Left atrial flutter & LAA

Hello,

I want to ask some questions about what it means if I have left atypical flutter post successful A-fib ablation 2019. When I go to Dr. Natale for left flutter ablation, does that necessarily mean I will have that LAA procedure. I’m not quite sure what all this means. Can you fix the left flutter without doing that other procedure? And if you do get the LAA, does that mean you have to be on a blood thinner or watchmen for life? If so, why?

Thank you.

"No" is the answer to all of your questions. I'll elaborate more when I have time if you wish.

If the source of your arrhythmia is found to be located in the LAA, Dr. Natale would want to isolate that area to block the errant signals originating from that source.

If he does isolate the LAA, I believe the statistics are 60% that your TEE results would show requiring either a watchman or long term use of blood thinners, possibly for life.
The other 40% of LAA isolated folks pass their TEE to not require either blood thinners or watchman.

This is my understanding.

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allofus
If the source of your arrhythmia is found to be located in the LAA, Dr. Natale would want to isolate that area to block the errant signals originating from that source.

If he does isolate the LAA, I believe the statistics are 60% that your TEE results would show requiring either a watchman or long term use of blood thinners, possibly for life.
The other 40% of LAA isolated folks pass their TEE to not require either blood thinners or watchman.

This is my understanding.

Thank you. Would theTEE be performed while you’re under anesthesia after having the LAA or is that a separate procedure time? And what is required for one to pass a TEE?

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Madeline
Would theTEE be performed while you’re under anesthesia after having the LAA or is that a separate procedure time? And what is required for one to pass a TEE?

A TEE is always performed under anesthesia when the doctors doing the procedure aren't barbarians.

The TEE isn't done during or right after your ablation. If your LAA is isolated during the ablation (which it may not be but you seem to be assuming it will), a TEE will be performed six months later. The purpose of that TEE is to assess how well your LAA is pumping blood. They measure the velocity of the blood flowing in and out of your LAA. A "passing" velocity is 45 cm per second. They also look at what's known as an E:A ratio and look for visible "smoke" in the blood flow, which indicates turbulence. It's a highly nuanced test and there's really nothing you can do to alter or interpret the results, so it boils down to a pass/fail test and they'll tell you the results a few days after the TEE. The odds are 60% in favor of failure and failure means lifelong anticoagulants or an LAA occlusion device such as a Watchman.

Can a Watchman and an ablation be done in one procedure? Yes, for certain people under certain circumstances, and lots of people are asking about that lately so I've got a series of questions into Natale about that. I haven't heard back yet.

Thank you, Carey. Iam not assuming to have an LAA. I thought that you and Shannon might have indicated that my flutter was most likely atypical left and I wasn’t sure if you meant if so, that meant its source could mean I would have to have an LAA. I am certainly not wishing for any big scenario. My highest heart rate was 214 and I have since read that it seemed like 240 or more were left-sided atypical flutters. I guess Shannon was just explaining to me the possibilities that could come from whatever Natale would find on my flutter ablation. If it is left atypical, does that always mean an LAA needs to be performed?

If it is right-sided, I could have just had it done with a local EP. But I am going to Natale just in case I need his expertise. Maybe that is the jist of what I was getting, I did understand Shannon to give me a few reasons why it sounded left-sided though. I have had flutter three times now since my 2019 ablation. The adenosine did not stop it. If it was only right sided, Dr. Natale would most likely have gotten it on the first atrial fib ablation.

I am just not totally clear on all this.

Your flutter is most likely left sided like Shannon said, and it might involve the LAA. If so, Natale will isolate it and all the stuff about TEEs will apply, but if it doesn't involve the LAA Natale will leave it alone and you won't need a TEE or Watchman. You could ask him for a Watchman anyway, but I still haven't heard back so don't know if that will be feasible.

From reading the archives Natale won't do the Watchman in the same procedure as an LAA.

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PavanPharter
From reading the archives Natale won't do the Watchman in the same procedure as an LAA.

There are some here who have had Natale do them together. I'm sure it depends on the individual situation. For example: [www.afibbers.org]

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GeorgeN

From reading the archives Natale won't do the Watchman in the same procedure as an LAA.

There are some here who have had Natale do them together. I'm sure it depends on the individual situation. For example: [www.afibbers.org]

Tom, did you get a LAA touchup the same time as your Watchman this year? 5 of us got our watchman the same month. I recall someone getting a touchup along with their watchman.

Always an exception out there somewhere.

I heard today it is a 40% chance of needing a watchman or anti coagulation with an appendage procedure.

I asked Natale's NP at Los Robles, they don't do Watchman and an LAA at the same time in case the LAA needs more work in the future.

Yes on 2/16 i was scheduled for touchup & watchman. Dr Natale found my LAA “dead” and one reconnection in the CS which he burned. Then he placed the Watchman

My LAA was silently not functioning/no volume flow too before the watchman. I’ll get my 6 month tee in July.