One Year Ago Today with Dr Natale

Exactly one year ago today at this time I was anxiously waiting to meet with Dr Natale for the first time with an ablation tentatively scheduled the next day.
I had a 45 min consultation with him at St Luke's here in NYC where I threw every question and scenario imaginable at him. He patiently, politely and thoroughly answered every question even when I challenged him about LAA isolation; we even discussed Arnold Schwarznegger as I was a heavy weight lifter myself for years.
Anyway he was booked the next day and it would be a challenge to do 3 ablations with a big meeting with executives scheduled in between. So he was willing to stay Thursday and book a later flight but seeing my disappointment in waiting a few days he asked me would you want to go now....? I jumped up with excitement and said YES let's do it now !!!!

After a rough month where i went into afib, tachy, flutter starting at day 15 which morphed into a high flutter of 144bpm sustained I had a ECV at day 30 By Dr Barrett.
My PVAI also included work outside the PVs including ablation in the posterior wall with a roofline to breakup the atrial surface that sustains AFIB and work in my CS, so I'm sure my heart was much like chopped meat with lots of inflammation. The next few months I had some flutter Tachy but nothing sustained. My heart has really calmed down the last few months and have been in NSR since the blanking period of 60 days.

I've also been under lots of stress at work and taking care of mom but the ablation is solid and holding The Beast in check. I'm grateful I had a more extensive ablation, you really don't want to be coming back for more procedures but I'm prepared for a touch up none the less.

Thanks to all that made this journey possible and encouraged me not to cancel like Researcher, Afhound, HANS especially Shannon who wouldn't let his foot off the gas in getting me to Dr Natale and being the portal to him when the aftercare at St Luke's was challenging.

Dr Natale well what can i say.....got to love the guy, truly a gentlemen and the most caring doctor I've ever met.
Simply the Best in my book!

Happy NSR to All,

McHale



Edited 4 time(s). Last edit at 05/28/2014 12:24PM by McHale.

McHale, Very happy you are doing so well now and hopefully for many more years to come. Dennis

I thought Dr Natale was in Texas..you saw him in NYC? Was that St Luke's roosevelt?

Hi McHale,
First, congrats on your 1st anniversary.

Question: How was your Afib history like before ablation?
You mentioned "After a rough month where i went into afib, tachy, flutter starting at day 15 which morphed into a high flutter of 144bpm sustained I had a ECV at day 30 By Dr Barrett". Is this typical for people to go through after ablation? That sounds scary, to be cardio converted AFTER ablation. Thank you for sharing.

Duke

Dr Natale was Exec Director of Al-Sabah Arrhythmia Institute at St Luke's at the time.

Yes Natale came to personally ablate me at St Luke's at the request of Shannon I was one of his first ablatees here at St Luke's and with my heavy Queens NY accent and his Italian accent it was some dialogue I recorded! Dennis and Barb who I've had the pleasure of meeting also followed my lead as did others.

Yes he set up shop here in May of last year 2013 as the executive director and recruited many EPs from Mass General, Dr Barrett and Dr Danick to mention a few who were both highly regarded. Dr Danik was listed as also doing my ablation so I had concerns that maybe he handed off part off the procedure to him which I was told he does not do as his signature and rep is on every ablation he performs; not true with other top Eps from what I've been told. I spoke to Dr Danik a few months back about getting a more detailed report and then I asked him straight up how much of the procedure he did. He answered absolutely nothing, just assisted with the mapping and other tasks. He told me it was Natale all the way foot on the gas non-stop ablating, like a machine, only stopping momentarily to redirect and start ablating other areas he saw activity in like the CS, posterior wall etc.....he never saw anyone ablate with the likes of Natale. Wow what an endorsement coming from an EP from Mass general who have so many top stars there too.
Sadly Mt Sinai took over and politics got in the way so Natale took off is my understanding!

Duke, Coincidently my AFIB was diagnosed Memorial Day weekend 4 years earlier, had a TIA/ stroke Labor Day weekend 2013 as my AFIB burden was becoming more frequent; from every 2-3 weeks to weekly episodes, then a few times a week right before my ablation.
Maybe more Typical to have flutter/AFIB during the blanking period with more extensive ablations with all the extra lesion burns/sets needed to form a good transmural barrier. Hey I had the Trifecta......Stroke, Ablation and cardioversion! I'm a true AFIB warrior!!!!!
My first ever ECV was fun especially the Propofol sedation...........bang 50 joules of energy and sweet NSR on the monitor as I was coming out of it!

Dennis good to hear from you again, hope Italy was a blast. We'll meet soon maybe again.

Haven't posted much for a while, been way to busy and stressed so I'm letting loose now.

Best,

McHale



Edited 3 time(s). Last edit at 05/28/2014 04:28PM by McHale.

Happy anniversary McHale;-) hardly seems like a year on one hand, but in another sense it seems like three years you've been in blessed NSR.

You were a very responsive and open student and initiate of how to navigate all the nooks and crannys of the ablation process and I was pleased to walk you through doing those early days post ablation knowing well that you had taken the single biggest and best step you possibly could toward ultimate freedom from this lousy and frustrating condition. And it's just as great, as it has been expected, and thus not surprising at all, to be able to read and enjoy your successful report at year one,

In answer to a question new poster Tic-toc has asked about EPs using a six month benchmark for success, I haven't heard of anyone of note seriously focusing on 6 months results as a standard reporting time frame and measure of performance for ages. No one does that anymore, nor have that been a frequently used measure for over a decade .. at least none that are serious in this field in any event.

The latest very encouraging and well done true prospective designed ablation outcome results study covers a full 10 year time period by following just over 530 or so patients (which included all the paroxysmal cases ablated at CC throughout the year 2001) who were ablated by Natale's group at Cleveland Clinic (the vast majority of them by Natale himself) over the course of that one year period from late 2000 through Jan of 2002 and then followed in real time as life unfolded over the next ten years up through end of year 2012 in which these paroxysmal patients where followed up with at every step of the way prospectively and not via the weaker retrospective view taken by most such shorter look back reviews of success rates.

This year of 2001 was still In the dark ages of AFIB ablation technology, understanding and experience as this was only 3 years after Bordeaux's discovery of the key role of the PVs in AFIB genesis which launched the whole field of PVI/PVAI ablations. And at a time with only old non-irrigated catheters, rudimentary imaging and mapping systems and so many unknowns still being first encountered by these pioneer Ablationists.

In spite of starting with such an ancient history of first ablations to follow, still 59% had undergone only one procedure and were completely Arrhythmia free and off all AAR drugs after 10 full years in 2012! Furthermore, 87% of this group were similarly arrhythmia free and off all AAR drugs at ten years when adding in the additional 28% who required one or more follow up ablations (average around 1.4 total procedures over the full ten years) in addition to the 59% who had only one procedure. The remaining 13% who had se additional activity during that ten
Year period and were offered a follow up ablation declined found so, mostly due to the breakthroughs being infrequent and short lived enough that they felt comfortable rolling with the greatly reduced AFIB burden even though still a bit shy of perfection.

That is truly an impressive study indeed, the abstract of which was published in late Dec in JACC and first presented by Dr Luigi Di Biase, senior researcher at St David's Medical Center, at the ACC annual meeting in Dallas.

We have all come a long way McHale and before you know it tis will be a 5th year report then a 10th of your own... Even if a modest touch up should yet be needed to put it all to bed for good. But hey you may be one and done as it is! Certainly an excellent outcome as it is.

Keep it up and hopefully the job and life stresses will subside some going forward.

Take care,
Shannon



Edited 2 time(s). Last edit at 06/03/2014 10:08AM by Shannon.

Glad to hear about successful outcomes..it seems Dr Natale is in Texas, no longer in NYC..Unfortunate for me, living 90 minutes north of NYC.Do not want to travel to Texas for an opinion and possibly ablation of my pvc's/pac's now tough to handle 9 months post ablation. I am looking at Dr Callans at Penn, or Dr Di Biase who goes between Texas and NYC.. Anyone have thoughts on these or other suggestions? I do not want to "doctor shop" and would like to settle in with a true expert and put and end to anything other than NSR!!
Thanks in advance for thoughts on the subject.

Congratulations, McHale! You must be so relieved to have this in your rear view mirror. I hope things are going as well as they can with your mother. Sounds like you're a good son

I wasn't as lucky, and will be going down to Texas for a 'touch up" ablation on June 20th. I did quite well until about a month ago, when I got an episode of Flutter while getting stuck wiht an acupuncture needle! Had my first ever cardioversion, which was kinda scary. While I don't have a lot of extra money for flying and hotels and things, I only trust my heart to Dr. Natale at this point, so...fly I will. Hopefully, this will be it and I too will be looking in the rear view mirror before too long.

Best to you and good wishes for your mom ~ Barb

McHale, Glad to see you doing so well. Best wishes for continued NSR and good living.

afapr, is going to Texas impossible? Seems that is the way to ensure you made the right choice. The other docs may be fine too, but you already know Natale is the best.

afhound99-thanks for responding
my issue is that in order to have an ablation for pac's, I need to be having them so they can be mapped while they are firing..since that is not always predictable,( tho off flecanide , quite often) I think it is too risky to travel to Texas ...I need a place relatively local for logistical reasons..I don't want to be in Texas with no ectopy, and then fly home and have it again...at least if I am local,it is not a disaster if my heart quiets for the day...also, my understanding is that a pac ablation is a bit less complicated than an afib ablation...I would hope the local guys in and around NYC can handle it...

I guess you could talk to Dr Barrett in NY, at least for the consult. He was hired by Natale at St Lukes as Director. He did my ablation at MGH in Boston before moving to NY and I believe he is still there.

Thanks...I am scheduled to see Dr Di Biase....also worked with Dr Natale
Appreciate your suggestions....