Ablation after CABG

Had ablation by Dr. Natale 8/2005. No problems until 3 months post CABG x 3 in 4/2019. Was cardio converted and now have been on Sotalol and Xarelto since. Feel tired but in NSR with hr in 50's. Live in Arizona and not confident in either hospitals or Electrophysiologist here. He suggested cutting back on Sotalol or stopping to see if Afib/Aflutter returns. Regular Cardiologist thinks it will return and so do I. I am 76 and really concerned with going back into Afib/Aflutter here. I know Dr. Natale is the Dr. I would want to do another ablation but at this point am concerned with being 76. Also I was on list for Natale ablation for months before being scheduled. Anyone had a recent ablation by Dr. Natale and how long were you on the waiting list? Any suggestions as to whether to even consider ablation at his point. Also how difficult is it to even get an appointment with Dr. Natale?

Bill

Your age is no problem whatsoever. Waiting times for people during 2020 were kind of all over the place because of COVID, but things have settled down now. I would expect a month or two at most from the time you contact them until the procedure. Getting the ball rolling takes no more than a phone call.

Keep in mind that AF brought on by major surgery is often temporary and resolves on its own. I personally wouldn't schedule an ablation without being sure I actually needed it. So I think you've got to stop the sotalol for that reason (you'll have to stop it for the procedure anyway). After all, what if you stopped it and nothing happened? That's entirely possible. So just talk to your EP to coordinate it so they'll be ready to restart the sotalol and cardiovert you if you go back into AF. Worst that can happen is an uncomfortable day or two.

Afib started 3 months post cabg. From what I have been told by Cardiologist at CCF that Afib right after surgery is normal which happened and resolved, but is not normal 3 months after cabg. I will probably at some point in the near future cut the Sotalol in half first. If Afib doesn't return then stop Sotalol. What you said makes sense if cardioversion would work or better yet Afib didn't return.

Failed to mention that I was in Pa at the time of going into Afib and was in Afib for 24 days prior to returning to Arizona and having a TEE and cardioversion and put on Sotalol.

I think cutting the dose in half first and seeing how it goes makes sense. Plus if you've been on a beta blocker like sotalol for a long time, it's generally better to taper off, so definitely get your EP involved.

Bill: I had a Natale ablation in 2007, more Afib in 2020, and another Natale ablation in February, 2021, almost at the height of the Pandemic restrictions and rescheduling. I was 83 years old then. I started working on scheduling it in late November, scheduled it for January at Los Robles in Thousand Oaks and Natale did the procedure on Feb. 11.

It went very smoothly even though Natale had to isolate my LAA, which he said happens more frequently as people age. This means I will get a TEE after 6 months and then either an Atria Clip or Watchman if NSR continues, which it has to date. I'm presently wearing the required 2 week monitor. at the end of my 90 day post-op period. I am taking only Eliquis and will for the 6 month period.

When I decided to do it I contacted all 3 of the hospitals where Natale regularly does procedures and it turned out that Los Robles had the shortest wait and was closest to me.

I found the procedure from a patient's point to be quite similar to what I went through in 2007 except back then I had to stop Coumadin 4 days before and in this one I took Eliquis the morning of the procedure. I went into the hospital at 6:00 AM, to Recovery at bout 8:00AM, had to lay around bored for 6 hours for the vein incisions to heal and was back at my hotel about 3:00 PM. I had a follow-up appointment with Dr. Natale and his NP, Kelley, at 9:00 the following morning and was released. Never had any significant discomfort.

I'd do another with the same crew at the same hospital without worry if I thought it desirable which I would if the alternative was a heavy medical cocktail mix for the rest of my life.

Gordon

Cutting Sotalol dose in half is the way I would go. Thanks for your opinion Carey.

Gordon. I haven't been on this site for years and haven't kept up with what is new. Sounds like things have gone well for you. Isolating the LAA is something new to me along with having to have a TEE after 6 months and then either an Atria Clip or a Watchman if NSR continues. Obviously l haven't researched all this. Back in 2003 to 2005 I was constantly researching and saw Electrophysiologists in Pa., Arizona as well as Dr. Natale.

Had the ablation, checked in with CCF for 3 months with some type of monitor and returned for a high speed heart scan to see if there was any stenosis of the pulmonay veins.

My ablation lasted 4 1/2 hours. Two hours for for the procedure?

I knew Dr. Natale performed ablations at different hospitals back then but am not familiar with where he performs them today. Seems like a short time to wait for the procedure. I waited much longer.

I hate the side effect of being tired all the time on Sotalol. Was very active prior to after my ablation. The pandemic put an end to going to the gym 5-6 days per week and have recently started exercising regularly again. Only able to get my HR up to 90 on Sotalol. When I was exercising regularly I always got my HR up to 85% of maximum.

Obviously, I will have to start doing my research to try to catch up with the improvements that have taken place since 2005. Don't have much faith in the Electrophysiologist here. Young Dr.

Thanks for your input.

The only person I recognize on this site now is Jackie. It has been a long time. Always completed the surveys Hans sent.

I am also curious. Is there anyone on this site who has undergone cabg or any other major heart procedures and then had an ablation?

Quote
1ablation
Gordon. I haven't been on this site for years and haven't kept up with what is new. Sounds like things have gone well for you. Isolating the LAA is something new to me along with having to have a TEE after 6 months and then either an Atria Clip or a Watchman if NSR continues. Obviously l haven't researched all this. Back in 2003 to 2005 I was constantly researching and saw Electrophysiologists in Pa., Arizona as well as Dr. Natale..

Natale stated isolating the LAA in some cases a few years after your ablation. For those who need it, it can be a game changer in ridding a person from afib. The issue is there is a 60% chance the patient will need lifetime anticoagulation or the installation of a device like Atria Clip or Watchman. This is because the procedure can reduce emptying velocity out of the LAA as well as degrading other parameters. See Shannon's post.

Quote

I knew Dr. Natale performed ablations at different hospitals back then but am not familiar with where he performs them today. Seems like a short time to wait for the procedure. I waited much longer.

Around 2008, Natale moved to the Texas Cardiac Arrhythmia Institute in Austin. He also practices in CA at Los Robles in Thousand Oaks and (I believe) Scripts in La Jolla.

Quote

I always got my HR up to 85% of maximum.

I stated in this thread: "My hypothesis is that if most recreational athletes spent most of their training time in Z2, we'd see much less afib in the group. Now once someone has afib, even Z2 may be too intense for some. All bets are off." There is more info on Zone 2 (Z2) in my other posts in the thread.

I've been here since 2004. Sorry you had to come back. There are a few others still here from that time. Hans retired 7 or so years ago and Shannon (who was here then) took over. I visited Hans at his house in Victoria two years ago, while on a trip. He is still doing well.

It's Scripps Hospital in La Jolla, CA (SanDiego). [scrippsamg.com]

Doesn't appear anyone had an ablation after cabg or any other major cardiac surgeries?

Has anyone had an ablation at Cleveland Clinic recently?

I don't think anyone here who has spoken up in the last few years has had an ablation following CABG. I think there have been a few ablations at CC, but I don't remember who they might be.

I don't quite get what you're trying to ask.

Quote
1ablation
Has anyone had an ablation at Cleveland Clinic recently?

I did a search on Cleveland Clinic here and the most recent ablation I could find was from 2012, mentioned in this post. dated Jan. 2019.

If I were in the market, I'd fly to Austin. I'd also ask Dr. N about ablation after CABG. I'm sure he's done plenty.



Edited 1 time(s). Last edit at 05/23/2021 01:45PM by GeorgeN.

Trying to find out if ablation would be appropriate after cabg and if there is anyone on this site that has had ablation after cabg.

When Dr. Natalie was at Cleveland Clinic everyone recommended him and I agreed and had him do the ablation. Since Cleveland Clinic is rated the top cardiac hospital in the country by many and doctors there have been performing ablations for years I wondered if anyone has gone there since Dr. Natalie and who performed the ablation? I have many relatives there.

Quote
1ablation
Doesn't appear anyone had an ablation after cabg or any other major cardiac surgeries?

is your question did anyone have an ablation RIGHT after or ?? I have a history and also have an adult congenital heart doctor. He works with the EP.. many people do have afib as kind of a result of other heart issues .. that is my understanding. my history is not cabg.



Edited 1 time(s). Last edit at 05/23/2021 10:59PM by bettylou4488.

CABG and afib ablation don't really have a lot to do with each other, at least not as long as they're not occurring within months of each other. If you've had a CABG and recovered successfully, but you still have afib, an ablation is perfectly feasible. There's nothing about the CABG that would prevent you from having an afib ablation.

As for Natale, he's still the same doctor he was at CC just with a lot more experience and currently at Texas Cardiac Arrhythmia Institute in Austin.

It's a little hard understanding what you're asking. Telling us a bit about yourself would help.

If you are wondering why Natale left CC, I recall the then MD CEO of CC was not happy that Natale was teaching other docs ON HIS OWN TIME. Hence the CEO did not renew Natale's contract. My thought at the time, "talk about cutting off your nose to spite your face!" My understanding is the folks at TCAI purpose built the facility for Natale. IMO, it is the best afib ablation facility in the world.

Basically the same thing happened to him at Sutter Health, (CPMC), in San Francisco. The administration was trying to bring in many specialties as employees to better control the total patient esperience and therefore the income from it so they lost the training Natale provided for many up and coming EP's due to their own restrictive policies.