My Consultation Today with Dr. Natale

I went to Scripps in La Jolla today to meet with Dr. Natale. Needless to say (but I will anyway) he is as patient, kind and charming as everyone says. And his assistant Linda is very, very efficient and "cut through" my ramblings about my condition!!

The VERY GOOD NEWS for me is that there is no need for me to have an ablation at this time.

I have been in afib since Jan, 2013. The cardiologists I have seen have been very disappointing and just wanted to drug me. After being on this site for about 2 years I was convinced (largely by Shannon) that Dr. Natale is "the Man," if you can see him; so when I found out he was 2 hours from me once a month I made the appointment.

Since I have been in permanent afib for so long I was worried about "structural remodeling," and quite sure I needed an ablation. Dr. Natale said that he sees no structural remodeling in my last echo cardiogram and that if it was going to happen it would have by now. He also said that even if there is remodeling, it is not a given that it will cause further problems.

I am not on any heart regulating medication and he did not want to put me on any. All I have to do is stay on Xeralto, which is not a concern of mine. I used to be on Pradaxa and although I didn't have any bleeding problems, I was concerned and for several months I was just taking Nattokinase; but I decided I was more comfortable being on a blood thinner, so I went on Xeralto rather than go back to Pradaxa.

Anyway, if my symptoms become worse, I have made the connection and I can always get an ablation later. They also referred me to a cardiologist they like in Beverly Hills, which isn't all that far from me, especially once every 2 years!!

So I feel very blessed that even though I have afib, it is not debilitating for me, as it is for so many. I am not in NSR, but I can live with a few rapid heart beats, PACs,and PVCs (although I cannot identify one from the other!).

I would never have learned about supplements (which I will stay on) or Dr. Natale without this forum and everyone who is fortunate enough to "land" here is blessed. Although I don't need anything immediately, I will continue to read forum posts. I wish everyone reading this, wherever you are in your afib "journey" to come to the very best treatment you can find; and the referrals and advice here are probably the best you will ever find. I am grateful to Hans, Shannon, Jackie and all the rest of the regular posters who share their experiences, giving soooo much of their time.

Best of Health to Everyone,

Louise

Louise: You're saying that you've been in constant afib since Jan 2013? Why would Dr. Natale not want to do an ablation?
Also, glad you're going to the good doctor. He did my ablation last March and I'm finally free of the afib beast. It's great to have my life back.
I loved your comment about Linda Couts...she's my favorite nurse, a real dedicated technician who knows her stuff. And she does know how straighten out one of patients, right quick.

Hi Louise,

If you do recall, I had Dr. Natale appointment a few weeks before you at Scripps Clinic as well. I remember you mentioned this in previous posts.
Anyway, I also don't have to get an ablation as well, but I'm going to get it done anyway. Unlike you, I'm in NSR, but I get an episode once in a while which self convert in 1 to 3 hours. I don't get ectopics too frequently and I'm not on any medication.

I guess if you're happy with your decision, then I congratulate you and wish you well.
Thanks for sharing your story.

Duke

Chrisdodt,

Actually, I misstated -- I have been in afib since January, 2010, which would probably make you more befuddled! But it's the fact that, although I have an "irregular heartbeat," which is, I believe the simple definition of afib, my symptoms are not severe. I have never been to the ER for it and I basically go through my life without too much interference because of it.

I am a pet sitter, so I walk dogs a lot; I also clean my house, work out with weights, etc. without too much effort. I cannot do high impact aerobics exercise; but I quit running after back surgery in 2006 anyway; and I probably would have a little more energy in NSR, but it is not drastic enough for me even to be on heart regulating medication -- just Xeralto to prevent a stroke.

So, Dr. Natale's opinion was that is was not urgent at this time, and if my symptoms don't change, it may never be required to have an ablation.
I probably would not have trusted this opinion from any cardiologist, but from Dr. Natale I will accept it. If my symptoms get worse at some point, I will revisit the ablation.

Louise

Louise:

I am surprised that Dr. Natale wouldn't do an ablation as you are in permanent AF. My mother was in permanent AF for about 14 years, she was not on any anti-arrthymatic drugs but did take Coumadin, at about 6 months before she died (at 92) she had black stools, which indicate she was bleeding internally. They didn't want to operate at her age and she also had congestive heart failure, I believe the permanent AF and the Coumadin contributed to her death. I don't know how old you are but if you are a good candidate for an ablation, why not?

Liz

Hi Louise,

So glad you got to see Dr Natale and Linda Couts today and had a nice meeting. His recommendation for you at this point in your AFIB experience is also another reason I feel so confident in easily recommending him to so many. Not only because of his consummate skill as an ablationist, but because I know that he will never try to even nudge anyone towards an ablation unless if truly feels its in their overall best interest with all factors considered.

I'm not at all surprised he would tell you that there is no urgency at this point in your still relatively young AFIB career, since you have so little symptomatic impairment and apparently on your echo he saw mo evidence of remodeling that might start to cause a problem
Down the road ... At least at this time.

There are as many shades and degrees of AFIB manifestation as their are people out there with unstable hearts, and there very much are cases, as yours appears to be at this time, where leaving it as it is and just insure proper anticoagulation can be the better recommendation.

As he noted, should your AFIB change its nature and become more symptomatic and/or some other manifestation such as an enlarging LA as evidence of more insidious and potentially problematic remodeling getting underway, then he would surely change his call for you.

But for now, just follow his lead and stay in periodic touch with him via very occasional follow ups and via more regular visits with the new Cardio he referred you too who is tuned in and simpatico with his vision.

You can take it to the bank with Dr Natale that when he says you need or can really use an ablation and offers you one he really means it. And that he will not try to lure anyone into doing an ablation when it's really just optional with no real compelling reasons for it just to pad his stats and hang a few more skins on his wall.

You might turn out to be one of those with little to know real impact on your heart from a rather benign case of slower persistent AFIB, while the majority of people seeing him with persistent AFIB he will readily and right away encourage them to get it done.

While a fair number of other EPs are similarly ethical and conscientious in their recommendation, certainly not all are, including some with little experience who really are trying to improve their skills and experience with as many ablation patients as they can find. Also, many others who are being ethical in their recommendation you not have an ablation based on their more limited track record and experience , are just being more reticent because they lack the confidence and skill to do a persistent AFIB ablation successfully. But when Dr Natale tells you that your situation doesn't equal a big encouragement to get an ablation done now, then you can rest assured that is the definitely word at this time.

Again, should your manifestation of AFIB change going forward and become more annoying or aggressive, you are already set up and in the chute with the best to get it fixed. Just enjoy your life and put out one foot in front of the other and do just as you said and stay up with the nutrients and with this forum.

Best wishes,

Shannon



Edited 1 time(s). Last edit at 07/11/2014 08:20AM by Shannon.

Hello Louise~ Thanks for your informative report. Good news about your heart status and that you can continue on without worry of remodeling.
I know a couple of people who have a similar situation who they have been doing very well for many years... fully functional and totally asymptomatic.
Quite a contrast from the typical afibber.

Be well and enjoy life.
Jackie

Thank you all for your responses.

Elizabeth, my mother is 95 and also in afib for many years. Her's was not diagnosed for many years. She DID have a problem with Pradaxa and internal bleeding when she was 92. She is now on Coumadin and Digoxin (sp) 3 times a week. She is pretty much asymptomatic and "they" would not ablate her at her age.

Having said that, I just turned 65. Surgery is surgery and I don't want to get it if it does not seem necessary. Since this was just decided yesterday it is a "brand new" relief and I am very happy for it. However, it does not mean I will not revisit the possibility down the road. I will see the cardiologist and be mindful of any increased symptoms. In the back of my head I think I will probably get ablated at some point -- before I am too old to do so. (Thankfully, Dr. Natale is relatively young so he won't be retiring soon!) I realize that a lifetime of blood thinners is not optimal, but I was on Pradaxa for a couple of years with no problems and am now on Xeralto. I may change that to Eliquis, since, although Dr. Natale said Xeralto is fine, he thinks there may be less bleeding problems with Eliquis. I did mention that I have on occasion cut myself (accidentally of course!) since being on blood thinners and I did not bleed profusely. I applied pressure for a few seconds and it stopped just like it did before I was on a blood thinner.

I also am still working, and if Dr. Natale had indicated an ablation was necessary, I would have taken the time off and just done it (in fact Linda had mentioned an opening the first part of December and before I talked to the doctor I was mentally planning it!) Since it would most likely take one or two follow-up procedures (according to Dr. Natale), I would prefer to wait until I am retired to start.

Louise