My Dr Natale Experience

I'm new to this wonderful group. The sharing of information has been such a great help that I thought it is my turn to participate by sharing my experience with my recent ( May 16) ablation by Dr Natale in Austin. My circumstance might be a little different than most because the ablation was the initial course of action. I've never been on rate or rhythm medications prior to the procedure. You might be aware Dr Natale advocates for ablation first if the circumstances justify. I am currently taking Xeralto and 12.5 mg Metoprolol three times daily post procedure.

First of all I was able to get the consultation and ablation quickly. Took about three weeks. Since I was coming from out of town his staff scheduled the consultation one day and tentatively the ablation the following. They are very knowledgeable and helpful. My only disappointment was the limited time I actually had with Dr Natale during the consultation. He had to break off for a conference call and never returned. He left me with one of his PA's. He was also late so much of my time was spent with support staff. As knowledgable as they were I would have preferred the time with Dr Natale. I found him to be very down to earth and easy to talk with. He explained his plan and patiently answered my questions. His confidence level for success was high. He felt, if all went as planned, I should be afib free and off medications with in three months. He didn't expect any issues with the LAA. He performed a PVI and SVC isolation.

According to Dr Natale he did not encounter any complications nor did he find anything unexpected. He initially ordered only Xeralto but told me I could take Metroprolol if the increased heart rate that resulted from the surgery bothered me. More on that in a moment. Like others who have posted I felt pain and pressure in my chest. It resolved 95% with in two days. I still have slight shortness of breath and get tired easier than prior to the surgery.

I did experience a scary situation on my trip home. While waiting for a plane transfer in Las Vegas I noticed that my vision was bilaterally blurry. I felt fine. My wife called the medics. My heart rate was up a bit to 115 bpm and BP was 147/92. Long story short ended up with overnight stay at a LV hospital. Cat scan, brain mri/ mra, echo and blood work all normal. They were obviously screening for stroke or tia. The consensus, to include DrNatale's staff, was I probably experienced dehydration due to the Lasix that I took for the days following the ablation.

The lingering concern I have is for the increase in my heart rate. Prior to the ablation my rest hr was about 65 when in nsr. Now, without Metroprolol, I'm at 94 bpm. With minimal exertion it goes to 100 to 105 bpm's. With the low dose Metroprolol it drops to about 87 bpms. Dr Natale explained, if I understood correctly, when ablating around the SVC certain nerves can be damaged that will result in an increase in heart rate. He said the heart rate usually slows over the next seven months to a year. He didn't say if I should expect it to go back to post ablation rate. He did say I should no longer have bouts of bradycardia like I did before the ablation. He feels if the rate stays between 60 and 100 bpm its not an issue. The cardiologist in LV felt the rate was too fast thus the Metroprolol was added . I'm just wondering how this stacks up with others who have had ablations. I'm wondering if my breathing and fatigue could be related to the increased HR? Thank you for any information!

Craig,

I'm not an ablatee, but have been around here for a long time. Here's my two cents:

1) Higher rates after ablation are normal because of burning around the vagus nerve. In fact, some data suggest higher post ablation rates = better probability of success. This usually does decrease over time.

2) Your fatigue could be a result of the Metroprolol. I'd loop that med addition with the Natale team to see if they think it is necessary. They are the experts.

George

My HR is pretty much back where it was pre-ablation, low to mid 60s - maybe a bit higher but not much. After ablation about 18 mths ago at Mass General is was low 80s for a some months - maybe up to 6? I'm not completely sure as I stopped using the monitor after about 6 months.. HTH

Craig,

I had an ablation with Dr. Natale on 4/21 and have had a similar experience as yours with an elevated heart rate. Pre-ablation hr was 51 (I am a long time runner), post ablation hr mostly in the 70's. I have not experienced any breathing problems. I am only taking xarelto.

.I have been afib free since the ablation so I no longer endure the fatigue associated with an afib burden of 30%. I can't tell the difference between an hr in the 50's and one in the 70's. What I really enjoy is not even being aware of my heart beating. It was about 2 months ago when I experienced an hr of 220.

I was given a similar explanation to yours in addition to being told that the hr should return to baseline in about 1 year.

Allan

i also had ablation at mass general, mine with moussa mansour...heart rate still up tho getting closer to baseline..but I am still on beta blocker, so despite that still 10 bpm above baseline now 9 months out from the ablation...major issues with lots of extra beats and needed to go back on flecanide. are you all good post ablation? this is regarding your post, afhound99...

Yes, everything is fine now. No Flec, no AF 18 mths out.

Hi Craigh,
And welcome to our board, though it sounds like you have been lurking for a while to great effect for you .

No worries about the still transient fatigue and breathing differences post your May 16 ablation, that was only less than two weeks ago and it will all gradually slip away into a distant memory before you know it.

The higher HR is perfectly normal too and frankly I would be more concerned if your post ablation rate was the same or lower than it was prior to the ablation for the very reasons George and Dr N elucidated. It is a sign of a higher quality ablation in most instances.

After my very extensive and comprehensive index ablation for highly symptomatic AFIB in Aug 2008 with Dr Natale, my rate remained elevated above previous baseline for almost two years, being as high as 110bpm 5 months later when I first when off the Sotalol I had been put on after the ablation. It started to drop quite quickly and then plateaued to around 90bpm within two months or so after stopping Sotalol and then slowly continued to reduce over the next year and a half or so until more or less normal baseline again to within a couple beats of my previous resting NSR level of 58bpm.

Its always nice to have as much time as one would like speaking with Dr Natale at every visit. but with the non-stop demands on his very valuable time that is not always possible. However over the course of your relationship with him I think you will find a most satisfying interaction and as you noted whatever time he has to spend with you he patiently answered your questions and clearly explained his plan for you. In my experience and that of so many others here Andrea Natale does give you his full attention during whatever time he can spend with you and tries to at least address the most important questions and communication one might need to know.

Also, over the next couple times you see him during follow up you will have a chance to ask him any remaining questions you might still have. By far, the most important thing though is his time wielding the catheters and determining just what, who and when to ablate.

That is a priceless skill he possesses and no amount of theory or concepts shared over a long meeting spent shooting the breeze with us that other less in demand docs may have the time to afford in more leisurely meetings, is worth it to listen too in exchange for having to settle for less experienced and skillful hands and know how at the all important time of ablation.

One of the things I find most remarkable about the man, is how consistently cool, calm, collected and caring the guy has remained every time I have been around him over the last 7+ years, which has been quite a lot of interaction over those years now, and on-going, and in spite of the literally non-stop action surrounding him where ever he goes. He definitely has a gift, and a rare one at that. So take heart in having made the good choice to pair up with this man to guide your ablation process. You could have hardly made a better choice.

Shannon

To everyone who already had ablations,

Do you all still have to be real careful with triggers, watch what you eat and had to take plenty of supplements like before ablation? or do you relax and let your guard down more after ablation? Can you completely eliminate supplements and not getting punish with an episode? Can you live carefree (I don't mean like over abuse with things), but I mean like someone never had Afib before, or like when life was real good before Afib existed?

Duke

You folks are great! Thank you so much for your replies. You called it right Shannon. I have been lurking.....and learning.....for a bit. I knew if I was going to do this ablation I wanted the best EP I could find. I was getting mixed advice from the various " local" cardiologist I was dealing with. Some thought an ablation was the way to go while others suggested the medication route. Its difficult for a regular guy to figure out what to do. Once I found out about Dr Natale on this site I started digging deeper and found nothing but good things about him. Now here's the small world angle on my story. So I pretty much decided to fly to Austin for at least a consultation with Dr Natale. I live in a relatively small community in northern reaches of Idaho. We have a small hospital and I think two cardiologist that practice locally. They are associated with a larger group out of Spokane, Washington. I have three friends that I worked with in California before moving to Idaho after retirement. We all moved to Idaho and we all have afib?? Seems odd to me. I mentioned that to Dr Natale and he said it must be something in the Idaho water. One had an ablation about two years ago. I had no idea that it was Dr Natale who performed the ablation at Scripps in San Diego. Then I discovered that my cardiologist partner routinely refers his patients to Dr Natale. Their group has several EP's but he is more trusting of Dr Natale's skills. My cardiologist actually referred me to one of their group EP's before I became aware of Dr Natale. Maybe I need to start seeing his partner? Though I found Dr Natale on my own....with your help...he is quite well known in my small circle of local contacts.

I hope to meet with Dr Natale for my 90 day follow-up at Scripps. I'm not certain how that can be worked out since the ablation was done in Austin. The travel to San Diego just works out better for us. Does anyone see any problem with seeing my local cardiologist rather than Dr Natale before the 90 day visit? I will definately schedule with him at 90 days.


Regarding difficulting swallowing that was the subject of a recent post. In my case, I had some difficulties the first few days. Again, kind of spooky but I was told to expect that. It has not totally resolved but is more of a slight nuisance than anything else. It did seem to get worse a day or two following the procedure. It wasn't a raw feeling one might expect from being intubated ( sp?) . The residual minor chest pain I still feel is kind of odd also. It feels like minor heart burn. Thats probably exactly what it is. The nurse told me Dr Natale burned for 58 minutes. I have no perspective if that was a long or short ablation. The total process took about two hours.

Craigh, you are welcome and sound like you had a typical Natale ablation and its not uncommon to have mild residual 'heartburn like' feelings periodically for a period of time after an ablation. Tis can be due to a mild typical pericarditis from a solid ablation. Nothing to worry about when there is no fever or increase in symptom intensity, and it will all fade away soon enough. Again, you are just at 11 days post ablation which is very early still and this is all par for the course.

Take it easy,
Shannon

"or do you relax and let your guard down more after ablation? "

Yes, I relaxed.

Hi Craigh,

Should be no problem at all arranging your follow up appointments at Scripps or CPMC when your ablation was at Austin. Happens all the time. For office visits I've see Dr N at CPMC many many times while my index ablation was in Austin. Four years later I got my LAA isolation touch up procedure needed to finish my persistent AFIB/Flutter ablation process which I did at CPMC and then topped it off with the Lariat procedure back at Austin last summer. I since seen him in San Fran twice plus just two weeks ago in Austin for a Lariat follow up TEE. That in addition to the more leisurely associations and discussions we've had at the various AFIB conferences including his own EP Live 2014 conference this past Feb in Austin he invited me too to cover for The AFIB Report.

So you can see him pretty easily where ever he practices, just try to set it up far enough in advance so they can fit you into the consult schedule. Linda Couts at Scripps can help you with that and she is a super NP and very much on the ball. Give extra time in advance to set a follow up at Scripps due to his being there a good deal less often than at Austin or CPMC.

Shannon

Duke,

Had a Natale ablation In Austin three years ago March and have been problem free. Other than warferin for 90 days post-procedure was not required to take any medication other than an aspirin per day. While I try to eat somewhat healthy have not changed my diet (have what I will call a very normal diet) or activites since the ablation. I also continue to be a social drinker of alcohol. Prior to my alblation was unsuccessful in determination of potential triggers.

I discovered this forum about a year prior to my ablation and started to take supplements at the recommendation of others on this site. Interestingly, I asked Natale his opinion on supplements and he told me "they don't hurt but you are probably wasting your money". Still continue with magnesium (~400 mg) and potassium (~500 mg) daily.

I was also back to my normal exercise program very quickly after my procedure and have no physical activity limiatations.


Steve
Spring, Tx..

Craig,

After my Natale ablation in Austin all my follow-up was through a nurse educator that was assigned to me prior to the procedure. I did not have any issues post-procedure so did ot have to return to Austin to meet with Natale. During the past three years have had several questions that I posed to Natale through the nurse and received very prompt replies.....in some instances almost immediate. I live in the Houston area so it would have been quite convenient to meet with Natale if an issue developed.

Steve
Spring, Tx.