Hi Pam,
Great to hear your heart is humming along again back in NSR after your very late recurrence over 10 yrs, following such great success from your index ablation with Dr Natale back when he was still director of AFIB at Cleveland Clinic.
Dr Natale prefers folks who have had an LAA Isolation to return to either Austin or San Francisco for their first follow up appointment with him after the LAA isolation, in order to have one of his TEE cardiologists at either facility do your important TEE that is somewhat unique compared to the parameters looked for in most routine TEE exams.
Not only do you then get a full follow up with his staff and often Dr Natale himself depending on when your follow up is scheduled, but most importantly he then knows for sure that the cardiologist doing your post LAA-isolation TEE that is looking specifically for three not that common parameters, are highly experienced in properly detecting and interpreting the results of your LAA emptying velocity, the evaluation of your Doppler A-Wave consistency as measured at the mitral valve infliw area, snd who is equally familiar with confirming the absence or presence of any amount of 'smoke' or SEC (spontaneous echo contrast) as seen in either the LA or LAA.
It is possible for a very experienced TEE cardiologist to ge good results and interpretation of these 3 markers that are key in determining whether, or not, you need to continue to address long term stroke risk going forward, but I have seen too that so often even after Dr Natale's office as sent a detailed description of just what they are looking for in these three tests to one of his LAA Isolation patients local cardiologist who then performs the TEE, for the local cardio to get one or more of these three test result interpretations wrong, and then requiring the patient to come to Austin or SF to repeat the test all over again.
If you do choose to have the TEE done locally he will request not only the written results from the local TEE cardio, but also the full CD video of the full TEE for Dr Natale to confirm the findings of the local cardio.
In light of how often I have seen otherwise experienced local TEE cardios get one or more of the three precise metrics that Dr Natale is looking for wrongly interpreted, or poorly visualized, after Dr Natale has reviewed the actual TEE CD, it is my strong recommendation to go to Austin or San Fran for one's 6 month follow-up if the afibber had an LAA-isolation in their procedure. That added peace of mind in knowing that the TEE captures the actual picture of your LAA mechanical function is well worth the effort in addition to getting a follow-up of your overall post ablation status where you got the procedure to begin with.
Shannon
