LAA Ablation Yesterday

I had my second ablation with Dr. Natale in Torre Pines yesterday and I'm enjoying the afternoon sun in Del Mar as I write this. Dr. Natale last ablated me in 2005. That was a successful ablation, but the problem returned years later. Dr. Natale observed that all of his previous work is still intact while he was in my left atrium and determined that I needed an LAA ablation which didn't exist in 2005. He took care of the problems around my LAA. It'll be 6 months on Xarelto before we know whether the LAA still works. If it doesn't we'll fix that. Meanwhile I'm glad to be on the other side of another ablation..

The folks at Scripps are first class. Thanks to Dr. Natale and Linda Couts.

Great news Afjun! Hope this puts away the beast for good.

Jim

Thanks for the update Afjun, and good news you got this last piece of the puzzle covered now. You'll be up and about soon after only an LAA isolation. This is a common culprit especially for late appearing arrhythmia many years after a previously successful ablation, especially after a first one done by an EP as thorough and highly skilled as Dr Natale, where very rarely is there any at all, or rarely just one or two previously ablated spots at most from the older prior ablation that need to be touched up.

Back in 2005 they were just starting to map some LAA activity and learning how to fully discriminate between the source of triggering that very much looked like it was coming from elsewhere in the left or right atrium when it was really centered in the LAA. Now the really top centers like Natales groups and Bordeaux, U Kansas, Montifiore now, and a hand full of others who see a lot of more advanced cases recognize the LAA as being the number 3 primary source of arrhythmia triggering after the PV's and posterior wall.

Less experienced centers who see a much smaller percentage of more advanced cases and focus more often on paroxysmal AFIB cases often don't even recognize or know how to properly identify LAA origin triggering from other sources that it can easily be confused with. Especially if they just park the lasso mapping catheter inside the LAA itself from where you can get a confusing and misleading mixed message. The Lasso mapping catheter must be placed inside the LSPV ( left superior pulmonary Vein) and then taking a far field view looking back toward to LAA. In addition, the posterior wall ideally must already have been isolated and made quiet to avoid often confusing signal origin. Also too, as noted, rapid RA activation is often confused as originating from what logically would seem to be the RA, when in fact it's genesis is in the LAA.

Shannon



Edited 2 time(s). Last edit at 11/21/2014 12:57PM by Shannon.

Thank you both for your good wishes.

Shannon, as you know there is a 70% chance that I'll need to have my LAA fixed in 6 months, but Dr. Natale can take care of that if necessary. But you have lead the way. You are a legend here. In spite of warnings that there could still be bad days I am still feeling strong and great today. It's still early, but I'm hopeful.

Thanks,

Nick

Hi Nick,

You should do fine and thats a great crew there at Scripps Green at Torrey Pines, its very reassuring too that, once again as I have seen time and time and time again, when Dr Natale goes back in for a touch up of one of his prior ablations, especially when he did the first one and no one else has been in there, there are literally no reconnected spots that need addressing almost invariably, or once in a blue moon one to two tops.

Sometimes, if the first ablation he did was a very long time ago, there will be new areas he typically addresses in an index ablation now that have to be addressed for the first time in a follow up, but very rarely are there any true reconnections and thus redo's of prior work required.

This is in stark contrast to the majority of EPs, including many even very good ablationists, whose main issue they find on follow up ablation is still reconnected PVs or other areas they previously ablated and are now requiring a repeat work over.

This is what I mean when I insist frequently here that a top ace like Natale is always one's best bet, if it is at all possible to put oneself in his hands, or the relatively few others in his general league. And if traveling to an elite caliber ablationist is out of the question, then at least use their overall template and choose some one who models their approach and passionate dedication to AF ablation after the elites, when trying to find your next best option.

Starting with only choosing a very busy and booked-up EP whose whole career is centered around left atrial ablations like AFIB/Flutter and with some VT as well. Stay away from the guys who simply include AFIB/left flutter as just one among a variety of EP procedures they perform more frequently than AFIB ablation. You cannot truly excel in this very challenging field unless one is totally dedicated to this specific area, and your ablationist should have a vast amount of experience with all kind of AFIB/Flutter cases especially persistent AFIB, and not just paroxysmal-only anatomical PVI that requires comparatively little real time electrophysiology to be performed.

Going this route is for sure the best true 'Less is More' approach long term, rather than going to those too reticent piece-meal approach EPs where they are trying so hard to do the very least they can get away with while shooting for a procedural endpoint of temporary peri-procedure PV isolation with bi-directional block confirmation. And yet, these patients too often wind up requiring multiple repeat ablations in which a large part of their repeat ablation(s) are taken up by having to redo previously ablated lesions and areas, and which is much less effective than getting the job done right the first time. That is where risks really do compound, and yet still these more reticent 'pseudo less is more' proponents often entirely avoid the real elephant in the room when the remaining issue is the CS and LAA in more advanced cases.

We can talk on the phone more if you wish Nick, as you get towards your six month follow up TEE.

Take it easy and let things heal up as this should be pretty straight forward from here.

Shannon



Edited 3 time(s). Last edit at 11/21/2014 01:28PM by Shannon.

Thanks Shannon. I am very pleased with my progress and choosing Dr. Natale. He is not only likely the most skilled ablationist, he is also caring and personable. You can't beat that. I'll keep the phorum informed about my progress and be in touch.

Nick

Congratulation Nick on another successful ablation by Dr. Natale.
Wish you a speedy recovery and many years of NSR!

Duke

Thank you Duke. I assume you are still doing well in your blanking period.

Nick

Hi Nick,
Yes, I'm in almost 2 months post ablation and doing quite well. My heart has been dealing a lot with many of my personal ordeals in my life since the ablation, yet it's coping quite well and I'm thankful for it. I still sensed some PVC's or PAC's (not sure which) from time to time, but no episodes.
I guess that is expected during the blanking period. Thank you for sharing your experience with us. Wish you continued NSR.

Duke