My Consultation with Dr. Natale

It went well. My EKG showed me to be in NSR which I have been for 3 months taking Multaq and Metoprolol.

The very 1st thing he did was to take me off Pradaxa and put me on Xarelto or Eliquis. I chose Xarelto because it is 1x a day. Dr. Natale is NOT a fan of Pradaxa; He said it has not shown him good results against blood clots.......

He told me my situation could wait; No need to hurry. It will schedule the Ablation in April. He also said to call if I went into AFIB so maybe they could work me in. It would be better for me to be in AFIB so he could find the "other" problem spots beyond the normal 4 that is normally done. He also says sometimes the other part will go into AFIB while he is Ablating the normal 4 he will do.

I wonder if I should wait until I am in AFIB again before I have this Cather Ablation Procedure. I would have a better chance of Dr. Natale getting me fixed the 1st time without a follow up Ablation......

It was a great visit. I am home and feeling good about this visit. The question is should I have the Ablation in April if I am in NSR or try and wait until I go into AFIB. If I do this, I might have to rater control for 3 months before he could see me.

The Nurses were so knowledgeable and friendly. It was a good visit.

Hi Smackman,

Good to hear you had a nice visit in Austin ... no surprise there. Regarding being in AFIB at the time, what he meant was there is no rush while you are in NSR but should you go into AFIN before April, then perhaps he could work you in sooner if there is a sudden cancellation and not to worry is you do go into AFIB as it will save hims a step of having to endure your AFIB during the initial EP mapping phase of the ablation.

Once you are off Multaq for the allotted time period pre ablation to get it out of your system, he will be able to induce your AFIB without much difficulty in most every case, especially for someone who is normally in persistent AFIB when not cardioverted and maintained in sinus with a drug like Multaq or Flec.

I would go for the April date as he suggested, you might even flip into AFIB some days after stopping the Multaq in which case just use a low dose beta blocker ( around 12.5mg of Toprol immediate release, not ER, twice a day the immediate release form is good in this case for the shorter drug half life prior to the ablation itself) to keep the rate reasonably comfortable, but ONLY take this low dose BB if your rate is too fast, say at least above 115bpm and too much of an annoyance. Otherwise, just tough it out until the ablation if its only a week or so until that time when, and if, you trigger into AFIB after dropping the Multaq.

Shannon

PS glad to hear he got you off Pradaxa .. an awful drug that almost everyone should switch off of in my view,



Edited 1 time(s). Last edit at 01/22/2014 02:06PM by Shannon.

Shannon Wrote:
-------------------------------------------------------
> Hi Smackman,
>
> Good to hear you had a nice visit in Austin ... no
> surprise there. Regarding being in AFIB at the
> time, what he meant was there is no rush while you
> are in NSR but should you go into AFIN before
> April, then perhaps he could work you in sooner if
> there is a sudden cancellation and not to worry is
> you do go int o AFIB as it will save hims a step
> of having to endure your AFIB during the initial
> EP mapping phase of the ablation.
>
> Once you are off Multaq for the allotted time
> period pre ablation to get it out of your system,
> he will be able to induce your AFIB without much
> difficulty in most every case, especially for
> someone who is normally in persistent AFIB when
> not cardioverted and maintained in sinus with a
> drug like Multaq or Flec.
>
> I would go for the April date as he suggested, you
> might even flip into AFIB some days after stopping
> the Multaq in which case just use a low dose beta
> blocker to keep the rate reasonably confortavble
> but ONLY if your rate is too fast like above
> 115bpm. Otherwise just tough it out until the
> ablation if its only a week or so until that time
> when and if you trigger into AFIB after dropping
> the Multaq.
>
> Shannon
>
> PS glad to hear he got you off Pradaxa .. an awful
> drug that almost everyone should switch off of in
> my view,

The 3rd time I went into AFIB back in Oct 2013, My Heart rate went to approx 150 ppm. I have 50 mg tablets of regular Metoprolol. I broke one of these tablets in half and took it. I sat in my recliner and relaxed. It took 3 hours for my heart rate to get below 100 ppm but I finally got it to stay 75-95 ppm by staying calm and support of the spouse. I was monitoring my blood pressure also because in reality, I have very little BP issues.

The next day I went to my Cardiologist and he Cardioverted me. I have went 2 months on just rate control due to no blood thinner in my system and I also had a stent installed during that 2 months.

I am going in April. The weather is nice and I want to start the progress of totally removing this AFIB from my life. I like Dr. Natale and my wife felt really good about the entire time at TCA in Austin. I can rate control if needed with meds; I have done it 2x in the past before.

Dr. Natale spoke highly of you. I appreciate the support and also this websites insight on Afib.

You are welcome Smackman,

If you have any more detail type questions you can PM me as well between now and April. Sounds like you already know the drill with the BB rate control steps, so you are in the groove and ready to go!

Cheers!
Shannon

Smackman,

Seems you have already made your decision but thought I would share my experience with you. Found this website after I was diagnosed with atriall fibrillation and quickly learned about Natale. As I progressed from "pill in the pocket" to daily anti-arrhythmic medication I suffered almost all the side affects on the medication. Switched to Multq in May of 2010 which eliminated most of the side affects but did not completely stop the arrhythmia. I had learned about a catheter ablation to a certain degree from my EP cardiologies but mostly from this site. I was adamantly against any type of procedure on my heart!!!

I did not want to be tethered to twice daily medication that did not completely resolve the problem......plus was incredibly expensive. So I became more open to the possiblity of an ablation if that would get me off the medication. As I did research on the procedure (with the information learned on the site) decided to go meet with Natale.....he had jjust recently began practice in Texas (live in the Houston area).

I met with him in November 2010 and was extremely impressed. He told me I was a good candidate for an ablation and could expect to have a high probability of success on the first procedure. He also told me that my atrial fibrillation would most likely progress to persistent and that the efficacy of the mediation would diminish as well. He at no point tried to persuade me into an ablation. His only suggestion was to get on his schedule and then cancel if I did not want to go through with the procedure.

So, after the meeting I decided to get on his schedule. Interestingly, in November he was scheduled through April 2011 and was told by his office would contact me once they began May schedule. In mid-January I get a phone call and they have a cancellation on March 10......do I want that date! After much soul searching and back and forth on a decision I accepted the date.

Now almost three years later I have been problem free. I was on warfarin for 90 days post-procedure but only medication he recommended was a 325 mg aspirin. He told me that they had difficulty inducing arrhythmia during the procedure so he was very conservative in the area(s) he ablated. I know my ablation is not a cure but rather a preventative......but do know that if the problem reoccurs I will be headed to Austin as quickly as possible!!


Steve
Spring, Tx.

Hi Steve,

Great to hear from you again and glad to hear things are ticking away just fine there in Spring Texas!

Take care,
Shannon

Thanks Shannon

Had I not conducted research on atrial fibrillation after my diagnosis would not have found this site. Otherwise, may have ultimately had an ablation with my ep cardiologist or someone else in Houston since I hated being on the anti-arrhythmic medication......or may have continued to struggle along. The results may have been just as successful.....but maybe not. However, the bottom line....learned about Natale and as they say....the rest is history!!!

Without being overly dramatic.....has had an impact on the life of both me and my family

s

JAYHAWK Wrote:
-------------------------------------------------------
> Smackman,
>
> Seems you have already made your decision but
> thought I would share my experience with you.
> Found this website after I was diagnosed with
> atriall fibrillation and quickly learned about
> Natale. As I progressed from "pill in the pocket"
> to daily anti-arrhythmic medication I suffered
> almost all the side affects on the medication.
> Switched to Multq in May of 2010 which eliminated
> most of the side affects but did not completely
> stop the arrhythmia. I had learned about a
> catheter ablation to a certain degree from my EP
> cardiologies but mostly from this site. I was
> adamantly against any type of procedure on my
> heart!!!
>
> I did not want to be tethered to twice daily
> medication that did not completely resolve the
> problem......plus was incredibly expensive. So I
> became more open to the possiblity of an ablation
> if that would get me off the medication. As I did
> research on the procedure (with the information
> learned on the site) decided to go meet with
> Natale.....he had jjust recently began practice in
> Texas (live in the Houston area).
>
> I met with him in November 2010 and was extremely
> impressed. He told me I was a good candidate for
> an ablation and could expect to have a high
> probability of success on the first procedure. He
> also told me that my atrial fibrillation would
> most likely progress to persistent and that the
> efficacy of the mediation would diminish as well.
> He at no point tried to persuade me into an
> ablation. His only suggestion was to get on his
> schedule and then cancel if I did not want to go
> through with the procedure.
>
> So, after the meeting I decided to get on his
> schedule. Interestingly, in November he was
> scheduled through April 2011 and was told by his
> office would contact me once they began May
> schedule. In mid-January I get a phone call and
> they have a cancellation on March 10......do I
> want that date! After much soul searching and
> back and forth on a decision I accepted the date.
>
> Now almost three years later I have been problem
> free. I was on warfarin for 90 days
> post-procedure but only medication he recommended
> was a 325 mg aspirin. He told me that they had
> difficulty inducing arrhythmia during the
> procedure so he was very conservative in the
> area(s) he ablated. I know my ablation is not a
> cure but rather a preventative......but do know
> that if the problem reoccurs I will be headed to
> Austin as quickly as possible!!
>
>
> Steve
> Spring, Tx.


I am already in persistent AFIB but have been in NSR for 3+ months after last cardio version.

I want to have Dr. Natale do the Cather Ablation "soon" but my concern is not being in AFIB when the surgery is done meaning he will not know where to Ablate for the persistent AFIB. He told me I might go into AFIB when he ablates the "4 normal spots" but there is no guarantee. To me that probably means another Cather Ablation will definitely be in my future because I am already Persistent.

I am going to schedule my Cather Ablation in April. I am doing well right now taking Multaq and a beta blocker Lopressor BUT I know AFIB begets AFIB. I absolutely hate my lifestyle being altered to this degree over AFIB.

You don't need to be in afib prior to the procedure, they will induce afib while you are out under the anesthesia so they can see the hot spots and ablate them.

______________
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.

Iatrogenia Wrote:
-------------------------------------------------------
> You don't need to be in afib prior to the
> procedure, they will induce afib while you are out
> under the anesthesia so they can see the hot spots
> and ablate them.

Dr. Natale told me there was no guarantee that I would go into AFIB during the procedure. It is a possibilty I would go into AFIB but not 100%. He stressed that with the wife and I being I am a Persistent Afib "person" If this was true,

I would have had my Ablation Feb. 3 a date that was open. He wanted me off the Pradaxa and on the Xarelto ASAP; That he did stress also.

One more comment he made; He said he would take a more conservative approach with my Ablation because of my age. I will be 56 in Feb.



Edited 1 time(s). Last edit at 01/25/2014 05:15PM by smackman.

56 is not old. I was 66 when I had my ablation, with no problems. I have known people who have had successful ablations in their 70's. I wonder why Natale said that.

Jim

Hi Smackman.

I suspect Natale won't have any problem triggering your AFIB during the ablation should you not go into it after coming off Multaq in the days before the ablation. Being a persistent afibber, once you have been cardio-verted and it holds either from the shock alone or with drugs and perhaps good heart quietening mineral restoration as well, there is no guarantee you will automatically trigger right away after going off the AAR drug.

Its true too that he can't guaranteed 100% that he will be able to trigger AFIB during the ablation, but the odds are very high that he will able too and, in any event, he will be able to do the whole ablation taking a conservative approach on this one, as it is. No worries, you are good to go in April.

As I understand it, you were diagnosed with persistent AFIB, is that right? And you were first diagnosed with this while being entirely asymptomatic prior to learning you had AFIB? If this is correct, and please clarify just how your AFIB history has unfolded, then do you have any idea how long you might have been in persistent AFIB prior to being diagnosed and cardioverted? Also, after cardioversion did you slip back into persistent AFIB and if so, how long did it take after either chemical or Electric DC cardioversion?

Finally, once you are in AFIB, is it true that you much be cardioverted either with an IV drug cocktail or an ECV shock to get back to NSR or can you spontaneously convert back to NSR and if you do convert in less than 7 days of persistence then perhaps you don't yet truly have persistent AFIB..

In any event, you are obviously in the right place with Dr N at the helm and he will walk you though the whole process whatever it takes. Hopefully you will be one and done as well, but as always the best mind set to take is to realize this index ablation with do the lions share of the work, if not the whole deal, but the odds are there that a touch up might well be needed down the road and if so, its no big deal and will with a high degree of odds be the last you will need. The first one will for sure make great progress on getting this beast in the rear view mirror.

Shannon

mailman52 Wrote:
-------------------------------------------------------
> 56 is not old. I was 66 when I had my ablation,
> with no problems. I have known people who have
> had successful ablations in their 70's. I wonder
> why Natale said that.
>
> Jim

He was saying I was a young man not old.

I do have persistent AFIB. I have always had to be cardio verted electrically. I have been shocked 3 times into NSR. I have no idea how long I was in AFIB when I was found with it in Dec. 2011 at a regular physical.

I went for a regular physical in Dec. 2011; I was found to hbe in AFIB. I had to be electricallly cardioverted 3 months later. 18 months later , I went back into AFIB; once again I had to be shocked into NSR after1 month. I month later I had to be shocked again. That was in Oct 2013 so I have been in NSR since even though tonight I am having heart palpulations and skips. I hope that passes because my Anxiety level is really high as I type.

Smackman, if you don't mind my asking, why would you take a conservative approach with a young man, rather than an old man? I would think it would be the opposite?

Jim

Mailman52,

What Dr Natale means by taking a bit more conservative approach is that he will start with a PVAI ablation and he will systematically challenge other non-PV sources to see if any other areas are triggering which is common with longer standing persistent AFIB. Its possible with Smackman's relatively young age and perhaps two year only bout with AFIB, and we don't know yet just how much fibrosis , if any might be there, such that he will not expect to have to do a more extensive ablation until and unless mapping indicates that. Furthermore, I would assume at his age if there is some activity from the CS and LAA he might well just add some lesion around the base of the LAA in this index ablation rather than a full LAA isolation as he would be more inclined to do at an older age or wait until, and only if, a follow up procedure is needed in which case any more extensive ablation would be done. He won't know for sure until he gets in there but is only sharing his very well educated assumption base on his vast experience.

AFIB is viewed as a progressive condition with age and if Smack were in his mid 60s or above with a longer history of AFIB, Dr N might expect a more extensive amount of work being needed in the first procedure. His goal is to do as much ablation as is needed to stop the arrhythmia and in a younger person, unless the LAA is the prime or only source of AFIB/Flutter he will typically leave a full isolation for if, and only when, a follow-up touch-up ablation might be needed. If the person is older and has more extensive persistent AFIB history Natale would expect more extensive fibrosis and a likely an increased likelihood of needing to do the LAA isolation in the index procedure to have the best odds of being one and done, or at least minimizing to only two max the number of procedures that might be required to get the job done.

A younger person typically has more reserve for doing another ablation down the road, if needed later on, than perhaps an older person who might be in poorer overall health as well, so that is a consideration too. The fact that an LAA isolation can make it necessary to need life long anticoagulation also is a factor in only doing that in people older than mid to late 50s, unless the LAA is found to be the prime or only driver found after the standard PVAI portion of the ablation in a younger person in which case he will of course isolate it in the index procedure as well.

So if the LAA is a prime source of Smackman's AFIB as discovered for sure only during the index procedure and its clear it will be a major driver for continued arrhythmia then he will take care of it now and give the best odds of being one and done, but with Smackman's reported history and symptoms Dr Natale likely feels he will be able to take the PVAI plus a few other non-PV sources approach to this ablation and 'may' not need to address the LAA at this time.

That is why a younger person with only a couple of years of AFIB history and currently in NSR might be in line for a more conservative ablation than an older person with persistent AFIB that is still symptomatic and in full sway in spite of AAR drugs during the first consult in which case a more progressive condition requiring a more extensive approach in the index procedure is more likely.

Shannon



Edited 1 time(s). Last edit at 01/26/2014 07:34PM by Shannon.

Thanks for your explanation Shannon. I get it now. I thought he was referring to how aggressive the burns would be, rather than how extensive the ablation would be.

Jim