all the more reason to demand the best. And you are lucky you live so relatively close to Austin. Many of us have flown from all over the country and world to put our hearts in the best hands possible and are very glad we did!
Best of luck to you, whatever you choose.
Shannon
Edited 5 time(s). Last edit at 12/03/2013 10:01PM by Shannon.
|
Re: Newbie with AFIB December 03, 2013 10:44PM |
Registered: 10 years ago Posts: 836 |
|
Re: Newbie with AFIB December 03, 2013 11:45PM |
Registered: 11 years ago Posts: 419 |
|
Re: Newbie with AFIB December 04, 2013 07:00AM |
Registered: 10 years ago Posts: 836 |
I am not questioning Shannon's knowledge. It will be difficult for me to schedule visits to a clinic 9 hours away; Not impossible but hard. My wife is not retired. I want the best. I just worry about the follow up visits and being able to do this at such a long distance from my home; 430 miles one way.
I admit I am scared. I want whats best. I had 3 differennt Doctors in the Monroe, LA area recommend Dr. Wiggins for my Cather Ablation; My Cardiologist in Monroe, LA set me up with Dr. Wiggins personally himself because he was trying to get me in before 2014 so I could have this surgery with my medical ded. met in 2013. I will be out at least $6000 dollars in 2014 because of higher deductibles but there is a 2 month wait for Dr. Wiggins.
I do have persistent AFIB but currently am in NSR.
Edited 1 time(s). Last edit at 12/04/2013 07:51AM by smackman.
I admit I am scared. I want whats best. I had 3 differennt Doctors in the Monroe, LA area recommend Dr. Wiggins for my Cather Ablation; My Cardiologist in Monroe, LA set me up with Dr. Wiggins personally himself because he was trying to get me in before 2014 so I could have this surgery with my medical ded. met in 2013. I will be out at least $6000 dollars in 2014 because of higher deductibles but there is a 2 month wait for Dr. Wiggins.
I do have persistent AFIB but currently am in NSR.
Edited 1 time(s). Last edit at 12/04/2013 07:51AM by smackman.
|
Re: Newbie with AFIB December 04, 2013 07:58AM |
Registered: 11 years ago Posts: 318 |
Smackman (funny handle!) I chose to have my ablation a long, long way from home because I was not satisfied with the level of experience at local clinics.
Investigation is important. I was able to easily obtain the brochures from each of the clinics of interest by placing a phone call and talking the receptionist or assistant.
They seem to take serious the need to inform if asked, so you should expect to receive statistical information on such things as: the number of ablations performed, initial success rate, complication rate and mortality rate. All of these numbers were significantly different for our local clinics compared to the data from Bordeaux where I eventually went.
Secondly, it is your right to know how many ablations this particular EP has performed. It is ok to look him in the eye and ask this question, as well as verbally asking for the same statistics in the brochures. I found at one clinic that the published data was different from the verbal data.
The number of ablations performed that this site (afibbers.org) generally suggests as a minimum, especially for more complex cases such as yours, is 1500. Of course doctors with less experience are not going to volunteer this info, but they will tell you if asked.
It also seems that you may not have addressed your electrolyte and nutrient levels, and it seems to be the common thought here that the success of an ablation may be dependant on getting your overall health in order. Specifically, the drugs you are taking could be putting you at greater risk. I'm not familiar with some of them, but aspirin and Lipitor are yesterday's news although they still make the drug companies a lot of money. All of them are are worth a google search and investigation.
The difficulty lies in what happens to a persons while they are struggling. My brain was quite foggy, my concentration was off and I found it to be quite a deep pit to dig myself out of. I found that finding a local doctor who specializes in integrative and functional medicine was one of the keys to success.
I hope this helps. There are some brilliant people on this site who can give you guidance with the specifics.
Ron
Investigation is important. I was able to easily obtain the brochures from each of the clinics of interest by placing a phone call and talking the receptionist or assistant.
They seem to take serious the need to inform if asked, so you should expect to receive statistical information on such things as: the number of ablations performed, initial success rate, complication rate and mortality rate. All of these numbers were significantly different for our local clinics compared to the data from Bordeaux where I eventually went.
Secondly, it is your right to know how many ablations this particular EP has performed. It is ok to look him in the eye and ask this question, as well as verbally asking for the same statistics in the brochures. I found at one clinic that the published data was different from the verbal data.
The number of ablations performed that this site (afibbers.org) generally suggests as a minimum, especially for more complex cases such as yours, is 1500. Of course doctors with less experience are not going to volunteer this info, but they will tell you if asked.
It also seems that you may not have addressed your electrolyte and nutrient levels, and it seems to be the common thought here that the success of an ablation may be dependant on getting your overall health in order. Specifically, the drugs you are taking could be putting you at greater risk. I'm not familiar with some of them, but aspirin and Lipitor are yesterday's news although they still make the drug companies a lot of money. All of them are are worth a google search and investigation.
The difficulty lies in what happens to a persons while they are struggling. My brain was quite foggy, my concentration was off and I found it to be quite a deep pit to dig myself out of. I found that finding a local doctor who specializes in integrative and functional medicine was one of the keys to success.
I hope this helps. There are some brilliant people on this site who can give you guidance with the specifics.
Ron
|
Re: Newbie with AFIB December 04, 2013 08:58AM |
Registered: 11 years ago Posts: 4,226 |
Your followups and ongoing care can be local. Longstanding persistent afib is very difficult to keep in NSR, with meds or an ablation. As Shannon mentions, the number of EP's (worldwide) who do an excellent job ablating these complex cases are few and Natale is at the top of the pack.
George
George
|
Re: Newbie with AFIB December 04, 2013 09:44AM |
Registered: 10 years ago Posts: 20 |
For being in right next to Texas, it wouldn't be too difficult to get to Dr Natale in Austin. I would make it my first choice. He has other Dr's on his team as well if he isn't available. Why not check it out?
[www.tcaheart.com]
The terms expert and pioneer stand out to me. That's what I would want, someone who is top in their field. He is also the Editor in Chief of the Afib Journal.
Just an aside, news elsewhere says he is no longer with the Cleveland facility.
Quote
Dr. Andrea Natale is a board certified electrophysiology expert and practices at executive medical director of the Texas Cardiac Arrhythmia Institute at St. David's Medical Center in Austin, Texas. Dr. Natale also is the Senior Medical Director at Pacific Atrial Fib and Arrhythmia Center in San Francisco. He visits MetroHealth in Cleveland, and Akron General, Ohio. He has pioneered a new circumferential ultrasound vein-ablation system to correct atrial fibrillation and performed the procedure on the world's first five patients.
[www.tcaheart.com]
The terms expert and pioneer stand out to me. That's what I would want, someone who is top in their field. He is also the Editor in Chief of the Afib Journal.
Just an aside, news elsewhere says he is no longer with the Cleveland facility.
|
Re: Newbie with AFIB December 04, 2013 09:53AM |
Registered: 12 years ago Posts: 486 |
I just want to agree with what Shannon and others said - go to Dr Natale even if it means inconvenience and waiting for several months.
I had highly symptomatic longterm persistent AF and live in UK. I went to Bordeaux because Professor Haissaguerre, like Dr Natale, is one of the best in the world. It involved flights, hotels and expense and still took 2 ablations to fix it but I have never had a moment's regret. In January I will celebrate 11 years or normal rhythm and my life was transformed.
Ablation of longterm persistent AF is very very difficult, and success depends entirely on the skill and experience of the person who is wielding the catheters.
Gill (pronounced 'Jill' and female!)
I had highly symptomatic longterm persistent AF and live in UK. I went to Bordeaux because Professor Haissaguerre, like Dr Natale, is one of the best in the world. It involved flights, hotels and expense and still took 2 ablations to fix it but I have never had a moment's regret. In January I will celebrate 11 years or normal rhythm and my life was transformed.
Ablation of longterm persistent AF is very very difficult, and success depends entirely on the skill and experience of the person who is wielding the catheters.
Gill (pronounced 'Jill' and female!)
|
Re: Newbie with AFIB December 04, 2013 10:05AM |
Registered: 11 years ago Posts: 4,226 |
"Just an aside, news elsewhere says he is no longer with the Cleveland facility"
In '08, or thereabouts, the Cleveland CEO declined to renew Dr. Natale's contract. Why? Because on Natale's own time, he was teaching others his skill! Of course Natale immediately had numerous offers to run centers in various locations. He selected Austin, but also operates in San Francisco, San Diego and New York. The CEO certainly cut off his nose to spite his face. The CEO's ego was a bit too large for his own good!
In '08, or thereabouts, the Cleveland CEO declined to renew Dr. Natale's contract. Why? Because on Natale's own time, he was teaching others his skill! Of course Natale immediately had numerous offers to run centers in various locations. He selected Austin, but also operates in San Francisco, San Diego and New York. The CEO certainly cut off his nose to spite his face. The CEO's ego was a bit too large for his own good!
|
Re: Newbie with AFIB December 04, 2013 10:17AM |
Registered: 10 years ago Posts: 836 |
I go back to my Cardiologist Dec. 11 for a follow up after my Cardioversion 3 weeks ago; I will ask him about Dr. Natale and try and get a referral from him. After discussing this with my wife of 36 years, she wants to pursue Dr. Natale in Austin.
As far as my medications, I have a chronic back injury from a car wreck in 2003. The Lipitor is for my chloseterol, The aspirin for my stent in Jan. 2011.
The Ativan is for Anxiety and pain relief caused by Intertestial Cystitus. The Elmiron,Neurotin and elavil are for the Intertestial Cystitus
The Fentanyl patch is for chronic pain.
The other drugs are for my Persisitant AFIB.
5 mg Valium a day as needed.
20 mg Prozac daily
15 mg Prevacid a day
60 cc shot of Testosterone Cypionate every 10 days. Testosterone is low due to schedule two narcotics.
.5 mg Arimidex 2x a week to keep Estrogen levels in check. T shots can cause rise in Estrogen.
100 mg Metoprolol ER 1x a day
25 mg HydroDiuril fluid pill 1x a day every 2 days.
Neurontin 900mg a day (for Neuropathic pain IC/CPPS)
800 mg of Magnesium daily . Different types
81 mg aspirin 1X a day. Heart Doctor order due to stent installed in Jan. 2012.
2.5 mg Eliquis 2X a day
Miralax 1x a day for constipation issues. I have tried so many different methods for Constipation since 2008. Fiber is in my diet but to much Fiber really Constipates me.
25 mg/hcr Fentanyl.patch changed every 2 days
1st ablation done Feb. 27, 2014 for Long term persistent AFIB Dr. Natale
2nd Ablation done June 16,2016 Dr. Natale LAA isolated
Edited 1 time(s). Last edit at 12/04/2013 10:18AM by smackman.
As far as my medications, I have a chronic back injury from a car wreck in 2003. The Lipitor is for my chloseterol, The aspirin for my stent in Jan. 2011.
The Ativan is for Anxiety and pain relief caused by Intertestial Cystitus. The Elmiron,Neurotin and elavil are for the Intertestial Cystitus
The Fentanyl patch is for chronic pain.
The other drugs are for my Persisitant AFIB.
5 mg Valium a day as needed.
20 mg Prozac daily
15 mg Prevacid a day
60 cc shot of Testosterone Cypionate every 10 days. Testosterone is low due to schedule two narcotics.
.5 mg Arimidex 2x a week to keep Estrogen levels in check. T shots can cause rise in Estrogen.
100 mg Metoprolol ER 1x a day
25 mg HydroDiuril fluid pill 1x a day every 2 days.
Neurontin 900mg a day (for Neuropathic pain IC/CPPS)
800 mg of Magnesium daily . Different types
81 mg aspirin 1X a day. Heart Doctor order due to stent installed in Jan. 2012.
2.5 mg Eliquis 2X a day
Miralax 1x a day for constipation issues. I have tried so many different methods for Constipation since 2008. Fiber is in my diet but to much Fiber really Constipates me.
25 mg/hcr Fentanyl.patch changed every 2 days
1st ablation done Feb. 27, 2014 for Long term persistent AFIB Dr. Natale
2nd Ablation done June 16,2016 Dr. Natale LAA isolated
Edited 1 time(s). Last edit at 12/04/2013 10:18AM by smackman.
|
Re: Newbie with AFIB December 04, 2013 01:34PM |
Registered: 11 years ago Posts: 419 |
|
Re: Newbie with AFIB December 04, 2013 01:49PM |
Registered: 10 years ago Posts: 836 |
afhound99 Wrote:
-------------------------------------------------------
> " It will be difficult for me to schedule visits
> to a clinic 9 hours away"?
>
> Not minimizing this but you still need a great
> ablationist if you are persistent AF. IMO one
> doesn't go to a local guy without the necessary
> deep experience if you value your health. It's
> that simple.
The EP I am scheduled to go to is not local; He is 120 miles away. I know he is not Dr. Natale but to write him off without knowing any background about him is hardcore.
I understand the passion but this EP Dr. Wiggins is known in this area as the Best. Is he good enough? He told me he was 80% effective with his Cather ablations; Not always after just one time. He also has a 2 month+ waiting list.
[www.arklatexcardio.com]
I will talk to my Cardiologist about Dr. Natale and getting a referral to see him. I have to have a referral right?
Edited 1 time(s). Last edit at 12/04/2013 02:17PM by smackman.
-------------------------------------------------------
> " It will be difficult for me to schedule visits
> to a clinic 9 hours away"?
>
> Not minimizing this but you still need a great
> ablationist if you are persistent AF. IMO one
> doesn't go to a local guy without the necessary
> deep experience if you value your health. It's
> that simple.
The EP I am scheduled to go to is not local; He is 120 miles away. I know he is not Dr. Natale but to write him off without knowing any background about him is hardcore.
I understand the passion but this EP Dr. Wiggins is known in this area as the Best. Is he good enough? He told me he was 80% effective with his Cather ablations; Not always after just one time. He also has a 2 month+ waiting list.
[www.arklatexcardio.com]
I will talk to my Cardiologist about Dr. Natale and getting a referral to see him. I have to have a referral right?
Edited 1 time(s). Last edit at 12/04/2013 02:17PM by smackman.
|
Re: Newbie with AFIB December 04, 2013 04:21PM |
Registered: 10 years ago Posts: 836 |
|
Re: Newbie with AFIB December 04, 2013 04:23PM |
Registered: 11 years ago Posts: 4,226 |
The 80% most likely represents relatively simple cases. Dr. N and Professor Haissaguerre (mentioned by Jill) have a patient load that is weighted toward the most difficult cases and "fixes" to messes that others have performed. If you needed to get your broken arm set, we'd most likely send you to the guy 120 miles away & you'd be fine. If you had a simple afib case, likewise. From what you've described, you've got a difficult case. This requires exceptional skill.
When you talk to Dr. Wiggins, describe your case and ask him if he considers you a difficult one. Then ask what percentage of his cases are in your category and what his stats are on those patients.
In my case, I had a 2 1/2 month episode 9 years ago. I've fortunately been able to control it very well with large quantities of electrolytes. The episodes I've had since are few and far between and convert within 1-4 hours with the med flecainide. However, I can tell you that my 2 1/2 month episode makes mine a complex case and if my situation changed and I needed an ablation, my personal choices would be limited to Dr. Natale or Professor Haissaguerre and his associate Dr. Jais in Bordeaux, Fr.
Your odds of a successful resolution are much greater with Natale. If you choose the more local option and have either a failed outcome, or worse (yes there are worse outcomes than "this didn't work"), the inconvenience of travel will seem to be nothing by comparison.
When you talk to Dr. Wiggins, describe your case and ask him if he considers you a difficult one. Then ask what percentage of his cases are in your category and what his stats are on those patients.
In my case, I had a 2 1/2 month episode 9 years ago. I've fortunately been able to control it very well with large quantities of electrolytes. The episodes I've had since are few and far between and convert within 1-4 hours with the med flecainide. However, I can tell you that my 2 1/2 month episode makes mine a complex case and if my situation changed and I needed an ablation, my personal choices would be limited to Dr. Natale or Professor Haissaguerre and his associate Dr. Jais in Bordeaux, Fr.
Your odds of a successful resolution are much greater with Natale. If you choose the more local option and have either a failed outcome, or worse (yes there are worse outcomes than "this didn't work"), the inconvenience of travel will seem to be nothing by comparison.
|
Re: Newbie with AFIB December 04, 2013 06:36PM |
Admin Registered: 11 years ago Posts: 2,779 |
Smackman,
Please let your wife read this too and don't worry too much about the referral. Just call Austin ask for Barbra Thomas at 512-415-7830 and tell her you need to make a consult with Dr Natale and were referred by a small army of grateful patients of Dr Natale. Since you are from out of town ...as are 98% of Natale's patients and most travel considerable distances to have only him do their ablation .... including infamous ex-Italian Prime Minister Berlisconi who while still Prime Minister flew in secretly to Austin shortly after Natale moved from Cleveland Clinic to St Davids in early 2008 and he could certainly afford to go to anyone in the world, you can do what many out of town patients do and set up your initial consult with Natale on one day and then do the ablation the following day or day after and thus save a lot of time and extra travel.
This is good to do when you are almsot positive you are a good ablation candidate and are ready to do it if Dr Natale concurs and this can be very helpful and save time and money on the back and forth travel.
In the meantime, you can learn all about Dr Natale which will only reinforce the wisdom of your good decision and you will feel very comfortable going to meet him and he will reveiw you case and discuss it all with you and then just get it done!
As for followup, you will be under Natale's care for for the first 6 months after the ablation and will be followed by wearing a heart monitor the first three or four months that will automatically capture and send to his office what your heart is doing and will capture any AFIB, Flutter or Ectopic beats that may occur during that blanking period. He emight switch you to Xeralto which is a much better drug than Pradaxa anyway, simply because of the new anti-coagulants Xeralto has the most studies done on it for use during and ablation. You will remain on the blood thinner likely for 5 to 6 months since you have had persistent AFIB, or until Natale feels confident you are not having any even short silent episodes again. You will need to see him in person only at 6 months and then only when you might want too in the future. You might find you prefer to come see him once a year or you might be fine with your local doc too either one works well.
Your local Cardio will be in the loop too with Dr Natale in your early follow-up, and you can see him directly too for any immediate needs should they arise and he and Dr Natale will be in contact with each other as a very good team approach that works fine. This is NOT an issue and certainly not a reason to settle for possibly a much less experienced ablationist in doing these kind of more challenging ablation procedures.
What is important for you to really grasp and digest Smackman is that, unlike in many areas in medicine where many smart and well-trained doctors exist in many specialties that can deliver a roughly similar level of care, this is not the case with more technically challenging procedure-based treatments such as AFIB ablation, which indeed is truly one of the most challenging of all medical procedures to master.
Im sure Dr Wiggin's is a kind, smart and no doubt knowledgable EP. He may well be a wonderful physician in his own right and it's possible he may even be a pretty decent ablationist as well, most likely with paroxysmal Ablations.
But unless he has many thousands of successful AFIB ablations under his belt and a big number of those are successful persistent AFIB ablation cases, even if requiring a two, or at most three, procedure process to achieve full and satisfactory long term success, the it's extremely unlikely any EP with much less experience and broad national and even international recognition and acclaim is going to be close to the league of a true maestro like Dr Natale.
Im not saying its impossible, stranger things in life have happened I guess, but unless any EP you are evaluating has vast numbers of successful ablations, and a lot of those are for persistent AFIB, the odds are simply vanishingly remote that the doctor in question really is some hidden gem of a maestro arising suddenly from the ARK-LA-TEX border area of Louisiana!
The doctor may be a decent overall ablationist, but no matter how well-meaning and no matter how knowledgable he is about Electrophysiology and AFIB ablations, it simply takes a long time and much hands-on experience working very often with the most challenging cases to develop the kind of inherent motor skills and dexterity with a catheter to be able to be truly great at this business and to be able to lay down solid transmural ablation burns throughout the left and right atriums on a consistent repeatable basis.
Thankfully the numbers of highly skilled ablationists are growing rapidly, but even still those with vast experience successfully quieting these persistent cases are a relative minority and when you have the very best, bar none, within the US in Austin, almost a stones throw from your house, it becomes very difficult to rationalize why a local choice would be the most prudent one.
In most fields of medicine, there are many doctors all over the US and world who are more or less interchangable. This is decidedly not true when it comes to AFIB ablation and certainly not for persistent AFIB.
An analogy here in another highly skill-dependent profession is pro sports. Most anyone with enough dedication, effort and time can learn all there is to know about playing golf, or NFL football for that matter, and at some point could become master of the information enough to be able to recite chapter and verse every nuance and detail there is to know about dropping that nine iron shot into the cup or throwing a backside fade into the end zone into double coverage to a wide receiver for the winning Touchdown. And one might even become very talented at coming close too actually doing it with some athletic talent too, maybe even pulling it off from time to time. But when it's your heart on the line its only common sense that you're odds are going to be much better off letting a Tiger Woods (in his prime) swing that 9 iron, or a Peyton Manning (in not to frigid temperatures) throwing that pass with the whole game on the line assuming you have the opportunity, as you do in Austin, to have one of these elite players on your team.
Furthermore, the EP community is a really tight nit one where real talent doesn't go unnoticed for long in the larger arena and such talent tends to rise to the top and get noticed. As such, major opportunities then open up for these up and coming EPs who show such consistent talent. Before long they inevitably start to move up in the EP world and get noticed overt a broad area and start attracting patients from far and wide, when it becomes clear they have the right stuff when it comes to excelling in such a challenging specialty that not every doctor can master, no matter how badly they may want to and how hard they try. The truth is, not every EP who is out there doing ablations should be doing them.
So when only an 8 hour drive or so to Austin is what separates you from having truly one of the top two or three in the world, if not the very best, in charge of your heart, its not at all being dismissive toward Dr Wiggins to go for the very best. You are not saying he isn't good, or even possibly good enough, just that you prefer to stack the odds in your favor when you can do so and still within your general region.
It is possible Dr Wiggins could do a good job for you Smackman. The question you have to get comfortable with up front before hand, is not might he be good enough to pull it off, but is he truly my best possible option I can arrange for myself?? If after comparing the two men's experience and record in this field, you still honestly feel most comfortable with the local EP, thats fine and is perfectly your prerogative. Our efforts here are simply to give you enough reason and room for pause before you jump with the more convenient and easy local recommendation so that you can make a very careful assessment and decision on that issue.
Ask yourself this, could a relatively unknown EP from a local Shreveport Cardiology Group whose members consist almost exclusively ( except for Dr Wiggins who is from Vanderbilt) of graduates from LSU-Shreveport Medical School really have one of the very best persistent AFIB ablationist anywhere in the region? Or is it more likely that he is perhaps, simply the best available ablationist that local Cardiologists in the Northern Louisiana area are familiar with, or even consider when referring patients out for a possible ablation? Like I said, he may be a perfect fine ablationists. but there is more than enough of a contrast here to warrant you making this a very high priority comparison and decision.
I doubt seriously whether a local Cardiologist will even take into consideration your persistent AFIB status relative to a paroxysmal and draw much of a distinction in their decision of who to send you too, and will more than likely just assume that if an EP is the best in the area, then he will be the best to sort it out for you once you are in his hands.
Most regulars here on this site know this part of my story well, but I am so adamant about this because of my own experience compared to that of my sister who also has persistent AFIB. My father had it before us and died of a massive stroke from it and I had my aggressively symptomatic persistent AFIB fixed by Dr Natale after flying all the way from Amsterdam where I lived for four years at the time, to see him.
My family grew up in Houston (after moving from North Carolina when I was two) and my older sister has never left Houston other than to attend Univ of Texas in Austin. When I flew back to Texas from Amsterdam in Aug 2008 for my index ablation with Dr N, my sister came to Austin for a couple days ( and my brother too from Santa Fe) to be there for me and met Dr Natale and she was as impressed as most everyone is.
I had strongly urged my sister to get her ablation done in Austin by Natale as well when she was ready to do it , and when I left back for Amsterdam she was all gung ho to do so Then about a year later I learned that she had allowed a local Cardiologist in Houston to convince her by singing the praises of this new Director of AFIB ablation as a large Houston medical center claiming EXACTLY what your cardio did that this guy with around 600 to 700 ablations under his belt was the 'very best ablationist' in the entire region and a real 'star' in the ablation world and that is why he won this top job at this prominent Houston medical center. etc. etc.
She has always been a homebody and while she says now that part of her knew this was a big risk, all the reassurances she got at the time not only from her own Cardio but several others including the head Cardiologist at Hermann Medical Center all signing the same high praises for this new ablation wizard finally convinced her to get it done there in her home town which conformed with her desire not to have to travel any at all, even the short 3 hour drive to Austin!
The guy butchered her in a 9 hour ablation that left her in worst persistent AFIB and led to a stroke not long afterward and she remains bedridden to this day, close to three years later. She was so traumatized by the severe back pain from the much too long ablation and beign strapped down the whole time that she would never consider going through it again even with someone like Natale, regardless of all the reassurances that it would be nothing like that with him.
Anyway, this doc has a spotty track record now, but even then, those Cardios should have known better than to send a woman with long standing persistent AFIB and other co-morbidities like severe Rheumatoid Arthritis to a guy with only 600 to 700 ablations total on his wall, no matter how knowledgable and charismatic he might have been.
The moral of all of this, is do NOT go solely by the recommendation of only local doctors for another local ablationist. You can take their counsel as a starting point and really research it all thoroughly to see if you can convince yourself that this person is truly your best possible option that you can arrange for yourself and then go from there, certainly when dealing with persistent AFIB you want someone who other EP's and Cardio's in the know from well outside the local region would also concur that he or she is the best you can do as well? You need to step out of the local bubble or circuit to get a clearer perspective.
Your wife's instincts here are on the money (my wife is often like that too :-) . Natale has done right around 9,000 AFIB/Flutter ablations now and many of these have been some of the most difficult cases from all over the US referred to him regularly. This is more AFIB ablations by a fair margin than any other EP in the world with Professors Haissaguerre and Jais of Bordeaux France being the only others who are really in Natale's same general skill and experience bracket. AFIB ablation is, for the most part, very safe and particularly in the hands of these three men most of all!
But you can have bad outcomes and the vast majority of the time these bad outcomes tend to happen with a lesser experienced EP who gets in over their head for the level of ablation they are attempting, so that is part of the equation to factor in too and the reason for insisting on a large amount of real world experience with tough AFIB cases.
Before seeing your cardiologist next, please learn more about Dr Natale, in the archives on this site and from the many studies that Natale's groups have authored, and by asking any of us more questions as well as from his Austin website linked to in the posts above. Then, when you see your Monroe Cardiologist you can politely insist that he refer you to Dr Natale should he express any reluctance too do so when you initially ask him to do so. This is your heart and your ablation and he should have no problem referring you to someone like Natale with his international stature in this arena. But even it he doesnt for any reason you can still just tell Barbara you folks are dead set on going there if thats the case and you'll get in.
He may or may not be familiar with Natale as a Cardiologist and not an EP, but unless he was really familiar with who he is, your doc wouldn't have likely referred you to Natale to begin with due to the distance. Like most Docs, they tend to work within their local or smaller regional 'bubble' when it comes to referrals and not too often think outside that box.
Best of luck to you Smackman,
Shannon
Edited 3 time(s). Last edit at 12/04/2013 10:24PM by Shannon.
Please let your wife read this too and don't worry too much about the referral. Just call Austin ask for Barbra Thomas at 512-415-7830 and tell her you need to make a consult with Dr Natale and were referred by a small army of grateful patients of Dr Natale. Since you are from out of town ...as are 98% of Natale's patients and most travel considerable distances to have only him do their ablation .... including infamous ex-Italian Prime Minister Berlisconi who while still Prime Minister flew in secretly to Austin shortly after Natale moved from Cleveland Clinic to St Davids in early 2008 and he could certainly afford to go to anyone in the world, you can do what many out of town patients do and set up your initial consult with Natale on one day and then do the ablation the following day or day after and thus save a lot of time and extra travel.
This is good to do when you are almsot positive you are a good ablation candidate and are ready to do it if Dr Natale concurs and this can be very helpful and save time and money on the back and forth travel.
In the meantime, you can learn all about Dr Natale which will only reinforce the wisdom of your good decision and you will feel very comfortable going to meet him and he will reveiw you case and discuss it all with you and then just get it done!
As for followup, you will be under Natale's care for for the first 6 months after the ablation and will be followed by wearing a heart monitor the first three or four months that will automatically capture and send to his office what your heart is doing and will capture any AFIB, Flutter or Ectopic beats that may occur during that blanking period. He emight switch you to Xeralto which is a much better drug than Pradaxa anyway, simply because of the new anti-coagulants Xeralto has the most studies done on it for use during and ablation. You will remain on the blood thinner likely for 5 to 6 months since you have had persistent AFIB, or until Natale feels confident you are not having any even short silent episodes again. You will need to see him in person only at 6 months and then only when you might want too in the future. You might find you prefer to come see him once a year or you might be fine with your local doc too either one works well.
Your local Cardio will be in the loop too with Dr Natale in your early follow-up, and you can see him directly too for any immediate needs should they arise and he and Dr Natale will be in contact with each other as a very good team approach that works fine. This is NOT an issue and certainly not a reason to settle for possibly a much less experienced ablationist in doing these kind of more challenging ablation procedures.
What is important for you to really grasp and digest Smackman is that, unlike in many areas in medicine where many smart and well-trained doctors exist in many specialties that can deliver a roughly similar level of care, this is not the case with more technically challenging procedure-based treatments such as AFIB ablation, which indeed is truly one of the most challenging of all medical procedures to master.
Im sure Dr Wiggin's is a kind, smart and no doubt knowledgable EP. He may well be a wonderful physician in his own right and it's possible he may even be a pretty decent ablationist as well, most likely with paroxysmal Ablations.
But unless he has many thousands of successful AFIB ablations under his belt and a big number of those are successful persistent AFIB ablation cases, even if requiring a two, or at most three, procedure process to achieve full and satisfactory long term success, the it's extremely unlikely any EP with much less experience and broad national and even international recognition and acclaim is going to be close to the league of a true maestro like Dr Natale.
Im not saying its impossible, stranger things in life have happened I guess, but unless any EP you are evaluating has vast numbers of successful ablations, and a lot of those are for persistent AFIB, the odds are simply vanishingly remote that the doctor in question really is some hidden gem of a maestro arising suddenly from the ARK-LA-TEX border area of Louisiana!
The doctor may be a decent overall ablationist, but no matter how well-meaning and no matter how knowledgable he is about Electrophysiology and AFIB ablations, it simply takes a long time and much hands-on experience working very often with the most challenging cases to develop the kind of inherent motor skills and dexterity with a catheter to be able to be truly great at this business and to be able to lay down solid transmural ablation burns throughout the left and right atriums on a consistent repeatable basis.
Thankfully the numbers of highly skilled ablationists are growing rapidly, but even still those with vast experience successfully quieting these persistent cases are a relative minority and when you have the very best, bar none, within the US in Austin, almost a stones throw from your house, it becomes very difficult to rationalize why a local choice would be the most prudent one.
In most fields of medicine, there are many doctors all over the US and world who are more or less interchangable. This is decidedly not true when it comes to AFIB ablation and certainly not for persistent AFIB.
An analogy here in another highly skill-dependent profession is pro sports. Most anyone with enough dedication, effort and time can learn all there is to know about playing golf, or NFL football for that matter, and at some point could become master of the information enough to be able to recite chapter and verse every nuance and detail there is to know about dropping that nine iron shot into the cup or throwing a backside fade into the end zone into double coverage to a wide receiver for the winning Touchdown. And one might even become very talented at coming close too actually doing it with some athletic talent too, maybe even pulling it off from time to time. But when it's your heart on the line its only common sense that you're odds are going to be much better off letting a Tiger Woods (in his prime) swing that 9 iron, or a Peyton Manning (in not to frigid temperatures) throwing that pass with the whole game on the line assuming you have the opportunity, as you do in Austin, to have one of these elite players on your team.
Furthermore, the EP community is a really tight nit one where real talent doesn't go unnoticed for long in the larger arena and such talent tends to rise to the top and get noticed. As such, major opportunities then open up for these up and coming EPs who show such consistent talent. Before long they inevitably start to move up in the EP world and get noticed overt a broad area and start attracting patients from far and wide, when it becomes clear they have the right stuff when it comes to excelling in such a challenging specialty that not every doctor can master, no matter how badly they may want to and how hard they try. The truth is, not every EP who is out there doing ablations should be doing them.
So when only an 8 hour drive or so to Austin is what separates you from having truly one of the top two or three in the world, if not the very best, in charge of your heart, its not at all being dismissive toward Dr Wiggins to go for the very best. You are not saying he isn't good, or even possibly good enough, just that you prefer to stack the odds in your favor when you can do so and still within your general region.
It is possible Dr Wiggins could do a good job for you Smackman. The question you have to get comfortable with up front before hand, is not might he be good enough to pull it off, but is he truly my best possible option I can arrange for myself?? If after comparing the two men's experience and record in this field, you still honestly feel most comfortable with the local EP, thats fine and is perfectly your prerogative. Our efforts here are simply to give you enough reason and room for pause before you jump with the more convenient and easy local recommendation so that you can make a very careful assessment and decision on that issue.
Ask yourself this, could a relatively unknown EP from a local Shreveport Cardiology Group whose members consist almost exclusively ( except for Dr Wiggins who is from Vanderbilt) of graduates from LSU-Shreveport Medical School really have one of the very best persistent AFIB ablationist anywhere in the region? Or is it more likely that he is perhaps, simply the best available ablationist that local Cardiologists in the Northern Louisiana area are familiar with, or even consider when referring patients out for a possible ablation? Like I said, he may be a perfect fine ablationists. but there is more than enough of a contrast here to warrant you making this a very high priority comparison and decision.
I doubt seriously whether a local Cardiologist will even take into consideration your persistent AFIB status relative to a paroxysmal and draw much of a distinction in their decision of who to send you too, and will more than likely just assume that if an EP is the best in the area, then he will be the best to sort it out for you once you are in his hands.
Most regulars here on this site know this part of my story well, but I am so adamant about this because of my own experience compared to that of my sister who also has persistent AFIB. My father had it before us and died of a massive stroke from it and I had my aggressively symptomatic persistent AFIB fixed by Dr Natale after flying all the way from Amsterdam where I lived for four years at the time, to see him.
My family grew up in Houston (after moving from North Carolina when I was two) and my older sister has never left Houston other than to attend Univ of Texas in Austin. When I flew back to Texas from Amsterdam in Aug 2008 for my index ablation with Dr N, my sister came to Austin for a couple days ( and my brother too from Santa Fe) to be there for me and met Dr Natale and she was as impressed as most everyone is.
I had strongly urged my sister to get her ablation done in Austin by Natale as well when she was ready to do it , and when I left back for Amsterdam she was all gung ho to do so Then about a year later I learned that she had allowed a local Cardiologist in Houston to convince her by singing the praises of this new Director of AFIB ablation as a large Houston medical center claiming EXACTLY what your cardio did that this guy with around 600 to 700 ablations under his belt was the 'very best ablationist' in the entire region and a real 'star' in the ablation world and that is why he won this top job at this prominent Houston medical center. etc. etc.
She has always been a homebody and while she says now that part of her knew this was a big risk, all the reassurances she got at the time not only from her own Cardio but several others including the head Cardiologist at Hermann Medical Center all signing the same high praises for this new ablation wizard finally convinced her to get it done there in her home town which conformed with her desire not to have to travel any at all, even the short 3 hour drive to Austin!
The guy butchered her in a 9 hour ablation that left her in worst persistent AFIB and led to a stroke not long afterward and she remains bedridden to this day, close to three years later. She was so traumatized by the severe back pain from the much too long ablation and beign strapped down the whole time that she would never consider going through it again even with someone like Natale, regardless of all the reassurances that it would be nothing like that with him.
Anyway, this doc has a spotty track record now, but even then, those Cardios should have known better than to send a woman with long standing persistent AFIB and other co-morbidities like severe Rheumatoid Arthritis to a guy with only 600 to 700 ablations total on his wall, no matter how knowledgable and charismatic he might have been.
The moral of all of this, is do NOT go solely by the recommendation of only local doctors for another local ablationist. You can take their counsel as a starting point and really research it all thoroughly to see if you can convince yourself that this person is truly your best possible option that you can arrange for yourself and then go from there, certainly when dealing with persistent AFIB you want someone who other EP's and Cardio's in the know from well outside the local region would also concur that he or she is the best you can do as well? You need to step out of the local bubble or circuit to get a clearer perspective.
Your wife's instincts here are on the money (my wife is often like that too :-) . Natale has done right around 9,000 AFIB/Flutter ablations now and many of these have been some of the most difficult cases from all over the US referred to him regularly. This is more AFIB ablations by a fair margin than any other EP in the world with Professors Haissaguerre and Jais of Bordeaux France being the only others who are really in Natale's same general skill and experience bracket. AFIB ablation is, for the most part, very safe and particularly in the hands of these three men most of all!
But you can have bad outcomes and the vast majority of the time these bad outcomes tend to happen with a lesser experienced EP who gets in over their head for the level of ablation they are attempting, so that is part of the equation to factor in too and the reason for insisting on a large amount of real world experience with tough AFIB cases.
Before seeing your cardiologist next, please learn more about Dr Natale, in the archives on this site and from the many studies that Natale's groups have authored, and by asking any of us more questions as well as from his Austin website linked to in the posts above. Then, when you see your Monroe Cardiologist you can politely insist that he refer you to Dr Natale should he express any reluctance too do so when you initially ask him to do so. This is your heart and your ablation and he should have no problem referring you to someone like Natale with his international stature in this arena. But even it he doesnt for any reason you can still just tell Barbara you folks are dead set on going there if thats the case and you'll get in.
He may or may not be familiar with Natale as a Cardiologist and not an EP, but unless he was really familiar with who he is, your doc wouldn't have likely referred you to Natale to begin with due to the distance. Like most Docs, they tend to work within their local or smaller regional 'bubble' when it comes to referrals and not too often think outside that box.
Best of luck to you Smackman,
Shannon
Edited 3 time(s). Last edit at 12/04/2013 10:24PM by Shannon.
|
Re: Newbie with AFIB December 04, 2013 07:00PM |
Registered: 10 years ago Posts: 73 |
Dear Smackman,
There are so many good responses above that I hesitate to add anything else, but I am relieved to read above that you will now consider Dr. Natale. We are all scared because there is nothing more fundamental to the sense of good health than being healthfully "unaware" of your heart beating. AF never stops being disconcerting in ways that really do take a toll on you after a while. Like others on this list, my fears kept me from pursuing an ablation until I was persistent (although I had just begun to meet this definition and was 24/7 when I first consulted with Dr. Natale in NYC in May).
I had lone paroxysmal AF for 19 years prior to becoming persistent in March of this year. In August I had a PVAI with Dr. Natale and I have been in NSR ever since with two minor bumps in the road in the first two weeks. One point worth mentioning here that I have considered many times when thinking about the importance of having an EP who is skillful enough to handle a catheter wherever there is need: after the PVI I was not in sinus rhythm, so Dr. Natale moved to the posterior wall of LA. As he was completing this part of my procedure, I converted to sinus rhythm. I have read on this list of EPs who won't go near the posterior wall because of the serious risks if there is a complication. In my case, this was likely a place that, if left untouched, would have resulted in a repeat procedure as a given. With persistent AF, Dr. Natale now also almost routinely does some work around the left atrial appendage, and he did this in my case as well. My ejection velocity is normal and there was no involvement of the LAA in the AF that I presented with. However, as many have noted on this list, the likelihood of the LAA being involved with future episodes of AF is very high, and this would have implications for anti-coagulation, etc. Dr. Natale feels that the work he does around the LAA (without isolation) has proved helpful in keeping patients with persistent AF in NSR, and that it may prevent further developments that could lead to the involvement of the LAA. So, my procedure is what one might call the "standard" first procedure that Dr. Natale does for persistent AF.
I present these details only to indicate that my first ablation was anything but routine, but in the hands of an EP like Dr. Natale, he presented it to my wife right after the procedure as an uncomplicated procedure and that everything looked fine. I can imagine where I would be today if there had only been ablation around the pulmonary veins. This is why there is so much emphasis among those of us who have lived this experience to push others to consider only the best when you have decided that ablation is the course of action that you need to pursue.
I would have gone anywhere in the US to have the procedure done by Natale, and it was worth all the travel, hotels, etc and being away from home to have this level of mastery when I needed it. It may be that I won't need anything further, and this would be another indication that seeing the best from the start is the best decision for your health. If I do need another procedure, I wouldn't hesitate to return to him no matter where he was practicing. You don't need to see Dr. Natale for follow-up monitoring, which can be done in consultation with a local EP and Dr. Natale. You need him when you are on the table. I am seeing Dr. Danik at St. Luke's later this month and he will consult with Dr. Natale as needed.
You are in a place right now that is difficult, and as RonB said above, there is a lot of stress that can sometimes lead to doubt. I remember this well. All I can say is that this is one of the most important decisions you will make about your health, and the option to be in the best hands is there. I would take it, and I've been grateful every day since my procedure in August for how much my life has changed.
All best wishes,
Rob
There are so many good responses above that I hesitate to add anything else, but I am relieved to read above that you will now consider Dr. Natale. We are all scared because there is nothing more fundamental to the sense of good health than being healthfully "unaware" of your heart beating. AF never stops being disconcerting in ways that really do take a toll on you after a while. Like others on this list, my fears kept me from pursuing an ablation until I was persistent (although I had just begun to meet this definition and was 24/7 when I first consulted with Dr. Natale in NYC in May).
I had lone paroxysmal AF for 19 years prior to becoming persistent in March of this year. In August I had a PVAI with Dr. Natale and I have been in NSR ever since with two minor bumps in the road in the first two weeks. One point worth mentioning here that I have considered many times when thinking about the importance of having an EP who is skillful enough to handle a catheter wherever there is need: after the PVI I was not in sinus rhythm, so Dr. Natale moved to the posterior wall of LA. As he was completing this part of my procedure, I converted to sinus rhythm. I have read on this list of EPs who won't go near the posterior wall because of the serious risks if there is a complication. In my case, this was likely a place that, if left untouched, would have resulted in a repeat procedure as a given. With persistent AF, Dr. Natale now also almost routinely does some work around the left atrial appendage, and he did this in my case as well. My ejection velocity is normal and there was no involvement of the LAA in the AF that I presented with. However, as many have noted on this list, the likelihood of the LAA being involved with future episodes of AF is very high, and this would have implications for anti-coagulation, etc. Dr. Natale feels that the work he does around the LAA (without isolation) has proved helpful in keeping patients with persistent AF in NSR, and that it may prevent further developments that could lead to the involvement of the LAA. So, my procedure is what one might call the "standard" first procedure that Dr. Natale does for persistent AF.
I present these details only to indicate that my first ablation was anything but routine, but in the hands of an EP like Dr. Natale, he presented it to my wife right after the procedure as an uncomplicated procedure and that everything looked fine. I can imagine where I would be today if there had only been ablation around the pulmonary veins. This is why there is so much emphasis among those of us who have lived this experience to push others to consider only the best when you have decided that ablation is the course of action that you need to pursue.
I would have gone anywhere in the US to have the procedure done by Natale, and it was worth all the travel, hotels, etc and being away from home to have this level of mastery when I needed it. It may be that I won't need anything further, and this would be another indication that seeing the best from the start is the best decision for your health. If I do need another procedure, I wouldn't hesitate to return to him no matter where he was practicing. You don't need to see Dr. Natale for follow-up monitoring, which can be done in consultation with a local EP and Dr. Natale. You need him when you are on the table. I am seeing Dr. Danik at St. Luke's later this month and he will consult with Dr. Natale as needed.
You are in a place right now that is difficult, and as RonB said above, there is a lot of stress that can sometimes lead to doubt. I remember this well. All I can say is that this is one of the most important decisions you will make about your health, and the option to be in the best hands is there. I would take it, and I've been grateful every day since my procedure in August for how much my life has changed.
All best wishes,
Rob
|
Re: Newbie with AFIB December 04, 2013 07:06PM |
Registered: 12 years ago Posts: 486 |
|
Re: Newbie with AFIB December 04, 2013 07:17PM |
Registered: 11 years ago Posts: 419 |
|
Re: Newbie with AFIB December 04, 2013 11:02PM |
Admin Registered: 11 years ago Posts: 2,779 |
Can someone post a link for Smackman showing success rates for ablations done by the top people compared with the average success rates?
Gill
Hi Gill,
I will try to finish that up tomorrow if I have time after the furnace guys finish installing a new furnace at our house in Sedona, its freezing out now and our's went kaput last week and am looking forward to shedding the polar bear clothes Ive been wearing inside the last 7 days. If not tomorrow, then Friday I will post the new thread on the very latest and ver encouraging long term ablation results study and this in, is particularly relevant as its from Natales groups following 513 patients in detail for over a ten year period ranging from late 2000 thru early 2002 (just over a year period) during which each of these people had their initial ablation which was back in the literal stone age of ablation knowledge, imaging technology and catheter evolution.
Even still, with these 513 patients being so long ago, the results were remarkable after 1o full years ending in early 2012 when they finished data collection and started compiling and analyzing it all.
I want to discuss in the new thread, which I will add a link too in this thread as well, the implications of these findings and how is shed light on the overall increase in good outcomes across the board from most major centers and skilled EP groups with the vast evolution in understanding around ablations and the big improvements in equipment and imaging systems since the 2000 to early 2002 period some 12 years ago.
Briefly though, of the 513 patients done by Natale's groups back then in that just over one year period ending in early 2002, the vast majority were ablated by Natale himself. That likely accounts for, even way back then, the major reduction in pulmonary vein reconnections found on those of this group who required a follow-up touch-up ablation compared to most top centers reports of long term PV reconnection rates found in thieir patients using their own approach to PVI ablation.
Of the 513 total who had paroxysmal AFIB in this study, 21% had at least one short episode during the first year after ablation, another 11% had some activity between years 1 and 3, another 4% had their first breakthroughs between year 3 and 6 and an additional 5% had their first episode between years 6 and 10, leaving a net total of 59% of those patients after only a single PVAI ablation so long ago who were still entirely Arrhythmia free the full 10 years!
Of the remaining 41% who had at least one short episode, or more, over this 10 year period, 74% or that group requested a follow up procedure with an average of 2 total procedures per patient. A small percentage required 3 procedures, and all of those who needed 2 or more procedures were found to have significant new non-PV trigger sources active and these were often found around or within the LAA and/or Coronary Sinus.
This finding showing that as more time progressed before late re-accurances happened, the more likely it would be that LAA or CS involvement was there and thus N Natale now addresses these issues, if they are found to be starting to cause mischief, in either the initial or most often first follow up ablation and that is why its increasingly rare these days for some one to need even a third ablation if they started the whole process with Natale the average is about 1.2 ablations for all of his patients overall these days. WIth an average closer to 2.0 procedures needed for now for most persistent AFIB cases too, though some of these more difficult cases are truly 'one and done'.
In any event, of all those coming for a follow up ablation, 31% were found to have had Pulmonary Vein reconnection... remember this was a long time ago before Thermo-cool water cooled catheters and Carto-3 3D imaging systems ... and yet this compares to the reports from other major center's long term studies of 5 years or more that show a range in percentage of PV reconnection found in their patients coming for repeat ablation between around 80% to 95% compared to only 31% for Natale back in the day as far back as 2000 to early 2002.
Interestingly, of the 31% who had reconnected PVs after a single old style ablation, none showed any PV reconnects after one follow up ablation.
The even better news is that now Dr. Natale reports that it is very rare for him to even find a PV reconnection in patients who need a touch up during to some non-PV new trigger source, whose initial ablation was in the last 4 to 5 years since the new water cooled catheters allow more consistent pressure and higher power application to be used which, in turn, insures greater trans-murality of the lesions (meaning the lesion is solid all the way through the entire atrial wall thickness), making them far more durable and solid.
This improvement in relatively lower PV reconnection should be happening for many other top operators at other major centers as well using similar technology, and one might expect them to get at least a relative proportional decrease in PV reconnects compared to their original PV reconnect stats, and relative to Natale's big drop in his own already impressively low PV reconnects form the old years.
Over all, this new study shows that 87% of the 513 patients with more extensive PVAI ablation procedure pioneered by Natale, including all that have had follow up ablations, were totally free from recurrent AFIB and Atrial Tachycardias at the 10 year point. This is impressive indeed as most other long term studies using both segmental ablation and less extensive antral isolation tend to show still good, but not quite such impressive long term results.
Nevertheless, we'll look at it a little closer in its own thread, yet it's a very safe bet with all the major evolution in understanding, techniques and technology, that were they to start a new ten year study with patients first ablated say 2 years ago and were to wrap it up in 8 years from now, its a near certainty the numbers are going to look even more impressive still yet. That is good news for everyone and all EPs.
Shannon
Edited 3 time(s). Last edit at 12/04/2013 11:57PM by Shannon.
Gill
Hi Gill,
I will try to finish that up tomorrow if I have time after the furnace guys finish installing a new furnace at our house in Sedona, its freezing out now and our's went kaput last week and am looking forward to shedding the polar bear clothes Ive been wearing inside the last 7 days. If not tomorrow, then Friday I will post the new thread on the very latest and ver encouraging long term ablation results study and this in, is particularly relevant as its from Natales groups following 513 patients in detail for over a ten year period ranging from late 2000 thru early 2002 (just over a year period) during which each of these people had their initial ablation which was back in the literal stone age of ablation knowledge, imaging technology and catheter evolution.
Even still, with these 513 patients being so long ago, the results were remarkable after 1o full years ending in early 2012 when they finished data collection and started compiling and analyzing it all.
I want to discuss in the new thread, which I will add a link too in this thread as well, the implications of these findings and how is shed light on the overall increase in good outcomes across the board from most major centers and skilled EP groups with the vast evolution in understanding around ablations and the big improvements in equipment and imaging systems since the 2000 to early 2002 period some 12 years ago.
Briefly though, of the 513 patients done by Natale's groups back then in that just over one year period ending in early 2002, the vast majority were ablated by Natale himself. That likely accounts for, even way back then, the major reduction in pulmonary vein reconnections found on those of this group who required a follow-up touch-up ablation compared to most top centers reports of long term PV reconnection rates found in thieir patients using their own approach to PVI ablation.
Of the 513 total who had paroxysmal AFIB in this study, 21% had at least one short episode during the first year after ablation, another 11% had some activity between years 1 and 3, another 4% had their first breakthroughs between year 3 and 6 and an additional 5% had their first episode between years 6 and 10, leaving a net total of 59% of those patients after only a single PVAI ablation so long ago who were still entirely Arrhythmia free the full 10 years!
Of the remaining 41% who had at least one short episode, or more, over this 10 year period, 74% or that group requested a follow up procedure with an average of 2 total procedures per patient. A small percentage required 3 procedures, and all of those who needed 2 or more procedures were found to have significant new non-PV trigger sources active and these were often found around or within the LAA and/or Coronary Sinus.
This finding showing that as more time progressed before late re-accurances happened, the more likely it would be that LAA or CS involvement was there and thus N Natale now addresses these issues, if they are found to be starting to cause mischief, in either the initial or most often first follow up ablation and that is why its increasingly rare these days for some one to need even a third ablation if they started the whole process with Natale the average is about 1.2 ablations for all of his patients overall these days. WIth an average closer to 2.0 procedures needed for now for most persistent AFIB cases too, though some of these more difficult cases are truly 'one and done'.
In any event, of all those coming for a follow up ablation, 31% were found to have had Pulmonary Vein reconnection... remember this was a long time ago before Thermo-cool water cooled catheters and Carto-3 3D imaging systems ... and yet this compares to the reports from other major center's long term studies of 5 years or more that show a range in percentage of PV reconnection found in their patients coming for repeat ablation between around 80% to 95% compared to only 31% for Natale back in the day as far back as 2000 to early 2002.
Interestingly, of the 31% who had reconnected PVs after a single old style ablation, none showed any PV reconnects after one follow up ablation.
The even better news is that now Dr. Natale reports that it is very rare for him to even find a PV reconnection in patients who need a touch up during to some non-PV new trigger source, whose initial ablation was in the last 4 to 5 years since the new water cooled catheters allow more consistent pressure and higher power application to be used which, in turn, insures greater trans-murality of the lesions (meaning the lesion is solid all the way through the entire atrial wall thickness), making them far more durable and solid.
This improvement in relatively lower PV reconnection should be happening for many other top operators at other major centers as well using similar technology, and one might expect them to get at least a relative proportional decrease in PV reconnects compared to their original PV reconnect stats, and relative to Natale's big drop in his own already impressively low PV reconnects form the old years.
Over all, this new study shows that 87% of the 513 patients with more extensive PVAI ablation procedure pioneered by Natale, including all that have had follow up ablations, were totally free from recurrent AFIB and Atrial Tachycardias at the 10 year point. This is impressive indeed as most other long term studies using both segmental ablation and less extensive antral isolation tend to show still good, but not quite such impressive long term results.
Nevertheless, we'll look at it a little closer in its own thread, yet it's a very safe bet with all the major evolution in understanding, techniques and technology, that were they to start a new ten year study with patients first ablated say 2 years ago and were to wrap it up in 8 years from now, its a near certainty the numbers are going to look even more impressive still yet. That is good news for everyone and all EPs.
Shannon
Edited 3 time(s). Last edit at 12/04/2013 11:57PM by Shannon.
|
Re: Newbie with AFIB December 05, 2013 09:11AM |
Registered: 10 years ago Posts: 836 |
Shannon,
My insurance will not pay for Xeralto; It would cost me over $300 dollars a month.
I am going to make this call this morning. I want to thank all for the encouragement; I am discouraged and Anxiety gets high at times over this Heart issue. There is 6 kids in my family and no one else has AFIB.
I just want to have the best for my situation. I have much to learn............
I will let you know what happens.
Edited 1 time(s). Last edit at 12/05/2013 12:16PM by Hans Larsen.
My insurance will not pay for Xeralto; It would cost me over $300 dollars a month.
I am going to make this call this morning. I want to thank all for the encouragement; I am discouraged and Anxiety gets high at times over this Heart issue. There is 6 kids in my family and no one else has AFIB.
I just want to have the best for my situation. I have much to learn............
I will let you know what happens.
Edited 1 time(s). Last edit at 12/05/2013 12:16PM by Hans Larsen.
|
Re: Newbie with AFIB December 05, 2013 11:01AM |
Admin Registered: 11 years ago Posts: 2,779 |
You are on the right track Smackman,
Try not to get too discouraged or overly anxious over all this , though I'm well aware that is easier said than done, Many of us here been through the gauntlet and come out the other side to report there really is a light at the end of the tunnel, particularly is you follow all the great guidelines on this wonderful site and partner with a truly elite EP like Dr Natale.
Make sure and read and digest this document: 'The Strategy' and you should probably ask your wife to read it too so she is up to speed as well on this aspect of specific nutrient repletion that can really help before in preparation for an ablation and afterward for sure in helping to keep the heart calm and quiet while the healing takes place.
Shannon
Edited 1 time(s). Last edit at 12/05/2013 12:20PM by Hans Larsen.
Try not to get too discouraged or overly anxious over all this , though I'm well aware that is easier said than done, Many of us here been through the gauntlet and come out the other side to report there really is a light at the end of the tunnel, particularly is you follow all the great guidelines on this wonderful site and partner with a truly elite EP like Dr Natale.
Make sure and read and digest this document: 'The Strategy' and you should probably ask your wife to read it too so she is up to speed as well on this aspect of specific nutrient repletion that can really help before in preparation for an ablation and afterward for sure in helping to keep the heart calm and quiet while the healing takes place.
Shannon
Edited 1 time(s). Last edit at 12/05/2013 12:20PM by Hans Larsen.
|
Re: Newbie with AFIB December 05, 2013 04:01PM |
Registered: 10 years ago Posts: 836 |
|
Re: Newbie with AFIB December 05, 2013 08:15PM |
Registered: 11 years ago Posts: 163 |
|
Re: Newbie with AFIB December 05, 2013 08:55PM |
Registered: 10 years ago Posts: 836 |
Randy Wrote:
-------------------------------------------------------
> Smackman, who is Barbra Thomas?
Read Shannons post above where she gave me a number to call
Shannon [ PM ]
Re: Newbie with AFIB
December 04, 2013 06:36PM Registered: 1 year ago
Posts: 613
Smackman,
Please let your wife read this too and don't worry too much about the referral. Just call Austin ask for Barbra Thomas at 512-415-7830 and tell her you need to make a consult with Dr Natale and were referred by a small army of grateful patients of Dr Natale.
-------------------------------------------------------
> Smackman, who is Barbra Thomas?
Read Shannons post above where she gave me a number to call
Shannon [ PM ]
Re: Newbie with AFIB
December 04, 2013 06:36PM Registered: 1 year ago
Posts: 613
Smackman,
Please let your wife read this too and don't worry too much about the referral. Just call Austin ask for Barbra Thomas at 512-415-7830 and tell her you need to make a consult with Dr Natale and were referred by a small army of grateful patients of Dr Natale.
|
Re: Newbie with AFIB December 06, 2013 12:39AM |
Admin Registered: 11 years ago Posts: 2,779 |
Hi Smackman,
Barbara Thomas has been with DR N for many years and followed him to Austin from Cleveland Clinic. While she isn't the normal person to set up appointments, he often suggest I have people I mention to him who are interested in seeing him from out of the area to call her.
She is head of the AFIB center there at St Davids and Texas Cardiac Arrhythmia and is a busy lady herself, so it may take a few days to hear back, hang in there.
Shannon
Edited 1 time(s). Last edit at 12/06/2013 12:50AM by Shannon.
Barbara Thomas has been with DR N for many years and followed him to Austin from Cleveland Clinic. While she isn't the normal person to set up appointments, he often suggest I have people I mention to him who are interested in seeing him from out of the area to call her.
She is head of the AFIB center there at St Davids and Texas Cardiac Arrhythmia and is a busy lady herself, so it may take a few days to hear back, hang in there.
Shannon
Edited 1 time(s). Last edit at 12/06/2013 12:50AM by Shannon.
|
Re: Newbie with AFIB December 06, 2013 08:44AM |
Registered: 11 years ago Posts: 163 |
Sorry, only registered users may post in this forum.