Recommendation of cardiologists to do TEEs/postWatchman

Hi,

I had my index ablation in 2019, got more flutter later & went back this year 2022 Aug & November. November they finished up an LAA that was started in August. I was supposed to have gotten a Watchman in November, but that did not happen then bec of too much inflammation after the completion of the LAA for accurate placement of the Watchman. Soon, I will go back for that Watchman, then ~8 wk later will go back for first TEE check of the implant.

Dr. Natale told me that if the first check is good, it is very likely all the rest will be fine too. He is starting to let go of some of the control re his doing all the TEE checks. Until he told me himself in November, I had no idea it was a cardiologist, not an EP, who one is to choose for the TEE. Specifically, he also said it had to be a cardiologist who had experience imaging for Watchman placement. If we get someone else & they try to follow Natale's protocol, but they still do not get exactly what he needs, we will have to have it re-done.

I just saw on the site where 2 EPs were recommended in Nashville (Chris Ellis & Wm Stevenson, both at Vandy) & that got me to thinking I could ask you about cardiologists at Vanderbilt who could do a proper TEE for Watchman imaging at the 6-mo & 1-yr checkups. Nashville is just a 3 hr drive from me. I used to live there & even worked at Vanderbilt Hospital, just lived a few minutes from there too. I haven't been back in ages, but this is definitely doable if someone could just give me a proper recommendation. And that goes for Memphis too or anywhere close.

Dr. Natale started talking to his nurses in the room, Audrey & Kim, trying to get them to help him remember a cardiologist from Memphis on whom he did an ablation in the past & to see if they could find him to see if he could help to give a recommendation, but since it is down the road, I am sure they have not given it another thought. It would be such a relief not to have to go to Austin those 2-3 extra times just for TEEs. I am fine with going the first time as recommended as very important, but need recommendations for the other TEEs.

All in all I will have gone to Austin 5 times by the time I am done with the first TEE following the Watchman placement. Any recommendations appreciated.

Natale implanted my watchman and two random cardiologists did the TEE and shared the images with Natale. I would speculate any local ep can do a TEE and share the images..or maybe I’m wrong.

Dr Stevenson offers a free phone call. PM me for the cell of his nurse to set it up. It will save you a trip. Then you can ask your questions at the leisure of being home. It’s a suggestion.

Madeline, your post is so timely. I had my first ablation with Dr. Natale February 23, 2022…..Previously had 2 failed ablations with a local EP. September 29 I had a 12 minute touch-up ablation and a Watchman was implanted. He was very insistent that the first 2 TEEs needed to be done there. On November 29 I had my first TEE and the watchman was sealed with no leakage. He said to come back there for the second TEE, that will be in 4 months because the first was delayed because of scheduling and for the third he would refer me to someone in Wisconsin. I really want the next 2 done closer to where I live, but am not sure how much to push it. We do not fly and the trips are getting difficult, especially for a 2 hour hour visit….prep and TEE.. I do not want to jeopardize the integrity of the TEE and would sure like a referral from him for the next 2. I would like to know how much I should “push” for this.



Edited 1 time(s). Last edit at 12/04/2022 07:57PM by Pixie.

I’m told the 6 week TEE and the six month TEE after a watchman was required but the 12 month TEE is optional.

I had a TEE during my ablation three days ago (at a few days shy of 10 months post watchman), my 6 week and 6 month TEE. IDK but all three shows it’s sealed. I don’t see the value of getting one the first week and a half in February. Am I incorrect?

Thanks Susan, I have PM'd you.

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susan.d
I’m told the 6 week TEE and the six month TEE after a watchman was required but the 12 month TEE is optional.

I had a TEE during my ablation three days ago (at a few days shy of 10 months post watchman), my 6 week and 6 month TEE. IDK but all three shows it’s sealed. I don’t see the value of getting one the first week and a half in February. Am I incorrect?

Thanks Pixie, I have PM'd you.

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Pixie
Madeline, your post is so timely. I had my first ablation with Dr. Natale February 23, 2022…..Previously had 2 failed ablations with a local EP. September 29 I had a 12 minute touch-up ablation and a Watchman was implanted. He was very insistent that the first 2 TEEs needed to be done there. On November 29 I had my first TEE and the watchman was sealed with no leakage. He said to come back there for the second TEE, that will be in 4 months because the first was delayed because of scheduling and for the third he would refer me to someone in Wisconsin. I really want the next 2 done closer to where I live, but am not sure how much to push it. We do not fly and the trips are getting difficult, especially for a 2 hour hour visit….prep and TEE.. I do not want to jeopardize the integrity of the TEE and would sure like a referral from him for the next 2. I would like to know how much I should “push” for this.

Madeline, I just sent a PM. Let me know if you don’t get it.

If your 6 week and 6 month TEEs are clear, there's really no reason to go back to Austin for another one. I had to because I was in a clinical trial, but had I not been in that trial there's no way I'd have traveled to Austin again. Just call Natale's staff and ask for a recommendation locally. If they don't know of one, find them yourself. I would expect any large medical center will have cardiologists experienced with the Watchman, so just call and ask.

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Carey
If your 6 week and 6 month TEEs are clear, there's really no reason to go back to Austin for another one.

If they don't know of one, find them yourself. I would expect any large medical center will have cardiologists experienced with the Watchman, so just call and ask.

I am expecting not to go back to Austin for the 6-mo one either, want to do it locally.

You say to just call a large medical center & ask for a cardiologist experienced with the Watchman. How exactly do I do that?

I won't call my cardiologist to ask him though he is in one of the 2 largest cardiology groups in Memphis. I won't ask him bec he tried to do a TEE on me once & could not do it, so I don't want him saying he will do it! But how can I ask him to find me someone else to do it.

I certainly would not get anywhere calling the office number & talking to one of the phone ppl to ask them who to call!!! They would ask if I was a patient & then refer me to my cardiologist.

It is a good question to ask, but don't know who to ask it of.

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Madeline
You say to just call a large medical center & ask for a cardiologist experienced with the Watchman. How exactly do I do that?

Just click this link and enter your location. This will give you a list of centers in your area that do Watchman implants. Centers that do Watchman implants will have cardiologists who do Watchman TEEs. Visit their web site and choose one yourself, or just call them and ask.

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Carey

You say to just call a large medical center & ask for a cardiologist experienced with the Watchman. How exactly do I do that?

Just click this link and enter your location. This will give you a list of centers in your area that do Watchman implants. Centers that do Watchman implants will have cardiologists who do Watchman TEEs. Visit their web site and choose one yourself, or just call them and ask.

Carey, I want my second and third TEE done close to home and the films sent to Austin. How would we know that a doc on the list would be acceptable for Dr. Natale?
If the technical part is flawed he would not use it. Or, are you saying just have it taken and read by one of the docs on the list and leave Dr. Natale out of the loop?

I had my six month post Watchman TEE in August and Dr. Natale said I could have the 12 month on done by my local cardiologist. Originally, back in 2017, my local cardiologist, has done many TEEs declined to do the one six months after my second ablation. His verbal reasoning was that even if Dr. Natale sent him explicit instructions on what he would be looking for in the TEE results, he could not be certain the results would be EXACTLY what Dr. Natale wanted and there was no need to risk me having to have two procedures.

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JayBros
I had my six month post Watchman TEE in August and Dr. Natale said I could have the 12 month on done by my local cardiologist. Originally, back in 2017, my local cardiologist, has done many TEEs declined to do the one six months after my second ablation. His verbal reasoning was that even if Dr. Natale sent him explicit instructions on what he would be looking for in the TEE results, he could not be certain the results would be EXACTLY what Dr. Natale wanted and there was no need to risk me having to have two procedures.

JayBros would you have felt more willing to do it if the cardiologist was someone Dr. Natale knew and had confidence in?

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Pixie
Carey, I want my second and third TEE done close to home and the films sent to Austin. How would we know that a doc on the list would be acceptable for Dr. Natale?
If the technical part is flawed he would not use it. Or, are you saying just have it taken and read by one of the docs on the list and leave Dr. Natale out of the loop?

I'm definitely not saying leave Natale out of the loop. Don't do that.

The most important TEE is the 6-week one. That one should definitely be done in Austin. It would be optimal if the 6-month one was also done in Austin, but that's negotiable. Try to use a cardiologist Natale recommends if you don't go to Austin. After that, I think any cardiologist with experience doing Watchman TEEs is acceptable. It's unlikely the results will be any different than the first two TEEs, so it's just not as critical.

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Carey

Carey, I want my second and third TEE done close to home and the films sent to Austin. How would we know that a doc on the list would be acceptable for Dr. Natale?
If the technical part is flawed he would not use it. Or, are you saying just have it taken and read by one of the docs on the list and leave Dr. Natale out of the loop?

I'm definitely not saying leave Natale out of the loop. Don't do that.

The most important TEE is the 6-week one. That one should definitely be done in Austin. It would be optimal if the 6-month one was also done in Austin, but that's negotiable. Try to use a cardiologist Natale recommends if you don't go to Austin. After that, I think any cardiologist with experience doing Watchman TEEs is acceptable. It's unlikely the results will be any different than the first two TEEs, so it's just not as critical.

I just looked at the list you provided. Dr. Natale has already told me he has someone closer to my home that he would refer me to.for the last TEE. He did not tell me the name, but I think I know who it is on the list. I just had my first TEE last Wednesday. We drove 2 1/2 days to get to Austin. I arrived at St. David’s at 7:30 for an 8:00 prep by 10:00 everything was done and food was being brought to me. I was discharged after I ate and Dr,. Natale and Shannon called me in afternoon to tell me everything looked good. I think the words on the report said “secured with no leakage”. My next one is in 4 months because that will be 6 months from the date of the implant. He said to come back to Austin.. if I could convince him to refer me to the doc he has in mind for the 6 month and one year would you feel confident with that?

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Pixie
if I could convince him to refer me to the doc he has in mind for the 6 month and one year would you feel confident with that?

Yes, definitely.

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Carey

You say to just call a large medical center & ask for a cardiologist experienced with the Watchman. How exactly do I do that?

Just click this link and enter your location. This will give you a list of centers in your area that do Watchman implants. Centers that do Watchman implants will have cardiologists who do Watchman TEEs. Visit their web site and choose one yourself, or just call them and ask.

Great Carey. Like I suspected, all the drs on the first hospital list from that link you gave are at my clinic as it is the largest in the tri-state area & been around for 100 years.

My cardiologist is at this clinic though he is not on the list. The EP I have seen there is on the list of recommended drs that you gave the link to. Only one of those docs is a cardiologist & the other 3 are EPs. Funny though, I had the cardiologist's bio pulled up for Dr. Natale to see when I was in Austin November, as Dr. Natale had told me it was a cardiologist who did the Watchman TEEs, not an EP. But, Dr. Natale said the bio meant nothing; he needed to know experience & current work in this area. The dr was even chief EP Fellow at Cleveland Clinic in 2011-2012.

I just called my EP, Dr. Lan's nurse, & left a message asking how many Watchmans & TEEs for imaging Watchmans had he done. Said I needed one for my dr in Austin. Wonder if I should leave the same message on the other 3 "candidates" nurse lines.

Thank you.

Keep in mind that an EP is a cardiologist first. There's no reason to choose one over the other when it comes to a TEE.

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Carey

Just click this link and enter your location. This will give you a list of centers in your area that do Watchman implants. Centers that do Watchman implants will have cardiologists who do Watchman TEEs. Visit their web site and choose one yourself, or just call them and ask.

Carey, Dr. Natale referred me to one of the doctors on this list for my second and third tee. As you say, these centers will have cardiologists who do the TEEs . So, I will apologize for this question, but if Dr. Natale referred me to a doc he has confidence in, he must know that doctor does not do his own TEE but has a cardiologist do them, just like in Austin, Then, I assume, the referred to doctor would do the reading of the TEE and make sure it fulfills Dr. Natale’s requirements. I should have confidence in the referred to provider even though that provider is doing the professional, not technical part of the TEE? Do you agree with my understanding of this?

I'm not sure I understand your question and I think you're probably overthinking it.

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if Dr. Natale referred me to a doc he has confidence in, he must know that doctor does not do his own TEE but has a cardiologist do them, just like in Austin,

No, there's no reason that doctor doesn't do his own TEEs. Like I said before, remember that all EPs are cardiologists first. The specialty of the doctor doing your TEE isn't particularly relevant.

Bottom line is if Natale recommended someone I would trust that recommendation, and whether they're a general cardiologist, an interventional cardiologist, or an EP isn't really important.

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Carey
I'm not sure I understand your question and I think you're probably overthinking it.

No, there's no reason that doctor doesn't do his own TEEs. Like I said before, remember that all EPs are cardiologists first. The specialty of the doctor doing your TEE isn't particularly relevant.

Bottom line is if Natale recommended someone I would trust that recommendation, and whether they're a general cardiologist, an interventional cardiologist, or an EP isn't really important.

Carey, what I am saying is, Dr. Natale referred me to a cardiologist who, coincidentally, is on the list you provided. I worked with the nurse of the doctor he referred me to, I faxed her the information Dr. Natale wanted him to have. It explained what he needed from the TEE, explaining how the results were to be sent to him, etc. When I looked at the patient portal of the hospital I am going to for this, it shows a different doctor is doing the TEE not the one I asked for!

I thought your previous response said the doctors on the list implant the watchman. They have their own cardiologist who does the TEEs. Your response now says, there is no reason that doctor doesn’t do his own TEEs.. What I am saying is that I thought I set up an apt with one of the docs on the list to do the TEE. It appears that another cardiologist does the TEEs. Just like in Austin, when a TEE is done, it it not Dr. Natale doing it, it is another cardiologist. I am sorry my post is confusing….