Ablation scheduling, early, late, just right?

May be a dumb question but seeming a little chicken and egg to me - looking for recommendations on timing for an ablation, prior to going into persistent or once you go in? Asking because its been a year since my flutter ablation and had my first breakthrough last night. Took some extra Rythmol immediately and converted in about 45 minutes, so guess that's good, but....in hoping for the best and preparing for the worst I called Dr. Natale's office to inquire about scheduling. He's about three months out, so my options seem to be a) schedule while I'm not in afib (and may or may not need the ablation when the time comes), or b) wait til I fail the Rythmol to schedule in which case I hope the next drug works or I may be in afib for 3 months while waiting, which of course I don't want to have happen. Just curious how others have timed it and your thoughts.

Thanks

Clay

Clay,

I'm kind of in your position. I've kept afib mostly at bay (using magnesium to bowel tolerance, potassium, taurine plus on-demand flec when the electrolytes failed) for around 11 1/2 years - following a 2 1/2 month episode in the first 4 months of my afib career. Four years ago, my then wife & I separated. My afib became much more frequent. The worst was 4 episodes in one week. If that had continued, I was ready to call Austin. I turned it around, first with flec before bed, which I titrated to zero over a month, while adding in powdered ginger. This worked OK, but still had an episode a month or so. Then I figured out I was overconsuming calcium by stress eating wheels of brie. After I cut that out, I've had 1 episode in 33 months (that was over 18 months ago).

From my perspective, one episode in a year (that converts in 45 minutes) is too infrequent to schedule an abaltion (my flec conversions usually take an hour or so, the longest in recent memory took 4 hours in the high calcium era). My sense of myself is the time to convert is also an indicator. 45 minutes is quick- an indication the system isn't that messed up.

I can understand your feelings. Every time I take flec, I wonder if this will be the time it doesn't work, especially if it takes a couple of hours. It has yet to fail me. The less I use it the more comfortable I am that it will continue to work.

If things got worse, you could get cardioverted and take a rhythm med, which would likely work while you were waiting to get your ablation.

George



Edited 1 time(s). Last edit at 03/02/2016 03:40AM by GeorgeN.

Hi Guys,

My opinion based upon going through what you are going through and having had 5 ablations over about 20 years is to make the appointment. Afib, from what I know, doesn't get better by itself. Be sure and make your appointment with the best. My first two ablations were not with Natale and that's why it took 5 of them. the first two didn't kill me, but they didn't help much. I seem to be fixed now.

Nickmou

Thank you both for your perspectives.

George - I know you're a legend on the health side and your discipline and approach are amazing. I feel pretty strongly that my regimen has helped, just wish I knew more about what helps and what doesn't!

Nick - That's why I called Dr. Natale's office. There is actually a very good EP here in town, Dr. Miller, who I'm scheduled with on sort of a rolling 6 month basis. I found him when I got very excited about the FIRM procedure, but he's slowing down his schedule and while I think FIRM has benefits in conjunction with PVI, it also has some shortcomings so I'm not as fired up on that option as I used to be.

Clay,
My take on it is anyone who still thinks FIRM has any merit 4 years after all the hopla or even believed it in the first place without any proof of concept IMHO may not be very skilled at all to do a proper PVI without any re-connections ,never mind going outside the PV'sand hunting for other Foci or electrical activity on the back wall,SVC, coronary sinus,LAA etc.....
My PVAI, all 4 PV's were transmural and intact with no re-connections almost 3 years later as my Cat scan showed the day before my Tuesday ablation.
As the Maestro told me without bravado 30 days after my followup in NY any afib/flutter after the blanking period won't be because of any PV re-connections but will come from other areas beyond as he just haven't seen any in the last 6 years.

This is what sets this man apart from any other EP, his gliding catheter guided by the Lasso Mapping catheter technique eliminates the gaps that are left by the point to point ablation technique done by almost all the rest.

I waited 4 years and ended up having a much more extensive ablation, needing a second which was much more than a touch-up.

McHale



Edited 5 time(s). Last edit at 03/09/2016 10:48AM by McHale.

McHale, I think by now, everyone that publish about AF ablation drag the catheters along the desired lesion sets and go back to focal during the challenge tests, so Natale is not alone. I think all the elites have been doing this for years now since they share best practices. I still see animations on the web that show point by point ablations to get the concept across to patients and those need to be updated badly.

[a-fib.com]
I was under the impression Natale so invented this technique and I know he's been show casing it to the EP world.
Not sure if many are actually doing it as it's rather difficult to master from what I'm told but not sure.

McHale

The first time I heard about it was 2008 during an expert panel discussion about how the top guns do their ablations. The presentations/panel consist of Natale, Packer, Reddy, Pappone, Kuck (perhaps 1-2 others that weren't on the podium) and the dragging (not lingering in one spot) was discussed then as the preferred approach for generating ablation lesions. There wasn't anything formal or quantitative about it but it was generally recognized as better than lingering at one spot that also resulted in faster procedures. It wasn't a Natale specific method as others talked about it.



Edited 1 time(s). Last edit at 03/15/2016 05:17PM by researcher.