Anyone out there that wants to share, guide and educate someone that will be going through the ablation process in a few months?

(of course with Dr. Natale)

Thank you

Assuming you're doing the procedure in a single trip to Austin, here's how the pre-ablation process works:

You'll receive pre-op instructions from Natale's office a week or two before the procedure. If you're taking an antiarrhythmic drug, it will tell you to stop it some days before the procedure (how long before depends on the drug). It will also tell you to have nothing to eat or drink after midnight the night before the procedure, but to take your usual dose of anticoagulant the morning of.

They will schedule you for a CT scan the day before the procedure. They use contrast for this, so they'll start an IV and draw bloods beforehand. Afterwards, you'll be instructed to drink a lot of water to help flush the contrast out of your system. Later that day, you'll receive a call telling you what time to arrive the next day for your procedure. The morning of your procedure, you'll do all the usual paperwork and then be taken to a pre-op area where you get the silly gown to wear, and they'll start an IV, hook you up to an ECG, etc. Eventually, you'll be wheeled to the lab area where the procedures are done. Don't be surprised if you spend a while waiting if you're not the first case of the day.

When they're ready for you, you'll be wheeled into the lab, which is a room packed with all sort of computer monitors and high tech gear. The room will be chilly but they'll give you blankets. There you'll be moved off the gurney and onto the table. They will apply a bunch more pads to your chest and back, a couple of them quite large. This just takes a few minutes, and pretty soon Natale will appear. Once he does, they'll put an oxygen mask on you and ask you to take deep breaths. At the same time an anesthesiologist will start the propofol flowing in the IV you have. Propofol works fast. Just about the time you start to feel the drug, you'll be out like a light. If you try counting backwards from 100 like they used to have people do back in the old days, you'll be lucky if you get to 98.

After that, the next thing you'll be aware of is waking up a bit groggy in a recovery area. There will be a nurse there who will check on you right away, ask how you're feeling, and checking you out. They'll let you lay there and gradually wake up and get your bearings for a while until your room is ready. Unlike most hospitals, at St. David's everybody gets a private room, which is really nice.

I'll write up the post-op experience later.

Very good description Carey!

And you really only have two key responsibilities once you arrive in Austin, Whitehaven.

1. Don’t be late! That includes for either your initial consult, which is typically the day before the ablation if you are on a single trip ablation schedule traveling from out of state. And especially don’t be late for your set arrival time at St David’s Cardiovascular Services section on the day of your ablation were they will prep you for the procedure.

They sometimes vary when you are given the scheduled time to arrive for the ablation, but at the latest you will be called in late afternoon to early evening of the day before the ablation, and at some time after your initial consult day at St Davids is over. Best to arrive a bit earlier than scheduled too just to be on the safe side. Starting next month, in early June, the name of the room you with check into for ablation prep may change as the whole operation is being shifted into the all new St David’s ElectroPhysiology Center which is in a brand new wing of the hospital with 6 state-of-the-art EP-Labs (i.e. an EP dedicated operating room) and all private brand new patient rooms.

2. Take your last pre-ablation dose on time! When they call you with your scheduled time to arrive for your ablation, they will also confirm with you exactly when they want you to take your last dose of whatever blood thinner you are on. This is a vital step as this is your one step to remember that contributes directly to a safe ablation process that you are asked to perform ... and that is, you MUST take your last dose at the assigned time of either Eliquis or Xeralto (less common these days is Pradaxa or Warfarin). This is your small contribution to completing the link in the ‘uninterrupted anticoagulation protocol’ that Dr. Natale spearheaded with his group back at Cleveland Clinic and that has for a decade and a half been the gold standard for ablation safety.

Nevertheless, don’t fret should you forget to take your last dose of OAC, they will notice that your ACT (activated clotting time) is too low before they do the transeptal puncture to access your left atrium with the lasso-mapping and ablation catheters, and they will boost your ACT to the safe level of around 350 seconds with IV heparin just before the two transeptal punctures. Just make Dr. Natale’s job easier by remembering to take you last dose of blood thinner on time.

Typically, if you are on Eliquis and your ablation is set for either the first or second procedure of the morning, you will be asked to take your last dose of Eliquis at 5:00AM. For 3rd or 4th ablations in the day they will give you a different time.

For folks on Xeralto you will be asked to take your last dose with your evening meal the night before the ablation.

That’s it!! Just remember these two simple responsibilities and the rest of the entire process is utterly effortless! You can totally relax in the comfort of knowing you could not have possibly made a better decision on whom to entrust your hearts care too ... and just go with the flow. The Docs, Nurses and Techs in the prep room and EP-Labs at the largest AFIB ablation research center in the world are highly professional and very experienced in making you feel well cared for and helping you feel at ease. Before you know? it’s all over and you’ll be back in your hotel room in less than 24 hours to take it easy for a couple days before flying home.

Best wishes!
Shannon



Edited 2 time(s). Last edit at 05/11/2019 02:11PM by Shannon.

PS I believe this is your first ablation is that right Whitehaven? If so, the pre-ablation CT scan at St David’s that Carey mentioned above is typically reserved only for folks who have had a prior ablation and is used, in that case, to rule in or out any possible pulmonary vein stenosis that may have occurred during any prior ablations. There can be other reasons why they may want a CT done pre-index-ablation, but those are more rare.

You won’t see PV stenosis from a Natale ablation, nor from the vast majority of operators using a similar ‘wide antral’ approach to isolating the four PVs. Indeed, Natale created the PVAI (pulmonary vein antral isolation) in the late 1999, primarily to avoid any PV stenosis from burning too close to the narrow part of each of the four Pulmonary veins going to and from the right and left sides of the left atria to each lung.

This is in contrast to the ‘Segmental PVI’ which was the original protocol for doing a PVI and conceived by the Bordeaux team in late 1998, and that has largely been abandoned including now by Bordeaux operators, in favor of the more effective and generally safer PVAI by largely avoiding the stenosis risk, and that also has some potential advantages in terms of being able to inherently bisect certain ganglionated plexi as a bonus to the geometry of the wider angle of encirclement of the PVs taken by the PVAI technique.

Shannon



Edited 1 time(s). Last edit at 05/11/2019 04:59PM by Shannon.

Quote
Shannon
Starting next month, in early June, the name of the room you with check into for ablation prep may change as the whole operation is being shifted into the all new St David’s ElectroPhysiology Center which is in a brand new wing of the hospital with 6 state-of-the-art EP-Labs (i.e. an EP dedicated operating room) and all private brand new patient rooms.

I have been meaning to ask then since this is a new wing of the hospital, will the address still be 3000 N. IH-35 Suite 720, Austin, TX 78705. We might look for air bnb's & want to be sure we have the correct address of where the ablation, etc., takes place.

Also, Whitehaven, when they contacted you to tell you when your ablation would be, how far out was it scheduled for from that date? I have not heard back yet.

Thanks, Madeline

Hi Madeline,
Im sure the new wing will have the same overall address as St Davids Medical Center. I suspect that the discounted hotels key on either the St Davids Med Centers main address and likely also accept TCAI address as well when offering discounts for people having procedures there at St Davids. Just check in the St Davids a d TCAI websites and see what address they suggest for setting up discount hotels. It’s quite possible the hotels don’t even ask for an address but may just ask for the phone number or a discount code you might get from St Davids website?

Just remember though the address you listed above is to Dr Natale’s group, ‘Texas Cardiac Arryhthmia Institute - TCAI’, and that is a different address than is St Davids Medical Center’s overall hospital address, so when sending in medical records etc. for Dr Natale and his staff, be sure you are sending those to TCAI rather than St Davids Medical Center address.

Again, just for clarity, the address at 3000 N. IH35, Suite 720, Austin TX 78705 is the address for TCAI, not for mail sent only to St Davids Medical Center.

Shannon



Edited 1 time(s). Last edit at 05/14/2019 11:27AM by Shannon.