Left atrial enlargement

This a.m. at the end of an afib episode I was disturbed to suddenly see on my Alivecor strip that the distance between Q and R had shrunk. All the previous strips I ran show the distace to be approx. 9 squares high and now they are only 4 squares high.

I had contacted my EP today because a few of my strips had rates in the 140's and 150's. He assured me that as long as I was not going on for days with these rates that I did not need to worry about remodeling, but did suggest that rather than a pip for my beta blocker that I go with a daily extended release. I am going to give that some serious . However, he totally blew off the short squatty Q R's. In fact his nurse said that for the type of monitor I am using that means nothing, it would mean something on a 12 lead ekg, but not with a hand held device.

Well, to make a long story short, I just knew something had changed and I went to the ER for a real ekg. That ekg gave a reading indicating left atrial enlargement. I will be having an echo to take a look and see, but that really blew my mind. Is my EP wrong can these intermittent high rates cause this kind of remondeling. As I understand it, this doesn't bode well for an ablation either if I should choose that route. I am only 52 and eat well, exercise, ect.

I feel so deflated.

Hi Lynn, we have more than afib in common, im 52 also. I would be really careful with the diagnosis. I mean any extended time in faster rhythms cause some enlargement but I don't think it's permanent. I think we recover from that unless it's very persistent.......I hope we do. I think you are ok

Lynn mine started when I was 54 and I bargained with the devil for 5 years. I eat well, lots of exercise, followed CR72 etc, but still it progressed. My doctor wanted me to go for an ablation about year 4, but I put it off for the ridiculous reason that I did not want to upset my travel insurance. It turns out the beast was given a chance to steal another year, and rapidly progress to a dangerous level.

Looking back, the ablation was relatively painless. I have been afib free for 6 months and slowly getting my life back. I'm skiing again, exercising regularity, travelling lots, and will be heading back out to play beer league hockey (sans beer) soon!

If you are eating well and exercising and repleting your electrolytes and the beast is still progressing, you would be wise to consider an ablation sooner instead of later.

Ron

I agree with Ron, my heart was losing strength while fighting afib with supplements, diet, etc. all the while progressing towards perisistence. For me it took two ablations (a second touch-up) but now my heart strength is coming back to full. The distorted chamber sizes do tend to return to normal.

Don't mess around. Determine your LA size immediately. If it is 45+ and appears to be enlarging you want to get with the best EP you can find and you want to do it quickly. Everything that I am reading indicates that the larger your LA size the lower the chances for a successful ablation although it is reaching the point where EP's are indeed willing to do ablations on those of us with LA's over 50mm.

I AM ONE OF THOSE UNLUCKY BUGGERS!

My left atrium was 49mm at diagnosis. I got messed around by an incompetent nincompoop of a cardiologist and before I knew it I was at 60mm!! EP flat out refused ablation as 'the success rate would be low". So I saw another EP and was put on TIKOSYN which I have been on for two years now. My LA I down under 55mm at last echo about 8 months ago or so and I am due for an echo shortly and hoping that my LA size is under 49mm after being in NSR for two years. It appears that the remodeling EXPANSION/ENLARGEMENT takes place much faster than the remodeling contraction of the LA. I can only sit back and pray that I am under 50 mm now and good to go for an ablation.

Having said that I am also led to understand that ablations are now being performed on those with grossly enlarged LA's but have not empirical data to support the results of same.

Whatever the case, my side effects from the TIKOSYN are becoming intolerable; robbing me of half my days with insomnia, light headedness, thick headedness, etc. It cannot continue much longer to be sure.

So, again, I simply say to you.... get a handle on your LA size and performance

Murray L

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

Thank you everyone for your support. I will be going for an echo soon which I guess should give me some idea of the size of the enlargement. The thing I am really irritated about is that my EP has always assured me that unless I was running high rates for days on end, which I have not, that there would be no worry of rmodeling. He has also discouraged ablation saying that they are not always effective and pose risks. He is always offering more drugs. He now says that an extended release bb may control rates better than the pill in the pocket. I may give this a try because propranolol er may take care of some of the stress that seems to be throwing me into afib.

I am now questioning a lot of things this EP has said. I have always self converting, but recently my episodes have been longer so I asked his nurse if I every had an episode longer than 24 hrs. should I go in to be converted and she said it was a matter of personal preference. I then asked if I needed some anticoag. other than aspring if I ran over 24 hrs and she said no. Then I asked her why they put people on blood thinners before they converted them and her response was that it was simply because of liability. ?????????? Am I getting some bad info here?

I am very scared of rhythm control meds.

My mother had afib starting in her 50s. I know she was on digoxin for years. She ended up in permanent afib, then with well controlled CHF. She lived to be 86, but suffered from depression and dementia the last six years of her life. So, I am weighing the risks.

I saw an EP at U of M about four years ago when I have an epidosde every month or two and he was encouraging an ablation at that time, but that is a big seller for U of M.

I do want to begin researvhing various drs. for an ablation. I know that everyone here is a big Natalie fan, but I don't want to simply rely on info on a web board. So how does one do their homework per se on these drs? Do you rely on them to give you all their stats.

Is ther anyone at Cleveland Clinic worth looking at?

I should add too that I have hypothyroidism and have been using compounding T3 for the last 5 years. Recently, I have detected variations in the compounded T3 and believe that I was back to hypo status after starting a new batch at the beginning of Dec....skin on hands cracking, falling asleep early in the evening. So I think that in the process my adreals that were already somewhat weak were forced to compensate for the thyroid, now they are even weaker. Throw in a death in the family and I really beleive that my adrenals are whipped and causing some of the afib issue. Interestingly enough, it seems that most of my episodes start in the morning withing an hour of taking my T4 and T3.

Maybe I need to start the L-theanine again. Maybe the er beta blocker will help if the T3 is to blame for the additional episodes. Wish I could find some quick way to get these adreanals back in shape, I use BHRT, take copious amounts of vit. C and some very good B vitamins.

Hi Lynn,

You are on the right track in your inquiry and definitely found the right place here for honest and helpful feed back. Regarding doing research on the best EP's for ablation, of course everyone needs to do their own due diligence in verifying the common discovery and many confirmations here about certain EPs capabilities with AFIB ablation.

Dr Natale is a very easy choice for many objective reasons and rationales, beyond the important fact of just how many of us here have had very positive outcomes often with very challenging cases of AFIB after making the same in depth investigation you are wishing to embark on and choosing him to guide us out of the AFIB woods.

You can certainly try to reinvent the wheel here and start from scratch, whatever that might look like, or use the volunteered advice and recountings of so many folks who have posted here of our real world first person experiences as a good starting point. None of us are selling anything here and there are no sponsors to this website influencing our recommendations, if that will help reassure you as well.

AFIB ablation is a very skill dependent procedure. One of the most challenging procedures in all of medicine to master and become consistently good at. As such, while there has been a very welcome increase in the number of more skilled ablationists available both here in the US, in Europe and other areas around the world, there is still no substitute for vast experience in actually doing these procedures and particularly lots of experience in successfully addressing the most challenging cases of AFIB.

This is where folks like Dr Natale and his group of well trained and mentored colleagues and the Bordeaux team, particularly Professors Haissaguerre, Jais and Hocini have a significant leg up in the experience and solid track record of excellence ledger over literally everyone else out there.

Dr Natale has done approaching now 9,000 AFIB/Flutter ablations since 1998 up though last May 2013 .. actually Natale's AF ablation work goes back a fews years earlier for when he was doing experimental focal ablations for AF before the seminal 1998 paper out of Bordeaux identified the pulmonary veins as a major source ( around 85%) of AFIB triggers for paroxysmal AFIB and launched the entire AFIB ablation bandwagon.

By comparison Haissaguerre and Jais combined had done around 10,500 AFiB ablations between them as of September of 2012, and thus at a max of say 500 a year which I don't think each of them does, that would be roughly 12,000 total between both of them between then by now.. being very optimistic ... and more likely their output is closer to 400 to 425 ablations each a year so probably a bit less than 12,000 total to this point. So, on the optimistic side, that would equal roughly 6,000 ablations a piece, though my sense is that Prof Jais does a bit more ablations than Prof Haissaguerre so its not likely a 50-50 split between then and they often collaborate on a given case. In any event, that is still a very large amount of ablations and second only to Natale in the world, whose output now is around 475 to 500 ablations a year. And in any event,this unparalleled level of experience is more than enough to qualify all three men as among the elite of the elite in the world, bar none ... so there is that.

Natale's output has slowed down slightly from some years back due to all his conference, research and directorship efforts as well, but he still does more actual ablations himself than anyone else on the planet, so the odds of any one else catching up to him any time soon are slim to none. Of course, its not only about sheer numbers done, but with Dr Natale and his group, and true too no doubt with Bordeaux and other top high volume centers, the more experience they accrue, the more knowledge and enhancement of their own skills as well as their on-going work with cutting edge ablation equipment development occurs.

Lesser centers and stand-alone EPs in small local groups in a given community of city simply don't have nearly the volume of cases to be on the front line of pushing the edge of the envelope in AFIB excellence and progress as these elite operators have and are privy too.

Another aspect that helps put the check mark solidly in Natale's box is his universally renowned manual skill with a catheter .. he has 'the touch' so to speak which is an innate talent or 'feel' for this procedure over and above his acquired skill and knowledge. This is not unlike a top athlete who not only trains very hard but has a copious amount of inherent talent to further blossom with that hard work and experience. I have heard first hand of this talent of Natale's with a catheter repeatedly from various EPs and an anesthesiologist who works with him frequently during ablations and has au front row seat, and these other EPs who themselves are skilled ablationists in their own right, who have worked closely with Natale and observed him in action carefully. They all spoke to me in glowing terms about their admiration for what he can do during an ablation and his confident command of the whole EP lab during the procedure.

At the recent Boston AFIB symposium ( help in Orlando this year two weeks ago) that I attended, another leading EP from Mt Sinai presented a paper in which he brought up reconnection rates on repeat ablations which showed the average number of patients for given centers and EPs who presented needing a touch up or repeat ablation, and noted as well what percentage of those patients recurrent AFIB or flutter was at least due, in part, to reconnections of the PVs or other areas they had previously ablated. Natale has a track record of having dramatically fewer reconnected PVs and other ablation lesion he made in the index ablation being found to have reconnected during repeat ablations, as this doctor remarked during his presentation.

It is that special skill with a catheter and knowing instinctively how to combine pressure, power, temp and time of contact at different areas within the LA in order to get more consistent transmural lesion creation that is responsible for the gap in reconnections between Natale and the vast majority of other EPs whose stats in this area we know anything about.

No one is perfect in this field, of course, but Natale has always had lower reconnection rates than even other top volume centers, and in recent years those reconnection rates have dropped much further still with the advent of irrigated water-cooled catheters which he help pioneer, as well as with the greater lessons learned from matching actual contact force pressure with perceived contact force during the developmental work on the new generation CF catheters in the final development phase now.

In any event, having the most experience in the world with the lowest rate of reconnections, which means he has truly excellent consistency in transmural lesion creation, are all big plusses in his column. Those alone are more than enough to justify his choice for the discriminating patients whose goal is really to align the best possible odds for a good outcome for themselves up front, all else being equal.

Fortunately, though not a surprise, Dr Natale is also at the forefront of AFIB research and understanding what it takes to perform a consistently high quality ablation process for a patient. That, and his very easy going and friendly manner and genuine care for his patients makes him a rather easy choice for just about anyone who would ask me the question "If you could go anywhere to anyone in the world for a persistent AFIB ablation who should you choose" .. I would say him since I was precisely asking myself that very question over 6 years ago and could go to any one in the world and did go to interview both Haissaguerre at Bordeaux and to Natale in San Fran having narrowed down my choice to these two men.

I was extremely impressed with both men and their centers, and thus chose Dr Natale since there was no compelling advantage to paying full cash in Euros for an ablation in France when my US insurance would pay it all and I was more than convinced from my three years of careful investigation and deliberations that I went through in narrowing the list down to these two men in the world and then meeting them both, that Natale was more than capable of doing just as good a job for me as I could get in Bordeaux.

It has turned out to be one of the best decisions in my life ... next to marrying my gal Magdalena :-).

In summary, if you read through this site and search the archives, I think you will be impressed at just how many here, who also chose the same path as I did, report very similar gratitude at having feelings about their choice to trust their hearts to Natale, after the fact and after their ablation process was completed.

No doubt, there is a growing number of excellent EPs out there and more coming on line all the time. but if you really want to stack the odds in your favor, and especially if you have any potentially challenging aspects to you AFIB that might imply a need for more than just a simple straight forward PVI or PVAI ablation alone, such as needing to address any non-PV triggers as well, then you simply cannot make a more objectively sound choice than Dr Natale at this point, in my view. A view supported by not only a lot of stats but shared by thousands have happy camper patients who made the same choice.

If you have a rather simple paroxysmal case of shorter duration episodes and not too long of an overall AFIB history, then the pool of likely decent choices is much larger.

I trust that gives you a good start in making you selection but you likely won't know for yourself for sure until you go and meet with him, or whomever you choose.

Best of luck to you Lynn,

Shannon



Edited 1 time(s). Last edit at 01/26/2014 11:38PM by Shannon.

Shannon:

Where did you go to get your stats when you first started your research? Did you contact the docs directly? If they are self reporting their data is it reliable? Do they report bad outcomes?

Are you able to address my question about remodeling and some of the other info. given to me by my EP?

Lynn,
Dr Tchou at CC is highly regarded and trained under Natale there.

McHale

Hi Lynn.

Starting with your last question first on what your current EP and his nurse have been suggesting. Either there was some miscommunication or he is misinformed. Remodeling can take place under a variety of circumstances and it is not only when 24/7 AFIB is running non stop at a fast rate for days on end that remodeling can happen'. Most front line AFIB researchers are recognizing now that AFIB is not one condition but may be more of a manifestation of a number of different but related cardiovascular dysfunctions. Both electrical and structural remodeling can happen even during early paroxysmal AFIB even though it is typically, but not always, more advanced in longer standing persistent AFIB. The bottom line is the least time you spend in AFIB/Flutter the better it is with respect to the likelihood of ongoing remodeling taking place, but it is no guarantee it will not continue if there is some genetic or proximal driver for remodeling and fibrosis progression in the substrate. Its a complex condition and several researchers at Boston AFIB 2014 conference were suggesting that we may be moving to identifying AFIB as a manifestation of a particular form of underlying slowly developing chronic cardiomyopathy.

In any event, the bottom-line is that while maintaining NSR is not a 100% guaranteed of stopping sino-atrial remodeling, by allowing AFIB or Flutter to continue unabated is a high risk for faster and more progressive remodeling to continue its march across potentially your left atrium over time. Can also happen in the right atrium as well.

His opinion on ablation seems very typical of an EP that doesn't do ablations, and may have never taken the advanced training and initiative to learn how to do left sided ablations. His warnings and opinions are also typical of a guy who sees and heres mostly of results from run of the mill and very average ablationist.

While there are more and more better trained ablationist coming along all the time, this is a field still where there is a big gulf between those relatively modest numbers of EPs who are very highly skilled and have the requisite longer term experience, and those who do maybe between 3 and 8 ablations a month which is harpy enough to hone ones skills toward excellence. Alas, there are also a fair number of EPs out there doing ablation for AFIB who have no business at all doing them and the group tend to have far higher complication rates than the very low complications experienced by the most experienced elite operators and even the more average but still acceptable ablationist who limit themselves mostly to just PVI or PVAI ablations but can do a decent job with these more straight-forward anatomical ablations.

The fact that your episodes are increasing in duration is a dead give away that remodeling is indeed taking place, both electrically and in all likelihood structurally as well.

As to your question about 'stats' from EPs. The top centers like Bordeaux, Natale's groups, Univeristy of Penn, UCLA and a few others have very reliable and consistent data collection, collating and reporting standards and requirements. They always include details on what percentage of paroxysmal and persistent cases are free of AFIB after one or more procedures at various time lengths from 12 months to 10 years and detail all complications as well as successes.

Futhermore, taking Natale and Bordeaux's stats for example, Hans Larsen who founded this site and The AFIB Report newsletter has conducted quite a number of long term very detailed surveys of ablation patients visiting this site over the years from all over the world, with a good number of them having had ablations with Natale and his group as well as at Bordeaux, these are direct feedback reports from the patients themselves over time to very detailed questionnaires structured to reveal the level of success and complications from each EP and center. Consistently, Natale and Bordeaux have come out on top with success percentages very close and affirmative to the large studies from these large groups themselves. So that too has been a valuable and totally independent check and balance further confirming the validity of the large center's reporting on results.

Finally, there is the large base of anecdotal reports here over the years that time and again reaffirm the wisdom of going to a guy like Natale, Haissaguerre, Jais, Schweikert, Pinski, David Callans at Penn, David Burkhardt and Steven Hao and a few other top EPs in Austin and San Fran respectively, Dhanunjaya Lakkiready in Kansas City, Saibal Kar at UCLA and Winkler in Palo Alto also has good reps for consistent quality as well as around 30 other top quality EPs with either a well established large regional, national or international reputation for excellence that our surveys have good data on and are reliable alternatives if for any reason you either can't or don't wish to go to Natale.

That does not mean that a relative unknown in a modest local city or community could not do a good ablation for you, but it does mean that making that choice will always include a substantially greater risk for you to make, up front, compared to choosing a Natale or one of the other renowned elite ablationist listed above with vastly more experience and a true international reputation for excellence.

Just be wary of automatically choosing someone who a local GP or Cardio recommended who is also a local EP that few have heard of beyond your local region. Granted, they may be very nice and well meaning doctors and perhaps may even be fairly skilled at doing simple paroxysmal ablations, but the typical small local groups or stand alone EPs, are where you are most apt to find unreliable stats and projections as they don't have the collection tools nor the wider scrutiny requiring the utmost rigor in their accuracy as do the top tier centers. The more local only the reputation and the fewer the number of total AFIB ablations an EP has the greater the risk you are taking without more exhaustive investigation and research on them which you will likely find hard to do.

Don't be afraid to have to travel as well to align yourself with the best operator you can for yourself. If you can at all afford to fly to say, Austin or San Francisco for example and spend five days there for the total process with usually only one night in the hospital with the rest in a close by hotel, then by all means you will be hard pressed to do better for yourself. You can save yourself a lot of potential regret at the least and have the peace of mind that in the single most important job you have in this whole process, you made the best choice for yourself that you possible could before hand.

Shannon



Edited 2 time(s). Last edit at 01/27/2014 09:32AM by Shannon.

Could you post a link to the data Hans collected on ablutions.

When you travel a fair distance for an ablation how is follow or complications 30 days after handled?

This is all so scary for me. I am afraid of the meds, afraid of flying, afraid of surgery.

I will begin researching, and hope that adjusting thyroid meds and working on adrenals will make it unnecessary.

McHale, thanks for mentioning the CC doc. Is he far less experienced than Natale?

Hi Lynn,

In my last longer post above I also added in the names of quite a few other EPs who you would be safe with and have very high odds of success with. will track down the list rom one of our last surveys of the 30 some odd other solid EPs who demonstrated reliable good results back in 2007 to 2009 range and can only have gotten even better since then.

Making the right choice and using a solid resource like this website is the best anecdote for your fear Lynn. Any procedure has some risks, but that too is why when you asked about what do we know of Dr Natale's stats and experience I shared the full range of supporting evidence with you. He is objectively the most experienced Ablationist in the world with a stellar tract record for consistent success with very low complication rates and extremely low serious complications. As such, I almost always start with the best with him in the US and Bordeaux in Europe you that folks like you have a model at least for what true excellence and reliability in this field looks like.

If for some reason, it's just too expensive or daunting for you to consider a 5 day trip to see an top tier EP like Natale, then at least you will have a high standard from which to discriminate and make the best choice you can from among the list of those closer to you to choose from.

As far as adjusting your compounded T3, if you PM me I can suggest a few things further too you that might be a little off topic in this thread. Compounded T3 is notoriously hard to make consistently with the small microgram doses unless you use a very reliable compounding pharmacy who is a practicing member of PCCA and follows their guidelines in manufacture and control testing of all of their BHRT compounds and especially compounded T3.

Anyway, if you wish we can discuss that aspect in more detail via a PM so just let me know.

Shannon

The follow up Lynn when you have to travel is not complicated. For example with Natale and his group of EPs their nurse practioner assigned to your case will give you a heart recorder before you return home that monitors your heart rate for 4 months and reports wirelessly back to Natale's office and they stay on top of you that way and in addition work with your local EP or Cardio for any in person follow up that might be needed. It's actually very little difference than your seeing your own Cardio and you go back at 6 months and one year they send a 7 day heart recorder again to monitor you 24-7 to confirm no silent AFIB and you meet again with Dr Natale at the 6th month meeting post ablation. It's all very straight forward and not too difficult at all when you are working through his established centers in Austin and San Francisco.

I'm sure it is similar with any if the other top EPs on the list above in my previous post as well when you have to travel to get your ablation.

The key take home message here Lynn, is that the person actually controlling the catheters and in charge of your entire ablation is the single most important factor in getting a good outcome. The follow up is relatively easy and far down the list and is not at all a good reason to compromise on the quality of the ablationist just to be near the doc so you can see them in person quickly whenever you wish. The vast majority of follow up issues can be handled over the phone and those few that might need you to see an EP or Cardio can easily be arranged via your local doc in consultation with your ablation EP.... No worries there.

Lynn,
Dr Tchou has been around as long as Natale, and I would consider him a Rock Star too. He was my second choice behind the "Man".

[www.afibbers.org]
Can't go wrong with him Dr Tchou.

McHale

McHale, thanks for that info. I've definitely got some research to do.

Shannon, thanks for taking the time to share all that great info. I will definitely PM you about the T3, it is one potential cause that needs to be nailed down before resorting to surgery.

Shannon, I noticed that you said it was a 5 day trip to have Natale do the procedure, but then I read the link McHale posted in reference to the doc at the Cleveland Clinic and it sounded like that was an overnight trip. Just wondering why the difference.

Also, if you spend five days out of town, are you able to get out and do some sightseeing or something fun or are you expected to lay low in your hotel room?

Its technically an overnight stay in hospital, but realistically you want to get there at least a day before the procedure for any blood work pre-op with INR or other tests they need.

Then after you check out of the hospital they want you to stay a minimum of two, preferably three days in the area when you are from out of town before flying home.

The same is true at CC if you are from further away. And yes you can go out and walk a bit around the nice Austin river front and go out to eat and to a Whole Foods which is only two miles from the hospital and several decent hotels including a couple with suite-type rooms with full kitchens very near by so you can go to whole foods and stock up with plenty of goodies to store in a full fridge and have plenty to eat at the hotel while resting as well. Even the first day out you can get around some but should rest a good bit too. Just take it easy and by day three you'll be more than fine to fly home.

Shannon



Edited 1 time(s). Last edit at 01/29/2014 02:13PM by Shannon.

Hi Lynn,

I recently had my very extensive ablation done by Dr. Natale in San Francisco on Wednesday 12/18. The "five days" you mention went as follows. Drove the six hour drive from our home in Los Angeles, ate dinner, and checked in to the recommended hotel on Monday 12/16, Tuesday morning took the shuttle bus from the hospital and reported to the hospital for a CT scan and blood work, had the rest of that day free, Wednesday reported to hospital at 8am for the procedure, Thursday at noon released to hotel for rest, Friday at noon started the drive home. If we had flown they ask you to stay one more day, that's one of the reasons we drove. They also asked me to stop about every hour or so to walk around a bit, stretch my legs, etc. We kept to that schedule...more or less! :-) Also, I don't mind driving, typically if a trip is less than 8 hours I usually just drive. No annoying people or delays, and I can listen to MY music. And actually on that drive home I did some of the driving!

So, you would have some time in the afternoon the day before the procedure after your morning hospital business was taken care of to see the sights. Also, if you came a day early you could sight see then as well. But after your procedure you will definitely not feel like it. It's not that you will be in any crazy intense pain, your condition feels more like flu symptoms without the stomach issues. That is to say, you feel VERY blah and VERY tired, like you just want to veg out, watch TV, take naps, if someone asked you at that point if you wanted to sight see...you would say "are you nuts! Go away!"

As for your fears, fear of the unknown is normal, a good sense of caution is healthy. I was afraid, I didn't cry or scream but I actually was afraid. We have a 10 month old Grandchild, and at the age of 56 I have lots I still want to do in life. I had never been fully under general anesthesia, only twilight sedation for colonoscopys and my stent. There's a lot of trust to being in that situation. But all of the things I thought were going to be painful or a big deal were not! Dr. Natale's PA and staff helps with these issues, they spend a good portion of their time dealing with fears, concerns, and patient education, and they are still available to me any day I need them. I absolutely know you will get compassionate and thoughtful care by top notch people at every step. At my consultation this last September it was remarkable, every one of his staff introduced themselves, all play a important role in your care.

As far as taking people's word on message boards, I also think your skepticism is a good sign as well. For such a big step like this sort of heart surgery I look for a consensus viewpoint. In 2007 when I had a two week bout of a-fib I joined the Yahoo Groups A-Fib board and learned quite a bit. I started seeing Dr. Natale's name back then mentioned, all good comments about him being "top notch" and held as a reference. In 2010 when I had solid a-fib for a year, and no insurance, I joined the Facebook Atrial Fibrillation group and this group Afibbers, again looking for opinions, looking for consensus about what I could do about my condition and doctors.. And I joined Mellanie True Hills website. On all these web sites Dr. Natale's name is held up as an example of a top notch guy, I've never heard anything other than 100%. He has done ablations on so many thousands of people they seem to be everywhere!

Due diligence is important and you should satisfy yourself that you are making a clear informed choice, the choice that's best for you. I'm a little biased though, Dr. Natale is the one that took away the daily hell of a-fib and gave me back my life!

Take good care,

Neil



Edited 1 time(s). Last edit at 01/29/2014 03:35AM by onewaypockets.