What to do?

I'm a 72-year-old male (looking to live forever), diagnosed persistent A-Fib. I've had prostate surgery about 16 months ago (confirmation of no A-Fib at that time). My heart doctor had me do an Echo. Heart muscle is strong, no valve issues although the technician said an interesting thing where he pointed out a light gray shaded triangular area stating that he sees this in A-Fib patents having had covid-19. Chemical stress test as well. All normal. Been in persistent A-Fib for some time after the surgery so a bit over a year. I do not take any heart medicine other than Eliquis. Resting pulse is 60-80 resting while with major physical activity (hard lifting - to near exhaustions) about an hour's worth i still do not get palpitations, never had a pounding chest, just a bit weak and tired (what i would expect with a person being older and somewhat out of shape (6'4" 230lbs.)) I've seen a pulse of up to 130ish.
Unless i really think about it, i don't know there is anything wrong.

With that said, my concern is that I'm being told by an electrophysiologist that I must do ablation ASAP as after a year, NSR is not as likely or i will digress to a point of needing constant medication and/or pacemaker along with possibly more involved treatments.

I have patient numbers for both Mayo and Cleveland Clinics. I Live in Florida but this is my heart and i only have one so I'm willing to travel to the best specialist i can find (if i even need one at all!).

Which leads me to who would that be? Certainly, would be grateful for any comments or referrals.

Thank you in advance
MarkoP

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MarkoP
I Live in Florida but this is my heart and i only have one so I'm willing to travel to the best specialist i can find (if i even need one at all!).

Which leads me to who would that be? Certainly, would be grateful for any comments or referrals.

Andrea Natale, Austin TX [tcainstitute.com]

He ran the EP program at CC till around 2008. The MD CEO of CC declined to renew his contract because he was training EP's at other institutions on his own time. This is like not renewing Tom Brady's contract because he has clinics for other QB's in the offseason. The folks at St. David's in Austin constructed a facility just for him. He also does procedures a few days a month at Scripps in La Jolla, CA and Los Robles in Los Angeles.

I'm sure others will chime in with the same suggestion.

Thank you for sharing George. Honestly i was hoping to hear i really don't need any ablation!

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MarkoP
Honestly i was hoping to hear i really don't need any ablation!

If you are asymptomatic in afib with a resting pulse < 100 and anticoagulated, you can also choose to live with it. Your EP is correct in that the longer you stay in persistent afib, the more difficult it is to solve. However, Natale is the best at this.

Cross posted with GeorgeN.

Mark, I think the response you’ll get from members here is pretty much the same as what GeorgeN said. I’ve wrestled with what to do about my Afib for 12 years and took antiarrhythmic drugs for many years until the side effects just became too much. I am also on the list for an ablation with Dr. Natale soon. The question for you is whether it is really necessary for you to get an ablation and that is a decision to make once you have more information. Some, who don’t even notice that they are in Afib and whose heart rate stays under a hundred while in Afib, choose to just take an anticoagulant and not treat the Afib. What you do not want is a heartbeat over 100 for an extended period of time as this can cause damage. And, Afib is progressive. Most of us will choose to treat the Afib because we do have symptoms that interfere with the quality of life, but it is a choice to make with your EP after you have done your research. Since you are in persistent Afib, if you do decide on an ablation, you would want to seek an EP who has good success ablating patients like you and there are only a handful and they aren’t necessarily at Cleveland Clinic or Mayo. The majority of Dr. Natale’s patients have a complicated history and many have been in persistent Afib for years. He does have a good success rate with complex patients.



Edited 1 time(s). Last edit at 08/09/2022 12:46PM by Daisy.

" I'm being told by an electrophysiologist that I must do ablation ASAP"

Seen that myself. He must have a Porsche payment due or his eye on a new home in Telluride.

Fire him.

Same thought patterns you and i. now it's to try and find the real truth.
I've contacted Dr. Natale's office. Spoke to a very nice nurse Norma. Seem to know her stuff, She recommended i try to get in the Pulsed Field Ablation trial as i will progressively get worse. Sure but in how long? in 5 or hopefully 10 years there could be some better treatments! unlike my prostate cancer that i had to take care of (again no symptoms) that could have killed me way sooner. So more Ferrari payments or the truth. I saw where Carey believes (in a reply to a different person) hold off with a resting heart beat below 100. So!!!!!!!

To me, it was the awful sensations, and that means quality of life. I thought I'd never agree to Amiodarone, but here I am on a six week regimen before Holter Monitor. My fervent hope is that both the ablation and the Amiodarone do what they promise, but only time will tell. In my case, though, HR was often 160 and up. i couldn't sustain that, and thankfully my ablation happened just as the first wheel left the bus.

The thing you must bear in mind is that, along with its progressive nature, AF holds hands with other disorders as they skip down the road behind you. Think long and hard about your ability to deal with AF constructively in five or ten years. Will anyone perform the ablation on you? How do you know?

Hi Gloaming,

Not there yet but certainly something to consider.. Any current cure should never go away completely but just be done more efficiently would be my hope

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MarkoP
With that said, my concern is that I'm being told by an electrophysiologist that I must do ablation ASAP as after a year, NSR is not as likely or i will digress to a point of needing constant medication and/or pacemaker along with possibly more involved treatments.

Fire him. Although what he said is partly true (longstanding persistent afib is more difficult to ablate), he's ignoring the fact that there are EPs who can do so and he's adding scary sounding stuff for effect. You don't need scary stuff.

Although Mayo and CC are excellent institutions, I agree with George and others who recommended Natale. Hell, he used to run the CC electrophysiology program and made it what it is. When it comes to ablating persistent afib, there is no one with a comparable track record. He would be my immediate go-to if I were in your shoes.

Hi Carey,

I followed the majority advise and did fire him. Have to say he came with very good reviews for all of the majors.
I am still confused over my own particular situation. I like your advise of just waiting as that i what i had in the back of my mind as well especially after hearing so much about Dr. Natale and his ability to treat long term persistent A-Fib patients. Waiting would certainly give more time for new techniques to appear but on the other hand I don't want something major to happen to me where i would be in a rush to do something.
I contacted Dr. Natale's office and spoke to his very nice RN, who appeared knowledgeable, Norma. Explained my situation exactly and her comment was that she would not recommend waiting but that it is always best to take care of it as soon as possible. That i can only get worse and harder to treat! That i could possibly get into the program for the latest Pulsed Field ablation. I really don't want to think of his office the same as my last electrophysiologist!
Having had this persistent A-Fib for so long, it's possible that i'm confusing the way i feel pretty good now just not remembering i was actually feeling better prior to this onset of persistent A-Fib? Therefore, should I have the procedure i could be feeling even better! .
I'm just still so puzzled at the differing opinions, options and possibilities to pull the trigger!

Thanks for taking the time to reply
Mark

I don't recall advising you to wait, and I wouldn't. There's no huge rush, so if you have to wait months for a schedule opening that's okay, but I wouldn't just put it off indefinitely. I doubt if anything's going to happen that would make it worse, but it won't get better, and it is true that in general the sooner you ablate, the better. There's an old saying that afib begets afib, and there's truth to it. The longer your heart remains in afib, the more it adapts to it and tends to remain in that rhythm. It's called remodeling because physical changes to your hearts conduction system do occur over time when it's in afib.

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MarkoP
I really don't want to think of his office the same as my last electrophysiologist!

I have spoken with Norma a number of times since I initiated the process for an ablation. I always found that her approach was to advise me personally according to my situation. At one point she even brought up that I might want to “wait and see,” since I was getting pretty good coverage with a new medication—I never felt I was being herded into an ablation. I think you can trust that Natale’s office will advise according to their experience with patients similar to you and their in depth experience with treating Afib.

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Carey
There's no huge rush, so if you have to wait months for a schedule opening that's okay, but I wouldn't just put it off indefinitely.

As Carey said, even if you do decide to seek an ablation with Dr. Natale, there will be plenty of time to research and consider before it actually happens. Because of his reputation it takes quite a long time to be accepted for an ablation and to reach your scheduled date. I started the process in early April and my ablation will probably be scheduled for September or October. This may have been an especially busy time for him though. During these months I have been in contact with several people on his staff (including his Nurse Practitioner) and had a video consult with him—plenty of opportunity to raise all my questions. I have felt no pressure, only support.

Thank you Carey for your thoughts and concerns. Good luck with your procedure