Referral to a good ablationist in Washington State

Hi everyone,
I'm new to the board but have read a lot of great information here. I really appreciate everyone's effort to bring comfort to the Afibbers. I have developed an Afib condition in March of 2016. Since then, I have 2 cardioversions without success. Then, I had an ablation about 3 weeks ago, but I went back to Afib after 8 days. I had another cardioversion but it only held for another week. Now my doctor prescribes me Amio as a preload for another ablation down the road.
I'm just wondering what you think of that approach, and if you can, please refer me to a great ablationist near Seattle area.
Thank you so much for your help. Good luck to all Afibbers out there.

Go to Texas to Dr Natale

I hope your doctor can find you a better alternative than Amio as it has a long half life and you will need to be off of it for your referral ablation. Amio also has a risky toxicity profile as I am sure your doctor explained.

Thank you, Imann, for your referral. However, due to personal reasons, I can't go to Texas at this time to see Dr. Natale.

Hi Researcher,
My doctor has explained the side effects of the Amio, but he said I'll be on it just for a short time, may be a couple of months, to see if either my heart responds to the med, or until the next cardioversion. I'll definitely keep this in mind though. Thank you very much for your advice.

Thanh,
Dr. Natalie is also in San Francisco's California Pacific Medical Center one week out of every month.

Thank you very much Mike.

Dr. Chris Fellows at Virginia Mason (VM) in Seattle is generally considered one of the best in the Northwest. He is the Medical Director of Electrophysiology at VM. I believe that he has performed approximately 600 ablations, although you'll want to confirm it. I believe Dr. Natale has performed over 8,000 ablations, but you'll need to confirm that as well. Then there are different methods of ablation. Radiofrequency (RF) ablation vs. cryoablation. There are differences of opinion on the effectiveness of each. Dr. Fellows practices cryo, whereas Dr. Natale practices RF.

If you do further due diligence, you'll find several top electrophysiologists in Seattle.

Best wishes to you!

Chuck

Thank you, Chuck. I really appreciate the info.

Welcome Thanh,

And really, with a case like your which very much sounds like persistent AFIB, and perhaps even long standing persistent AFIB (LSPAF) if you have been asymptomatic and yet in AFIB prior to March 2016 formal initial diagnosis?

In either case, you definitely want to go to Dr Natale for such a case. He will want you off Amioderone for a minimum of 2 to 3 months before you come in most cases ( there are exceptions) because AMIO has a very long half life that can suppress the very triggers an EP is trying to detect with real time EP sleuthing and then ablate.

Your EP who is preloading you with AMIO is following a European protocol that focuses mostly on an anatomical PVI-only ablation where real time EP sleuthing to try to locate all active triggers is never attempted, and when you are still in AFIB or Flutter after such an index ablation, they may start you on AMIO to increase changes of acute AFIB termination during the second procedure which some European EPs feel is associated with slightly better long term freedom from AFIB.

However, many other studies have shown no real long term advantage in achieving acute AF termination during the procedure compared to if the ablation just converts you from AFIB to an elongated slower speed flutter at which point if NSR does not occur, then you are cardioverted at the end of the ablation to NSR. That has just as much chance of being long term successful as if you are terminated to AFIB acutely during the procedure IF this is a more extended ablation for either advanced paroxysmal, persistent or LSPAF.

What really matters is not whether or not you have AFIB termination during the procedure, but whether or not all Non-PV triggers as well as all anatomical PVI and posterior wall isolation is done with expert transmural lesion creation. If an extended procedure that includes Non-PV trigger detection and ablation as well as PVAI + Posterior Wall isolation is all done with great skill without reconnections you will almost certainly experience long term freedom from arrhythmia.

Im talking now mostly about people with persistent or LSPAF, not so much simply early stage paroxysmal cases where often the condition has not progressed to the point where focal Non-PV structural triggers have yet to manifest .. which sound very much like what you case may well be. That is, your case sounds like a more advanced case of persistent AFIB with all the failed cardioversion and a failed first ablation which sounds like it may have been just a PVI.

Nevertheless, please don't compromise on the choice of any future ablation EPs, in a case like yours you should demand the most experienced possible ablationist who specialized in ablation the most challenging type cases. That is a perfect description of Dr Natale.

It will only require 5 days out of your time to go to San Francisco for a consult and next day ablation, plus two to three days recovery in a local hotel nearby before flying back to Seattle.

His staff will follow up with you for the first 6 months with a 4 month use of a cardiac monitor to document any breakthroughs or silence, and then at 6 months they wish you to fly back from one evening to met the next day for a consult and follow up before releasing you to your local EPs care.

Trying now to find the best local guy due to it not being convenient or even a personal issue that, unless it simply is out of the question under any circumstances for you to travel for this period or if you simply cannot get some one else to help you with any such duties at home or at work that might make you prefer to find someone in Seattle, is not recommended in a case like your unless there really is not other choice and it is simply put of the question to travel beyond the Seattle area.

If it is then lets talk and will try to find you as suitable alternative in your general regional area as possible, but first think long and hard it there is any way at all you can carve out 5 days of your life for a trip to San Francisco to get this taken care of by a true maestro at these kind of more challenging cases.

I would hate to see you get stuck on the ablation merry-go-round where a list of well-meaning or local/regional EPs without the needed experience in such cases tries to fix you with not much more success than your first procedure.

In any event, if you wish to discuss you options then PM me with the PM link at the top of this post with your cell number Seattle area and I will try to call you in the next couple of days to discuss.

Best wishes Thanh,

Shannon