Dr Natale - Thoughts & Experiences?

I notice that alot of people here have gone to Dr Natale for an ablation? Why is that? Is Dr Natale the best? What has been your experience? And, if Im coming from out of state how many visits do I have to make total, including pre, procedure, post, etc....? Thanks!

I made the initial appointment with his NP and saw Natale the morning of the ablation. He is a very kind man..excellent bedside manners and so far after 4 months I am in nsr. My local EP is an excellent doctor and was humble when I asked him who should do the procedure. My local EP told me Natale has more experience and Natale would be the only doctor he would recommend (other than himself)

Yes, he is arguably the best EP in the world. He fixes arrhythmias other EPs can't.

If you travel to Austin for an ablation with him, you should only need one trip. Here's the basic procedure:

1. You call and request a consult.
2. Your local EP/cardiologist sends your records to Natale's office.
3. He'll look them over and if he agrees to take the case, they'll call you to schedule it. Expect the procedure to be weeks or months out.
4. A couple of weeks before the procedure you'll be contacted and given detailed instructions.
5. You'll have an appointment the day before the procedure for lab work and possibly a chest CT. You will probably also meet with him that day to discuss the procedure. You'll be given an arrival time for the next morning.
6. The next day you show up, they get in you a gown, start an IV, and wheel you to the lab. You'll probably wait a while before actually going into the lab.
7. Once in the lab, look around at their brand new high-tech lab quickly because you'll be unconscious in minutes. You'll wake up a couple hours later in the recovery area. You should feel perfectly fine if all went well.
8. You'll be required to lay flat for 2 hours and then you can get up, walk around, eat, etc.
9. The next morning you'll be discharged. Your only limitation will be no lifting anything heavier than 10 pounds for 5 days.
10. They ask that you stay in Austin for 2 days, so you just go back to your hotel, go have some good Tex-Mex, walk around and sightsee, or do whatever you want as long as it doesn't involve lifting.

If you're traveling alone, pack with care because you're going to need that bag to weigh less than 10 lbs. I also strongly recommend arriving in Austin at least one day before your appointment. I came within 1-2 minutes of missing my appointment because of a canceled flight followed by a delayed flight. I made my last connection literally as they were closing the gate doors. I got into Austin after midnight Sunday night and my appointment was at 6:00 am Monday morning.

Bonus: All their rooms are private, the staff is outstanding, and they have the best hospital food I've ever encountered.

Oh, and you shouldn't need any follow-up visits. You'll be assigned to a nurse practitioner who can answer questions, adjust meds, or take care of any issues. They'll probably want you to send them a Kardia recording once per week, and then at six months they'll send you a monitor to wear for a week. If that recording is free of problems, you're done.

To my knowledge and experience, he is the best, and Carey is right on in his analysis and description. Natale is a pleasure to interact with (though, being very busy, he won't hang around for much idle chit chat). He seems also to have a gift for attracting and holding onto wonderful staff. I've worked with three of his NPs (in San Francisco and San Diego). They all have been spectacular.

Best wishes,

--Lance

Thanks all for such wonderful responses! How much roughly does a procedure cost? And does he require meds before and after procedure?

Quote
cirenepurzalot
Thanks all for such wonderful responses! How much roughly does a procedure cost? And does he require meds before and after procedure?

Are you self paying all of it? If so, I believe you're looking at around $20,000 but you'll have to discuss that with them. That number is what I was told they charge self-pays, but that was a year or two ago. Could be more now. But if you have insurance then it's going to depend on your deductibles and copays. No way for us to guess what that might be. .

Meds before and after are going to depend on you and your situation. Obviously, an anticoagulant before and after will be required. He usually puts ablation patients on some type of antiarrhythmic for 1-2 months after the procedure. He's fond of Multaq for that purpose but I've seen him choose other drugs for other patients.

Natale is the best and the one and only top grade EP in the World and, as he can't ablate everyone, it's a chance most afibbers in the World can't afford a trip to meet Him.

Thank you all for your feedback!!!

Quote
Carey
Oh, and you shouldn't need any follow-up visits. You'll be assigned to a nurse practitioner who can answer questions, adjust meds, or take care of any issues. They'll probably want you to send them a Kardia recording once per week, and then at six months they'll send you a monitor to wear for a week. If that recording is free of problems, you're done.

Natale plan is to see me every 3 months for now (maybe longer window later on) for 5 years. If any concerns come up he has an excellent NP.

Do you live near him or will you have to travel?

Natale is in CA one week a month for follow up appointments and Ablations. Monday Tuesday at Scripps/La Jolla (near San Diego) and Wednesday Thursday Friday in Thousand Oaks CA (little north of LA). I believe he may fly back Saturday morning.

Totally agree about Dr Natale. I had a failed ablation in MN in Aug 2016 and then met both Travis and Shannon who got me connected with Dr Natale and Salwa his Program Director. I travelled to San Francisco March 2017 for my ablation which was a total redo plus some extra from the one I had in MN. The staff and experience there was wonderful as well and I feel blessed to have many of these connections still to this day. My follow up with Dr Natale was again in San Fran in Jan 2018 where I needed a touch up -- no Afib but some adjustments to the LAA needed due to SVTs. Felt wonderful and have been free of AFIB since my first time with Dr Natale in 2017. The last thing I had done was the internal echo in Austin in July of 2018 to ensure all was well with the heart itself. I was extremely impressed with St. Davids and the Texas Arrythmia Center as to their well defined quality processes the moment you walk in the door. Since I have worked in quality management for years and taught others how to manage with defined processes and data, I couldn't stop smiling! The staff are excellent and so nice and helpful. I was delighted as well to be able to visit with Dr Natale and Salwa again and meet the staff in Austin. What is wonderful is I can continue to follow up with them as questions arise from anything my local EP ( now Denver) has advised me about . I trust Dr Natale and his staff with my life.
Thanks Carey for all the great outline of information too and all the advice you provide here as well as to everyone else sharing your thoughts, feelings and things to consider. When I had AFib I was petrified all the time and never want to experience it again. Blessings all.

Quote
susan.d
Natale plan is to see me every 3 months for now (maybe longer window later on) for 5 years. If any concerns come up he has an excellent NP.

Okay, but you're an atypical patient with ongoing issues. Most of his patients don't need follow-up visits following their ablation and they shouldn't expect to travel back to Austin if their ablation is successful. Communication with his NP via phone and email is usually all the follow-up they need.

These days it seems that ablations are so common that if you check the reviews of EPs you should be able to find one rather locally to do a good job. Am I wrong?

Quote
cirenepurzalot
These days it seems that ablations are so common that if you check the reviews of EPs you should be able to find one rather locally to do a good job. Am I wrong?

Good luck.

Quote
Carey

Natale plan is to see me every 3 months for now (maybe longer window later on) for 5 years. If any concerns come up he has an excellent NP.

Okay, but you're an atypical patient with ongoing issues. Most of his patients don't need follow-up visits following their ablation and they shouldn't expect to travel back to Austin if their ablation is successful. Communication with his NP via phone and email is usually all the follow-up they need.

So what do “normal non atypical patients “ usually do? See their local EP afterwards? How long usually does Natale NP follow up? 5 years or less? His NP wants to see me in 3 weeks since I’m off multaq and the office will stick on another Zio patch and dr Natale I believe in March. Probably because of my aggressive frequent PVCs I experienced ten days after the ablation.

We need to talk privately because I don't think your situation applies to most people.

Quote
cirenepurzalot
These days it seems that ablations are so common that if you check the reviews of EPs you should be able to find one rather locally to do a good job. Am I wrong?

"Finding someone locally" is often the cause of failed ablations--unless you find an EP who does hundreds per year and has been trained by the best. Ask them how many they have done, who trained them, etc. I live in a mid-sized city and I have never met anyone who has had a successful ablation here--though there are lots of EPs doing ablations. I wouldn't consider it.

Quote
Daisy
"Finding someone locally" is often the cause of failed ablations--unless you find an EP who does hundreds per year and has been trained by the best. Ask them how many they have done, who trained them, etc. I live in a mid-sized city and I have never met anyone who has had a successful ablation here--though there are lots of EPs doing ablations. I wouldn't consider it.

When Dr. Natale was head of the program at Cleveland Clinic - he moved and started the program in Austin about 12 years ago - they published a study. In this study, the cutoff between a high volume ablating EP and lower volume was 400 afib procedures a year. This is a place to start looking.

Shannon's afib is hereditary. His dad died of an afib related stroke. His sister also had afib. He was living in Amsterdam and she said she was considering an ablation (he's reported all this here). He strongly suggested going to Natale in Austin. Because he was out of the country, he did not find out until after the fact she'd gone to a "good guy" in Houston. Unfortunately there was a problem (tamponade or punch through of the heart, I believe) that required that she live out her life in a care facility. So it wasn't just a failed ablation, it was a huge problem.

In this vein, even if you go to a well-known person. Make sure they will have their hands on the catheters. A number of years ago a member here went to a very well known EP. Unfortunately he was out of the room when the fellow (doctor in training) placed the catheters and ripped a valve. This ended in a lawsuit. She had a failed ablation and an ongoing problem. She'd been a cardiac nurse, so was familiar with the system.

When my best friend from childhood was diagnosed with afib in 2014. I insisted he go to Austin and see Natale. He questioned me. His Houston cardiologist also questioned him as the cardio said he was referring my friend to the best EP in Houston. I persisted with my friend and insisted. He called the Houston EP's office and asked how many the guy had done. The answer, "he's done a lot, around 800!" My friend then checked with Natale's office. The answer was over 10,000, as I recall, at that time. My friend had a longer procedure time than Shannon's, which was the longest Shannon knew of, at that time. It took two procedures for my friend as he also needed LAA work. It took quite a while for his heart to heal to the point that the LAA metrics allowed him to get off all anti-coagulants, but today he is afib free without meds. Every time I see him, he and his wife profusely thank me for being so insistent.

Thanks George. I appreciate the advice. I just hope I can afford the trip out to see Dr Natale.

George:

You said:

It took two procedures for my friend as he also needed LAA work. It took quite a while for his heart to heal to the point that the LAA metrics allowed him to get off all anti-coagulants, but today he is afib free without meds. Every time I see him, he and his wife profusely thank me for being so insistent.

Most people that have posted on here and have had LAA work done have had to be on anti-coagulants for life.

:Liz

Quote
Elizabeth
Most people that have posted on here and have had LAA work done have had to be on anti-coagulants for life.

Liz, others like Shannon will know the stats better, but I think there is a 60% change of needing anti-coagulants for life or a device like the Watchman placed after LAA work.

My friends numbers from his TEE's were borderline. It took maybe 2-3 years before they improved such that Natale approved him going off them. I understand his case was unusual in that he actually improved enough after all that time.

George

Could I tell from my 6 lead Kardia ECG if I'll need LAA work done? Or is that impossible to tell with these devices?

Quote
cirenepurzalot
Could I tell from my 6 lead Kardia ECG if I'll need LAA work done? Or is that impossible to tell with these devices?

No, usually don’t know if extensive LAA work is required till after the index ablation. From a conservative point of view, extensive LAA work is typically not done initially.

Your afib history could help predict. If you’ve had long standing persistent afib, then the extensive LAA work is much more likely..

Quote
cirenepurzalot
Thanks George. I appreciate the advice. I just hope I can afford the trip out to see Dr Natale.

Shannon has posted the Medicare data before. Something like 80% of the Medicare ablations were done by EP's who do ~25 or fewer ablations a year. You clearly don't want to be with those guys. Mostly you'd like a high volume center with a high volume EP who actually has their hands on the catheters. Shannon is in the best position to give advice on choices in your area. If you PM him as many details of your situation as possible, your phone number, time zone, where you live and good times to call, he will chat with you. He attends the EP conferences and knows many of the top guys personally and who he'd recommend. It is easier for Shannon to talk than type as he has post polio syndrome with issues in his hands. He got polio from the vaccine in 1962,

Quote
GeorgeN

Thanks George. I appreciate the advice. I just hope I can afford the trip out to see Dr Natale.

Shannon has posted the Medicare data before. Something like 80% of the Medicare ablations were done by EP's who do ~25 or fewer ablations a year. You clearly don't want to be with those guys. Mostly you'd like a high volume center with a high volume EP who actually has their hands on the catheters. Shannon is in the best position to give advice on choices in your area. If you PM him as many details of your situation as possible, your phone number, time zone, where you live and good times to call, he will chat with you. He attends the EP conferences and knows many of the top guys personally and who he'd recommend. It is easier for Shannon to talk than type as he has post polio syndrome with issues in his hands. He got polio from the vaccine in 1962, Other info is what your afib situation is - how long have you had it, how frequently episodes come, how long they last & etc.

When you leave the Texas Cardiac Arrhythmia Institute, after an ablation, do you have to constantly wear some type of monitoring device for a while? Or will a Kardia suffice? (I don't live in TX.)

Quote
cirenepurzalot
When you leave the Texas Cardiac Arrhythmia Institute, after an ablation, do you have to constantly wear some type of monitoring device for a while? Or will a Kardia suffice? (I don't live in TX.)

A Kardia will suffice. At least two years ago their procedure was they wanted you to take a Kardia reading once per week and email it to the NP you're assigned to. And then at six months they'll send you a monitor to wear for a week so they can get a full 24/7 view. If that final week of monitoring is clear, you're done!

Nice! Thanks!

Quote
Carey

When you leave the Texas Cardiac Arrhythmia Institute, after an ablation, do you have to constantly wear some type of monitoring device for a while? Or will a Kardia suffice? (I don't live in TX.)

A Kardia will suffice. At least two years ago their procedure was they wanted you to take a Kardia reading once per week and email it to the NP you're assigned to. And then at six months they'll send you a monitor to wear for a week so they can get a full 24/7 view. If that final week of monitoring is clear, you're done!

Maybe their procedure has slightly changed. I was never asked to share a weekly Kardia reading. Howevee I do send his NP occasionally Kardia strips when I’m concerned.