Thanks to Dr. Natale I am free of AFIB and Blood Thinners

Hi Everybody,
I wanted to post the final results of my ablation with Dr. Natale which was highly successful, resolved my AFIB, and put me back in NSR.. However there was an interesting twist related to discontinuing my blood thinners, that I wanted to share.

Dr. Natale performed my second ablation on May 21, 2014 (the first ablation was performed by a different EP), and after approx. 5-6 mo., I had my first TEE. The results showed that my Left Atrial Appendage Emptying Velocity (LAAEV) was “low normal” at 42 cm/sec. Dr. Natale said at that time that due to the marginal LAAEV, in addition to other parameters that I did not understand very well, I need to continue to take Eliquis (blood thinner), and that I should have another TEE in 5-6 mo.

So, I had my second TEE in Feb of this year, and this time the LAAEV decreased to 38 cm/sec. At that time Dr. Natale advised me to either continue staying on Eliquis or have an ATRICLIP surgery, if I really wanted to get off Eliquis. I decided that I will have one last TEE in 4-6 mo. and if the results are still marginal I will go ahead with the ATRICLIP surgery.

I had my third TEE on July 2nd of this year, and this time the LAAEV was even lower at 33 cm/sec., so I did not even bother consulting with Dr. Natale, but I made an appointment with an ATRICLIP surgeon (DR. Dunnington in Santa Helena, CA), who was recommended to me by Dr. Natale at the February consultation. I was ready to have the ATRICLIP surgery on Monday, July 13, when I got a call from Dr. Natale’s office to cancel the ATRICLIP surgery, and make an appointment with Dr. Natale for further consultation. I agonized over it for a while, since I was prepared to go through with the surgery, especially if this consultation with Dr. Natale turned out to be another false hope of the type “you are done 90% but if you want to be 100% done you need to do the ATRICLIP”. I consulted again with Shannon, and he communicated directly with Dr. Natale who said he would review all my TEEs and make a determination for my path forward. I cancelled the ATRICLIP surgery.

Then I saw Dr. Natale on July 22nd; and, to my surprise, he told me straight away that he had reviewed all my 3 TEE results in detail and that his advice to me was that I didn’t need the ATRICLIP surgery, and also that I could discontinue the Eliquis Blood Thinner.

I almost fell off my chair when I heard the above. He further elaborated (and here I will have to give you a disclaimer that what I am going to say is my interpretation of what I heard) that he looked at all my TEE results (including their ultrasound video results) and that, based on new research / evidence, even though my LAA Emptying Velocity was marginal (last one was 33 cm/sec), my E and A waves were strong, and the LAA was moving and contracting quite well, and was emptying the LAA, which eliminates the risk of clot formation in the LAA. He said that he encountered cases where the LAA Emptying Velocity was much higher than mine, but the LAA was not moving / contracting properly and as a result was not emptying the LAA properly, but my case was just the opposite. He almost implied, in my opinion, that the LAAEV and LAA moving /contracting are somewhat disconnected, which was a great surprise to me. Again this was my understanding of what he said, which could be less than 100% correct.

Needless to say, I was thrilled with his decision that I don’t need to go forward with the ATRICLIP procedure, and that I can go off Eliquis.
This meant that I was done for now; I am AFIB free in NSR (except some occasional PVCs), and Eliquis free (which started to be a nuisance any time I had to do a checkup procedure). I will see Dr. Natale after 6 mo. for another checkup.

I would like to take this opportunity to thank all the members that helped me during the last 2 years with the myriad of questions that as a novice I had , and especially Shannon who always extended a helping hand in times of crisis.

Peter F

Hello Peter~

Congratulations!

Thank you so much for taking the time to write your informative and detailed report.
Certainly great news.

Enjoy the rest of your life in blessed NSR.

Best to you,
Jackie

That is great news Peter!
Good for Dr. Natale (and staff) for being so effective in caring for his patients. Most doctors would not have bothered.
Shannon also helped save the day, again.

I had a second ablation Sept 2014 for Left Flutter. I had my first TEE June 30, 2015 at Scripps. Dr Natale's nurse "unofficially" told my wife my TEE was 24 or 28, not sure.
I haven't heard for Dr. Natale's office about the official results of the Echo and TEE.
This leaves some hope. At age 51 the idea of being on blood thinners the rest of my life isn't a good thought.

Don

It was wonderful news Peter and very exciting to be there, so to speak, as it unfolded :-)!

And your description didn't need a disclaimer you pretty much covered the reasons why you got a reprieve very well. The LAA emptying velocity and at A-Wave at the doppler inflow of the mitral valve where the LAA empties into the Mitral valve ( or more accurately where the combination of the pumping action of the LAA combined with the valve action of the mitral valve together determine the overall flow characteristics and indicate if there is enough dynamic consistent flow to eliminate or minimize below any level of concern the chances for thrombus formation within the LAA.

The fact that your case was always rather a borderline one is telling and important for others who may need to consider the Atriclip after an LAA isolation to keep in mind. Had your emptying velocity and Mitral inflow doppler A-Wave been as respectively low and inconsistent as both mine and BillK who will soon be sharing his very exciting, successful and rewarding Atriclip installation procedure rendering him in the same boat now as Peter, in being off all OAC drugs for good and enjoying ongoing NSR too... than had you been in both Bills and my boat with clearly far too low pumping and velocity our of your LAA, then the decision to go for the Atriclip would have been a no-brainer from the first TEE forward.

It is only these cases where one of both of the parameters are more or less borderline that the chance for recovery of mechanical function is really possible and thus warrant a watchful waiting approach for a while longer doing several TEEs to see if such a recovery is in the cards for you are if its likely going to remain too long or gradually decline and thus either stay with OAC for life or move on to the Atriclip.

And with BillKs report soon to come, I'm even more in favor of most such folks to opt for the Atriclip now that such progress is being made in both the installation precision and ease of recovery from same with very modest and short lived pain and discomfort too.

Anyway, will wait until Bill has a chance to report on this too, and in the meantime Peter, celebrate and enjoy your great good fortune!

Cheers!
Shannon