Not Happy with Dr. Natale - Looking for Alternatives

Hello everyone. While I'm pretty active in the "afib community" this is my first post here. I'm hoping you guys can point me in the right direction.

I have an ablation scheduled with Dr. Natale in Austin, TX on February 2nd but I'm having second thoughts about him and his practice. When I flew down there (I live in Minneapolis, MN) I was very disappointed. He was over an hour late for my appointment and when he finally came into the room he was very hurried and rushed. He gave me just 10 minutes of his time and he was gone. It wasn't a great experience at all but I went ahead and scheduled the ablation anyway.

Lately I've been having more and more episodes. I'm now having 1-2 episodes per week. For now I'm popping Flecainide at each episode (PIP) but even Dr. Natale said if I start having 2 per week I should go to a daily program of Flecainide or some other mix of drugs until the ablation. Well I emailed my only contact at his office (his scheduler) to find out what daily drugs they think I should go on. She won't return my emails and she won't give me direct access to Dr. Natale's nurse either.

Bottom line, their "customer service" has been horrible since day one and I'm getting a sense they are basically an ablation factory where everyone is just a number. I'm having serious second thoughts about going through with this ablation with him. For one, I need immediate help NOW. I need to know what drugs I should be taking to keep these episodes at bay until February. I'm also supposed to go on a blood thinner for a month leading up to the appointment but I'm starting to wonder how that's going to happen as I can't get them to answer my emails or phone calls.

At any rate, I'm thinking about finding another EP and I'm wondering which one you'd recommend and why. I'm thinking of these two EPs:

Dr. Robert Fishel down in Florida (JFK Medical Center)
Dr. Douglas Packer here in MN at Mayo Clinic

Dr. Packer would be the obvious choice because he's "local" but I've heard this Dr. Fishel has done as many if not more ablations than Dr. Natale! It would be nice to find someone in MN but on paper I think Dr. Fishel has more experience.

I'm also considering the first EP I worked with when I was first diagnosed with afib (he's only 30 minutes from my home). His name is Dr. William Katsiyiannis. He only does about 200 ablations a year and has probably only done about 2,000 procedures in his entire career. He's also one of these guys that point blank tells you afib can't be cured and is very very conservative when it comes to doing ablations. He looks at it as an absolute last resort option. He's a super nice guy but I want my EP to be positive about albations and give me hope I can beat this thing!

What are your thoughts? Should I stick with Dr. Natale or should I switch? And if I switch, which of the 3 doctors above would you recommend?

Travis

Hi Travis,


You can blame me for the reason Dr. Andrea Natale was late. Seriously, me and people like me. People like me make Dr. Natale late because he takes on the "basket cases" of the a-fib world, the patients who often need so much additional "burn time" in his cath lab (I needed four hours, more than twice what it normally takes) that it completely destroys the rest of his schedule for that day (IE: afternoon office visits with new clients like yourself). As for myself, I had a ten year history of progressively worsening a-fib before finding this message board and having my ablation done (and thanks to Dr. Andrea Natale, a total success!). I was in solid a-fib 100% of the time 24/7 for ten months leading up to my ablation. Another Natale patient that I followed had previously five failed ablations before Natale fixed him. One and done.

It might help to outline the day of my ablation to you. The much older woman who had her ablation immediately before mine (she had the early slot that morning) was in a wheel chair and could barely stand (my wife saw her the day before at our pre-op, overheard conversation, and pointed her out to me). Her ablation ran over a bit, my attendants got the call to send me down from the holding area at 10:30am, I had been in this holding area preped and ready to go for two hours in case the previous ablation ended early. I entered the cath lab close to 11am, probably about an hour after I normally would have, and while I don't remember much of anything before 4:30 or 5:00pm, I am told that Dr. Natale was with me continuously and I was 100% under his care until well after 3:00pm.

It's my understanding that at the office I was at, the San Francisco location, that Dr. Natale sees several patients in his office in the afternoon starting at 2:00pm. That schedule was completely blown out the window on my day! And going way back to my original consult like you just had, Dr. Natale was about an hour late for that one too! Personally though, I would rather eat at a crowded restaurant than a half empty one, wouldn't you? Dr. Natale is at the top of his game, and as your comment of running an "ablation factory", actually I think that's a good thing! I'd like to think of it as a well oiled machine, everyone in Natale's office has their job, and I got wise and compassionate care throughout. The three EP's I saw in the Los Angeles, in your line of looking at things, were all "pace maker factories" with their waiting rooms all crowded with pace maker patients. I cry for an ablation factory, and thankfully I found a most perfect one! I think Natale is up to 9,000 or so now. Rest assured though, when you are in front of Dr. Natale on the table, he will do a 100% complete job, you will have his undivided attention, he will be doing 100% of the ablation and nothing will be farmed out to a resident or helper. And you will probably make him late for seeing someone for a new consult upstairs!

In closing, how the process works....you will hear absolutely nothing from Natale's office until about a month before your ablation (you are supposed to be under the care of your local EP or cardiologist that knows you, can lay hands on you as they are local to you). Your phone will suddenly light up with calls almost every day, first from the scheduler asking if you still want to keep your date as they have dozens of patients that would rip your arms off for your space at your date, seriously the wait list is long. If you still want the date, you will then get a call from Dr. Natale's nurse making sure of a few things, and you will have full access from then on before and after your procedure.

My sincere recommendation. Smile and stay the course!



Edited 1 time(s). Last edit at 12/12/2014 03:35AM by onewaypockets.

Travis,

I went to his San Francisco office in Sept. and had a very similar experience as far as wait times go, maybe even worse. My appointment was for 9:30 and it was 1:15 when he arrived back in his office. I was told by his staff that my wait was very rare. While I was waiting, about every 15 minutes, one of his people would stick their head in the door and say he was still in surgery. While I waited, I was thinking that when my ablation comes, I just hope he takes the time he needs to do my procedure, no matter how long it takes. When we talked, He told me what he thought about my condition, answered my questions and was gone in about 20 minutes. His NP had spent an hour with me before, so I was pretty much up to speed on what he was going to do.

The scheduler told me he does 3 ablations a day with 2 on Friday. All it takes is one of those to go south and it will take extra time. I wasn't the least bit unhappy when I had to wait. After all, I went 600 miles to see him, so what's a little extra time ?

During the past year, I have talked to 2 different people that make the schedule and make sure the paperwork is in order for the ablations. Both were just great. I also had reason to call with a question about medications and his NP got right back to me. She was very caring and took all the time needed to answer my questions. She also said that I could call anytime I need to.

So, I would have to say, my "customer service" has been great.

If I were you, I would call his office (other than the direct line to the scheduler) and say you have a question about medications. I bet they put you right thru to a NP that will answer your questions.

As to the ablation with Natale, I would only go someplace else if I thought that I could find someone that would have a better success rate and/or less complications.

Best of luck on Feb. 2 if you follow thru with your ablation.

...ronH



Edited 3 time(s). Last edit at 12/29/2014 07:54PM by ron.

The more procedures a EP Dr. does, the less they want to deal with the routine care of the patient. The medication issue can be addressed by another EP, that is not so busy.

Recommendation:

Get an EP who doesn't even do Ablations, have him or your even regular Cardiologist handle everything else but the Ablation itself. Just use Natale for the Ablation.

Hello Travis,

My experience with Dr Natale was very similar to yours. I learned of him through this group. I did additional research and liked what I read about him. I calledhis Austin office and spoke to a few different people. I was given slightly different information about how quickly I could be seen by Dr Natale and how soon I might expect the ablation...if it was necassary. They were very good at calling me back. It was on the second day that we firmed things up. I would fly to Austin for a consultation with Dr Natale the following week. If an ablation was required it would be done at St Davids the following day. That concerned me a bit because I knew they had blocked time for my procedure without ever seeing me. I wanted to be sure Dr Natale recommendation was based on what was best for me vs the need to fill that reserved time.

Dr Natale was about an hour and a half late for our appointment. I later learned he had been dealing with an emergency situation involving someone in this group. He only had about ten minutes available for our consultation. He was called out to another meeting. What impressed me was his knowledge of my specific case. He knew my history fairly well. That made me feel much better when he recommended the ablation. i had only gotten through about half my questions when he left. His NP answered the remaining questions.

In Austin he has a very experienced staff. The " process" runs very smoothly. They all have their roles and they handle them well. I didn't see much of Dr Natale. I know he spent about 5 hours with me during the procedure. I saw him right before they wheeled me into the lab. He actually talked with me very briefly just outside the lab. He relied on his staff to handle all the preop stuff and to address any remaining or new questions. I saw him for a few minutes in my hospital room the following morning. He basically told me things went fine and he expected a good result. I had no complications in the hospital and was discharged the following day.

I had a nurse assigned to follow me up to now. Its been six months. She is my point of contact with Dr Natale's group. I was required to send weekly ekg strips from a device they provided. I had a few complications during this six month period. I consulted with the nurse but my local cardiologist and other doctors addressed my issues. It mostly involved testing and ekg's. My doctors had acess to Dr Natale but really didn't need him. So, in my experience, it was a lot different than going to a local doctor who provides total care for you. If you use Dr Natale you will be getting his entire team. You will be dealing mostly with his nurses following the ablation. The only time I know they consulted with Dr Natale was with the Holter monitor I wore at the six month post ablation milestone. He reviewed the results and, through his nurse, took me off Xarelto because I exhibited no evidence of afib or flutter. He wasn't kept from me, I just didn't need him. It was a little hit and miss with the nurse returniing my calls or emails. I used mostly email. A couple times I had to send an email twice to get a reply to a question.

So I think your characterization of Dr Natale's operation as an ablation machine is fairly accurate. That's what they do. They do ablations. I don't know if Dr Natale carries any other type patient load. I doubt it. He is very busy with three centers he heads. You will in all likelyhood need a local EP or cardiologist to follow you after the ablation. I found St Davids to be outstanding. They took excellent care. The cost for the hospital and procedure was about $98,000. I don't know what they settled with insurance for. I know only $78 is outstanding because of some drug I received in the hospital they keep going back and forth on it. Eventually they will get it resolved!

I went to Dr Natale because of his reputations of being one of the best. I think he is! I know in my case he took his time. I noticed in my report that after he ablated around my pulmonary veins he induced afib to check his work. He noticed one spot that had not blocked the impulse. He went back to that area and completed the job. I don't think all EP's would have done that. If he hadn't, at some pount, I would have required another ablation. He also spotted a-flutter originating from my superior vena cava. He ablated that area. Some EP's only ablate the pulmonary veins. Again, had he not taken the time to check that area my procedure would have failed.

I'm sure there are other world class EP's available. I just wanted to share my experience with you so that you might make the best decision for you.

Wishing you the best!

Craig



Edited 1 time(s). Last edit at 12/12/2014 02:01PM by Craigh.

Dr. Natale done my Ablation in Feb. 2014. The visit in Jan 2013 was a little late but everything went smooth as silk.
I had a booklet given to me upon discharge with the numbers of his Nurses whom I talked to frequently when I have a question.

Where is your discharge paperwork? It should have Dr. Natales Nurse number in that booklet on a personal card.

My experience was above measure with Dr. Natalae, The Nurse staff and St. Davids medical center.

I would not want a EP who is not a "Ablation Machine". 170+ EP's watch my procedure. I was ask if it would be okay ahead of time and I said yes.

I do not know what went "south" for you but sugar works better than vinegar to build a relationship. You are the 1st poster I have encountered who has had such a overall bad experience with Dr. Natale and his Austin group.

He is the Maestro of Cather Ablation IMO and I would not hesitate to use him again and I live 8+ hours from Austin.
I have been in NSR with negligible issues since Feb 2014 Ablation

Travis - Welcome to our forum and congratulations for making the wise choice to consult with Dr. Natale. It's also your choice to look for an alternative, but from my experience, that would not be your best option.

As I understand it, the nursing staff assignments are made for you once you sign on for the procedure and then they can then respond to your questions about medications, dosing and so forth as a formal patient. Another afibber with whom I communicate is having his ablation on 12/31 and I understand there are a few dates available at the year's end as did open more dates. If you are interested, I'd definitely find out and lock in a date right now.

As the other responses before this one have indicated to you, Dr. Natale is in high demand because his procedure excellence, experience and consistent results that are without peer. He's considered the best ablationist in the world....and the result of that is sometimes, we have to wait to see him. Sometimes, he only has a few minutes because he gave extra time and care to the previous patient. It's worth the wait. His success rate is unparalleled. I know because he's been my EP since 2003 and have been participating on this forum since 2001. My first Natale ablation was in 2003..at the Cleveland Clinic (I live in Ohio) and I my second Natale ablation was this past summer in August - in Austin, Texas.

Now, that said... my own experiences with care at the Cleveland Clinic versus Austin are worth mentioning. Adequate in Cleveland. Outstanding, unparalleled in Austin at the Texas Cardiac Arrhythmia Institute. Every facet of care showed attention to detail and concern for the patient's well being. I would go back if I had to ... "in a heartbeat."

Please feel free to send me a PM (private message) by clicking the PM letters next to my name and I'll be glad to communicate with you and help with some of the protocols we all find useful to prepare you settle down while you wait for the ablation procedure.

I wish you well.

Jackie



Edited 1 time(s). Last edit at 12/12/2014 11:15AM by Jackie.

St. Davids Medical center was great to me; the entire staff.



Edited 1 time(s). Last edit at 12/12/2014 11:48AM by smackman.

OK Travis, after reading all of the above posts you should probably stick with your ablation date as it is worth its weight in gold to you. If it was me I would follow his advice and just stay on the Flec. the next time you have to go PIP.The dose that kept me in NSR until my ablation was100 mg. of Flec per day and 25 mg. of Metaprolol (a beta blocker) I would cut each pill in half and take a dose of each together in the morning and then the same in the evening. Now depending on how much the "loaded dose of Flec you were taking as a PIP and how long it would take you to lose its effect....sounds like 2-3 days, I would wait a day before starting the daily regimen. If you have a regular heart doctor you might want to run this by him first....stay warm up there and enjoy Texas in Feburary.

Travis,

there are many good EPs. Unfortunately on major centers and with the hype of success we will slowly but surely become only numbers. Natale is one of the best. as far as excuses of other patients and extended procedures etc. Thats no excuse we all should be treated with utmost respect and care. I have had four ablations none of mine were under 7 hours! So they should plan on it. they should know especially if they are a big center with lots of cases what it takes to get you in and out. i dont want to be a number, a blank face laying on a cath table. There are many great centers doing the same things Natale does. you might look into Dr. Scweikert or Dr. Tomassoni (my EP) who trained, learned and worked side by side with Natale.
ps If you are having that many episodes I would do Flec daily . My PVI was done in Feb and I still take a samll dose ev day. It helps

Hi Travis. My local ep and cardiologist make the day to day calls on my treatment and dr Natale made the calls immediately pre and post ablation. On the initial consultation he was terrific. He was on time and spent a lot of time with me. As I recall it was I who ended the session by stating I was ready to schedule. At the touch up ablation consultation I knew he was seeing me between scheduled procedures but again I was not rushed. When consulting with him it is really very simple for me. I already knew a about his vast experience, that he alone worked the catheters inside the heart and he ablated both difficult and routine cases successfully. I knew I was going to get an ablation that he does for everyone else but customized to my unique presentation. I did not need to know if he was going to ablate the superior and inferior vena cava. I trusted he would do what was necessary and do it safely. I could nitpick abit about some aspects of customer service too. However my focus was on the star of the show and he didn't disappoint me at all. My recommendation is if you need an ablation Dr Natale should be your first choice!! Good luck with your decision. Dennis

HI Travis,

I just wanted to let you know that Flec made me worse. At first it worked great, but then my episodes got longer and more frequent after starting it. Finally, I had a 36 hour episode with some a-flutter that I never had before. I stopped the flec and made it through my last 3 weeks to the ablation on Aug 12th. Still in NSR ( Dr Schweikert in Akron did mine)

John

First, I want to thank you all for giving me greater confidence in Dr. Natale's team. This is my first experience with an ablation so I have no idea what to expect. Up to this point, my only experience with EPs have been with my local EP's and they have always been great when it comes to "customer service" (i.e. never being late for an appointment, giving me all the time in the world to discuss my questions, etc.). I assumed it would be the same with Dr. Natale so when it was totally different, it was a shock. I guess I never stopped to consider he was probably just finishing an ablation when he met with me - and likely was off to do another right after my appointment. He was definitely in a rush that day and come to think of it, he was in scrubs - not in a suit or anything like that.

The whole experience just made me nervous...like are they going to be in a rush when I'm on the table? It sounds like that's definitely not going to be the case! You guys have renewed my faith in him. I will stick with him and go through with my appointment in February.

On another positive note, as luck would have it, I finally got a call back from one of Dr. Natale's nurses this afternoon. She was super nice and very helpful. She got me squared away on my meds too!

I'll keep you posted on my progress. I'm crossing my fingers that I'll be one of the Dr. Natale success stories!

Travis

Travis - Rest assured... Dr. Natale will not be rushing through your procedure to get to a consult or start another procedure or leave for the day. He devotes all the time he needs to the patient on the table. Keep in mind that while we all think that by now having an ablation should be a 'cook book' procedure, every single patient is a unique individual and requires specialized care according to what presents in every step along the way.. from start to finish. What should be comforting about that is Dr. Natale has many years of experience and knows how to manage safely and effectively whatever presents at the time.

I recall recently Shannon told of a case in which there was difficulty in doing the transseptal puncture where they cross from the right side of the heart to the left side. When it should have been straight forward and easy, it took several hours just to reach the left atrium due to some scar tissue, I believe he said. So then, the whole procedure after that was delayed. Unforeseen circumstances do happen. Not that these are common, but just to illustrate that delays can happen.

It's normal to be anxious and on edge when going for your first ablation consult. Glad you feel more confident and that you're back on track. February will be here before you know it. Take comfort in knowing you're in the very best of care with Dr. Natale and his outstanding team.

Best to you,
Jackie



Edited 1 time(s). Last edit at 12/13/2014 10:17AM by Jackie.

Hi Travis

And welcome to our cozy board here, where you will find a wealth of in-depth advice and guidance. I am on a temporary sabbatical at the moment but when I saw your thread post come through my in box I wanted to also add a little perspective to working with Dr Natale that many of his former patients have already shared with you above and in light of our conversation in Chicago last month when we first meet at the AFIB Summit kindly hosted by Janssen Pharmaceuticals in an effort to bring various AFIB patient advocates together to discuss ways to improve patient education.

(Travis has started a new blog Travis' blog In which Travis is sharing his own experiences in navigating his AFIB adventure as it unfolds.

It's understandable how you might have been a little unsure when Dr Natale did not have the time he would have preferred to have a more leisurely first meeting.There are a good number of us here who have had plenty of time with him in first meetings and others who, like yourself, had a more perfunctory 'all business' first meeting due to unavoidable and unpredictable delays that can and do occasionally happen in such a busy practice which is made up of a large percentage of very challenging cases.

The example Jackie mentioned above is a perfect one. One of our readers here who is a very nice and thoughtful young man in his low 30s that I have had the pleasure to get to know and follow along the last half year or so with his efforts to address a challenging and complex arrhythmia issue, much of which stems from congenital heart issues including an atrial septal defect (ASD) of some size that required surgical repair and closure many years ago.

He has had several non-AFIB ablations and heart surgery (with the ASD issue) previously as well, most all having to do with accessory pathway issues which you see more commonly in complex arrhythmia scenarios and that often include Ventricular Tachycardia (VT) as a manifestation.

This young man has also had to deal with Ventricular tachycardia as well as now AFIB, and had been on Amioderone for 10+ years up until this summer when he first met Dr Natale and his long time protege and colleague Dr. Luigi DiBiase who has recently been appointed Director of EP at Montefiore Medical Center and Albert Einstein School of Medicine in NYC.

After meeting Dr Natale in Austin last summer and setting a plan of action to deal with his issues in what was assumed might well require a two procedure process to achieve a long term excellent result and freedom from arrhythmia. He was cardioverted by Dr DiBiase in NYC where the patient lives, and taken off Amioderone and then asked to wait for at least three months to give enough time for the Amioderone to leave his system enough to avoid overly suppressing active triggers during this first AFIB ablation with Dr Natale, and with Dr DiBiase assisting in Austin at St Davids.

In any event, when his ablation date arrived just before thanksgiving I was giving him encouragement and support in the knowledge that he was in the best hands possible for such a situation.

Later that evening I got word from him in his hospital bed after the ablation had been a very long and incredibly challenging procedure for Dr Natale, of over 4 hours total (which is long for a Natale ablation these days unless of high complexity) . As it turns out, near the very beginning of the procedure when Dr Natale was doing the transeptal puncture to allow catheter access to the left atrium ( which until the mid 90s was considered the no mans land where one could not dare venture inside a beating heart), this normally 5 minute stage of any typical AFIB ablation wound up taking 3 full HOURS!! to complete!!

And this, by one of the most skilled and experienced ablationists on the planet. The patient's entire atrial septal wall was thickened scar tissue in addition to having a large piece of Goretex now imbedded and grown over with endothelial tissue along septal face, that was used to repair the ASD many years ago by a cardiac surgeon and there had been nothing in his records indicating the nature of this repair... these days a more refined Amplatzer septal occluder plug or Gore Septal Occluder plug is typically used for closing such holes as an ASD or PFO ( patent foramen ovale) in the septal wall.

This Goretex material is very tough and trying to penetrate it with a normal transeptal needle just causes the septum to deflect under pressure and then spring back pushing the needle back toward the right atrium. Dr Natale was able to make the puncture with a Bayless Radio Frequency (RF) transeptal puncture device but the thick scar tissue that made up this man's atrial septum was so thick and was of a consistency that the hole would instantly close again upon withdrawal of the RF needle.

Dr Natale was then forced to be creative ... he has after all pioneered aspects of the very important transeptal puncture process as well ... by then taking a guide-wire inserting it through the hollow center of the Bayless RF needle device and then he started by advancing various size balloons along this interior wire withint the RF needle.

Starting with a smaller balloon and eventually requiring a larger diameter balloon in order to hold the puncture hole open just long enough once he has quickly remove the needle leaving the balloon on the exposed to prop open the hole, so to speak, and then quickly deflating the balloon while simultaneously sliding in the ablation catheter sheath as well as the lasso mapping catheter sheath in a second puncture, before this scarred and thickened septal tissue could close around the separate shealths, each within its own puncture.

Once that herculean feat of 3 hours was accomplished, it only took 45 minutes to finish the actual ablation plus another 30 or so for isoprel challenge and final removal of all the catheters and finishing the procedure.

Dr Natale also had to very carefully ablate a couple of very hard to reach focal areas inside the right atrium which are drivers for this patients occasion runs of VT. He had to do so delicately as well due to a long due to the nature of the area noting that he may possibly have to comeback there for a touch up to finish the dealing with the VT part of the equation, as I recall from speaking with the young man, but that is in the right atrium and would not require another left septal puncture to address, if that is even required.

In any event, when I mentioned to Dr DiBiase when I ran into him at the American Heart Association Scientific Sessions while in Chicago that his and Dr Natale's patient had recounted to me the details of his procedure. Dr DiBiase smiled and said "Shannon, I can tell you without a doubt, no one else in the world would have kept going at that very difficult transeptal puncture for 3 full hours!" After an hour and a half of effort without much progress, Dr DiBiase who was assisting in the procedure, asked Dr Natale if he wanted to call it a day on this one, which no one would fault any EP anywhere for doing at that point.

But Dr Natale said no he was going to finish the job, knowing that this was a 33 year old young man with his whole life in front of him and this was his big chance to get a major leg up on being able to enjoy that life with the least amount of arrhythmia issues as possible in his life going forward. He told my new friend afterward, just as Dr Natale has said top him before when planning the procedure last summer, that he might need one more touch up with it being such a complex case and with the delicate VT related focal area as well, and he is doing well so far at just under a month into the blanking period, having already had the lions share of any work that will be needed, even if he isnt done already, to deliver real freedom long term from a difficult scenario.

This kind of case, with such an unknowable issue facing them before hand, is a classic example of the kind of issues that can arise in a busy ablationists day and throw a monkey wrench into the schedule. While good planning is a must for any EP, it is not true that any EP should be able to plan for all delays within such a schedule, but then very few EPs do multiple ablations 4 days a week as well. Most otherwise considered busy ablationist do 3 to 4 a week while Dr Natale does up to 15 a week during busy week but has recently scaled back some to a average more around 11 to 13 in light of his many travels to various conferences and ongoing research etc.

Even the low volume EPs have times when their best laid plans go haywire through no fault of their own, but when you go to a busy skilled EP, its a good idea to plan for a little more time and thus avoid being upset if you have to wait an extra hour or so.

Unlike some EPs, Dr Natale sees new patients not only on the one day a week normally set aside for seeing new and follow up patients each week in most practices, but he also fits them in in between ablations when there is space to fit one of two in between cases. If he did not with his demanding schedule, it could stretch to a 6 months wait to get to see him at all. Obviously, the odds of having a delay increase if your first appointment falls on an ablation day but its very much worth that minor price to align oneself with such a consistent perforrmer who can truly handle whatever your heart my bring to the table.

As Tsco noted, there are a number of other very skilled EPs too, a good number of which has mentored under Dr Natale. and particularly if you case is paroxysmal and not too difficult .. at least from what can be gleaned up front, that is a viable option too.

But I strongly suggest making such a decision to go somewhere else, once youve made the initial choice to see Natale and have an appointment scheduled with him, only if their if some very compelling reason to cancel out beyond him being a bit late and not having a lot of time that first appointment or if you didn't feel fast enough response from one of his nurses on a question at a time before your care has been fully transferred to being under their wing in the month prior to ablation.

As frustrating as those inconveniences might feel at first, you can read in our archives many years worth of testimonials that the level of care overall received via Dr N. at his various centers has been for the most part exemplary and the with unprecedented consistently good outcomes.

The point being that don't drop Natale out of the mistake impression that he is just an uncaring ablation mill with little attention to his patients as a few posts almost seemed to imply. That is simply not the case.

The key thing we tell everyone going to see him, or any other superstar ablationist with a full dance card, is that most of the time things run relatively smoothly with first appointment schedules, but Dr Natale's time is always given highest priority to his patients who are already on the table that day, as any prospective patient in the waiting room should, and would, certainly understand and appreciate.

Rest assured, though, that Dr Natale, even when he doesn't have as much time to shoot the breeze between ablations as everyone would like, including him, never leaves a first appointment until he has all the pertinent information he needs to make a sound clinical decision about a prospective patient and an ablation they might need. Not only from his meeting with the patient even if for 10 minutes, he has also digested the records the patient sent in and that the NP has collected before seeing him.

You will also get time with him after the ablation when he comes to your room and during follow up meetings at 6 months and one year. And if you have any questions for him that his very well trained and experienced NPs cannot answer, they will get those that are urgent questions answered by him in the same day almost always.

Typically too, his office does not take over your regular heart and AFIB care until you start the anticoagulation protocol about 1 month before the procedure, so typically a patient is expected to follow up with their on established cardio or EP they already work with for medication adjustments etc until that time and then they will follow all of your heart issues until after follow up is complete and they release you back to your local EP with a complete follow up and ablation report....

That is how it usually goes unless he has specifically prescribed and given a script for a medication to a new patient before the AC stage starts, in which case you can follow up with his NPs. for that medication adjustments earlier than is typical.. Do keep in mind though, that they are very busy people too, and try not to call for any less urgent questions that might run though our minds, when your local EP who I can almost guarantee is much less in demand, can address those as well.

Anti-AFIB noted as much in suggesting that if you want to have nice long chats and a lot of face time, then find a very good EP who is not doing several ablations most every day. But you do not want an EP typically who can see you any ole time you chose to, and can spend 45 minutes or an hour going over your every question and speculation as necessarily the same person working inside your heart, in most cases.

And in Dr N's case, the relatively short amount of time he can spend with some occasional initial appointments does not reflect in any way a disinterest in the patient. Anyone of us who have been with him for anytime and have been through the whole process with him can verify and second that view in a heart beat.

I have had a number of hour long meetings with Dr Natale when seeing him just as my doctor in an official appointment, including my very first one with was an hour and 15 minutes after flying in from Amsterdam to see him in San Francisco. And also quite a few meetings where it was 10 to 15 minutes and yet I always try to streamline my questions and record our conversations on my I-phone to maximize our time together.

Bottomline, Dr Natale is the most compassionate, and truly passionate about his field, physician I have ever had the pleasure to get to know. He is always courteous and with a gentle demeanor, even when rushed. Combine all that with his near unparalleled skill and knowledge with a catheter, gives one a large measure of patience on those days when he might not be able to spend as much time with you as would be ideal.

And yet for those golden minutes your heart is in an EPs hands for an ablation though, you want the very most experienced and dedicated ablationist you can possible arrange for. That Natale is also so personable and caring is a huge bonus, no doubt, as you will see when you do have a little more time with him soon, but even if he were an Ogre I would absolutely prefer someone of his experience over a really nice guy who isn't so sure ablations are a good idea and is not so confident he can really help you long term.

Best of luck Travis, we are off to Houston soon after stopping at home lsat night for a day and a half to reload on this venture with my wife to address her concerns now. I'll drop back in occasionally when I can.

Cheers!
Shannon

PS Please forgive any typos I dictated this reply this morning and have no time to edit it down.



Edited 3 time(s). Last edit at 12/13/2014 03:49PM by Shannon.

Travis,

You have made the right decision to go with Dr. Natale. I can't make as strong or effective a case as Shannon has, but I can testify about my own experience. I had my second ablation, in La Jolla, with Dr. Natale, 3 and a half weeks ago. It was a non trivial LAA ablation. I did get some precious time to visit with the doctor both before and after my ablation while I was in the hospital. After the ablation NP Linda Couts was in daily communication with me and she was in communication with Dr. Natale. It is very comforting to know that they are committed to follow up and to your complete recovery. I am very satisfied with my care which continues as needed.

Nick

Shannon:

What a pleasant surprise to hear from you. I wasn't expecting a response from you given your wife's situation right now so I sincerely appreciate you taking the time to drop me a line (or two...lol). After reading your post I feel stupid I had any concerns in the first place! By the way, I already posted this in the other thread where you made the announcement that you'll be gone for a while, but I wish you both the very best and I pray for both of you.

Like I said, this is my first (and hopefully last) time I've had to work with an EP about having an ablation. I knew Dr. Natale was the best, which is why I'm spending all the extra money to fly down there and work with them, but it didn't occur to me to think that one of the best EPs in the country is probably just a little busy at times

I'm glad I didn't make any rash decisions and drop my appointment with him. What a colassal mistake that would have been. Thanks everyone and God bless. I'll be sure to drop a line here after my ablation.

Thanks,

Travis

Travis,



Edited 1 time(s). Last edit at 04/15/2022 05:59PM by gianfry59.

I haven't had time to read all the replies above so if I repeat verbatim I apologise.

I have a motto NEVER trust a clinician who NEVER runs late.
Its incompatible with real life.

Mark

Travis,
Now do you believe me what I said about Dr Natale......simply the best and the most compassionate doctor you will ever meet.

When I had my ablation done at St Lukes here in New York I was one of his first patients.......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 6 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. The way Dr Danik spoke of Natale he was in awe of the man, the admiration for him while he watched him perform his magic on my heart came thru the phone with such enthusiam. Wow what an endorsement coming from an EP from Mass general who have so many top stars there too.

He is a machine, a marvel to watch work, goes into a zone while he's ablating as Shannon has told me when he had the pleasure of personally watching Dr Natale do an ablation a few months back.

Any doubt now why he is considered the BEST?

McHale



Edited 1 time(s). Last edit at 12/14/2014 10:00AM by McHale.

Gianfranco,
Good to hear from you again. Last post I remember from you was you went out for a jog 4-5 months out from your procedure and the beast came back? Glad you had a touch up and are doing well. Was it a reconnection or another spot outside the PV's?
Dr Pinski is also a top gun, as he trained under Natale while at CC if I recall.

McHale

Travis,

Had a Natale ablation in March 2011 (Austin) that so far has been successful. Learned about Natale on this site and echo all the prior comments.

However, want to share an anecedote......I am a testicular cancer survivor. When diagnosed was referred to a very highly regarded oncologist here in Houston. We waited for over 2 1/2 hours for the initial appointment.....was not happy and my wife and I discussed whether to stay or to leave. However the people in the waiting room told me he was infamous for incredbily long waits for appointments. When I finally got to see him.....he spent about 90 minutes with us as he examined me, discussed my cancer and potential treatment options and strategy. Never once during our sessioni did I get the impression he had to leave!!! Fortunately I was cured.....but learned very quickly that when it is "life and death" time becomes a minor issue. He tried very hard to develope a plan such that his patients did not have to endure such lengthy waits.....but in the end he spent as much time as was required for each case and you just accepted how it all worked.....actually saw him once at 8:00 pm for a 4:00 pm appoiintment (didn't get there until about five!!!).

I relate this experience because from what I learned here about Natale expected a simiilar situation. We waited close to two hours for my initial appointement.....again others in the waiting area commented that the waiting time frame was not uncommon. During my appointment with Natale never once did I feel rushed......in fact at the end of my approximate 45 minutes meeting he asked if we had additional questions and basically we ended the meeting. He also apologized for the wait.


Steve
Spring, Tx.

If you had Michael Jordan on your team during his prime, would you trade him? No, don't. He is a very busy guy. I am just amazed he makes the time to meet with all patients and answer emails.

I couldn't agree more about Dr. Pinski. He did a successful ablation for me in 2007 and I am still Afib free. However, since there is already an appt made with Dr. Natale, I think he should stay with it.

It definitely makes sense to have a EP who prefers to spend his time in the OR getting the procedure done correctly/thoroughly.

But... this does raise a (perhaps misguided) concern about the minimal amount of time spent examining the patient before beginning ablation.

In other areas of medicine (eg, spine surgery, knee surgery, shoulder surgery), it's been my experience that the surgeon typically spends a lot of time interviewing and examining the patient (rather than just trusting the imaging: X-RAY, MRI), and asking for specifics about their symptoms, because in many cases the medical imaging can be misleading. For example, lots of people have bulging discs, but they are not painful. Or the symptoms may not warrant the type of surgery the patient is requesting.

Is it a different paradigm in EP-land?

In other words, does the imaging (from the electrical mapping sw, etc) pretty much "tell the whole story", to such an extent that the EP doesn't need to have an extended examination/conversation with the patient before they begin ablating?

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