My 4/27/23 Watchman Implant Experience with Dr. Natale

Hello everyone. I've been lurking behind the scenes here over the past several weeks in preparation of my recent Watchman implant with Dr. Natale. I read every post in this forum about the Watchman so I knew everything I needed to know to prepare for the procedure itself as well as what to expect afterwards.

I have a blog where I have documented my entire a-fib journey going back to 2006. If you are considering the Watchman or are in the process of having one put in, you might find my latest blog post helpful. My Watchman was put in on Thursday, April 27th. Here is my latest blog post detailing my Watchman (and 3rd ablation) procedure:

My Watchman Implant Experience

I hope everyone is doing well!

Travis

P.S. I'm doing great and the Watchman implant procedure was a piece of cake!



Edited 1 time(s). Last edit at 05/01/2023 05:40PM by tvanslooten.

Hi Travis,

We crossed paths at TCAI—I got the Watchman on April 26 and was discharged at noon on the 27th. Dr. Natale did rounds at about 8:30 a.m. just before he implanted your Watchman. My experience was almost the same as yours except I was successful in getting the nurse to put my IV near my wrist. I saw her looking thoughtfully at my hand and asked her please not to go there! Also, I did not take colchicine this time. I had 12 minutes of touchup and felt like popping a champagne cork when D. Natale told me I was cleared for 2.5 mg of Eliquis. 😊

Daisy you stayed overnight? For me the NP didn’t request a room so I got discharged after my watchman 4 hours afterwards.

Quote
susan.d
Daisy you stayed overnight? For me the NP didn’t request a room so I got discharged after my watchman 4 hours afterwards.

Yes, I stayed overnight and that seems to be a good precaution. For me (and a number of others) urine retention after general anesthesia is a problem and they watch for that. They did an ultrasound of my bladder several times during the night and I really needed the IV Lasix push in the morning. Also, because I have Dysautonomia, my BP dropped in the night and they needed to watch that closely.

Daisy:

Small world! You were heading out just as I was going under. Too funny! Congrats to you as well. And I totally agree, it was awesome to hear that I could go down to 2.5 mg of Eliquis immediately as well.

Susan:

When I spending the night I was talking to one of the nurses and she said Dr. Natale requires ALL of his patients to spend the night, but other doctors in his group do not. The other doctors are a little more liberal when it comes to making the call whether or not they want their patients to spend the night. The night I was there they had done 10 procedures that day but only 5 patients were spending the night. They were all Dr. Natale's patients! I found that interesting. I personally prefer Dr. Natale's more conservative approach to requiring an overnight stay, but I found it fascinating that the other doctors of his group don't necessarily require an overnight stay (for ablations or Watchman implants). The nurse said that the other doctors usually only require an overnight stay if the ablation is complex or if they have to cardiovert anyone during or after the ablation. Otherwise if it's a straight forward ablation, touch up, etc., or a Watchman implant, they usually let their patients go home the same day. Dr. Natale is the only one that requires an overnight stay regardless of the procedure (according to this nurse anyway).

Travis

That is interesting as I had assumed that all the TCAI doctors had their patients stay the night. The day of my procedure, 16 procedures were done and they told me that they had a full house for the night—but then I heard that there were only 12 rooms some some must have gone home. With the level of attention that Dr. Natale gives to “fluid in, fluid out” over that first day post procedure, I assumed that this was standard practice. (They weigh you right before your procedure, measure how much water you receive from the catheter, how much IV fluids and then measure how much you drink when you get to your room and they measure your urine output. They also weigh you during the night and, in my case, did several bladder ultrasounds as I was retaining urine.) Then an IV Lasix push in the morning. Since Dr. Natale feels that all this is important for safety, I’m surprised that it isn’t standard practice. Also, we hear of other complications, though rarely, so I am glad that he keeps all his patients overnight.

I know of several people who've developed complications following an ablation such as pericarditis, and the symptoms of those complications often didn't appear until hours after the procedure. I think holding overnight is prudent and releasing the same day is overconfident. The last situation I would want to find myself in is being in some local ED at 3am with chest pain following an ablation. The ED staff is going to do a full cardiac workup, they'll get abnormal results because of the ablation, and so they'll likely admit you to the hospital, which could last for days and involve many unnecessary tests. Meanwhile, if instead you'd stayed overnight at St. David's, they would have understood the issue and dealt with it promptly in a non-emergent manner.

Quote
Carey
I know of several people who've developed complications following an ablation such as pericarditis
, and the symptoms of those complications often didn't appear until hours after the procedure.

Is post-ablation pericarditis associated with fluid retention? I remember that some complication is, but forget which one.

“ I am glad that he keeps all his patients overnight.”

Maybe for ablations but not for my watchman. His NP didn’t request or put a hold on a room for me so I was sent home 4 hours later.

So not “all” his patients stay overnight. After my first ablation (4 ecv / many burns) I was offered to stay a few hours in the Cath lab recovery or go home. I stayed. Ablation #3 I’m happy I stayed because 9am the following day after the ablation my heart stopped/paused for 15 seconds. It’s better to be in telemetry than home. My watchman procedure was an error in not pre-reserving a room so I was discharged. Maybe this reflects only Robles hospital or the attending NP assigned to in Thousand Oaks CA —and not Austin practice of an overnight discharge.



Edited 1 time(s). Last edit at 05/06/2023 12:52PM by susan.d.

Quote
Daisy
Is post-ablation pericarditis associated with fluid retention? I remember that some complication is, but forget which one.

It results in fluid accumulation in the pericardial sac surrounding the heart, but not elsewhere in the body. I can't think of a complication of ablation that causes generalized fluid retention, but anesthesia can if your kidneys are slow to "wake up."

Quote
Carey

Is post-ablation pericarditis associated with fluid retention? I remember that some complication is, but forget which one.

It results in fluid accumulation in the pericardial sac surrounding the heart, but not elsewhere in the body. I can't think of a complication of ablation that causes generalized fluid retention, but anesthesia can if your kidneys are slow to "wake up."

Thanks. I meant to ask if fluid retention (caused by anesthesia) could result in pericarditis? If so, maybe that is why Natale is so careful about monitoring fluid in - fluid out.

No, fluid retention doesn't cause pericarditis. But it's not unusual for anesthesia to hinder kidney function for a period of time after a procedure, plus they give you a boatload of fluids during an ablation, so adverse fluid retention is always a possibility.

As always, if Natale is doing one thing and everyone else is doing something else, I'm going with what Natale does. He has a habit of being right when others think he's wrong. A lot of things now accepted as standards in electrophysiology today were pioneered by him.

Hey Travis,

Regarding the overnight stays after a procedure at TCAI in Austin, be sure to keep in mind that a good number of TCAI EPs are often treating local patients who live within an hour or so of an easy drive to their own homes.

Plus, with the approximately 14 plus EPs working under Dr Natale, it is more likely for local patients, perhaps doing a follow-up PVI, to stay over night and thus can make for a more efficient all-around schedule for TCAI as a whole each day ... depending on the nature of their procedures of course.

In addition, Dr. Natale patients from out of town and out of state, tend to need more advanced ablations to begin with, and thus more often require a full nights stay compared to many local folks, and occasionally for a bit longer stays.

Cheers!
Shannon

I had my third ablation and Watchman implant in 2/15/22 and swiftly continued on with the rest of my life so I haven't visited the website, I guess since my six-month TEE. My one-year TEE was done locally. It is very interesting to read Travis' blog on his third ablation and Watchman implant and compare our experiences. I've made 32 more trips around the sun than Travis, but our third ablations had quite much in common. Dr. Natale had told me in 2017 that if something went wrong after my second ablation I would be a candidate for a Watchman. My third ablation was about twice as long as Travis' in RF energy applied but the Watchman implant was a stand on my head breeze. I stayed one night at St. David's and an extra day in Austin as routine for out of towners. There was a very small leak, less than 1mm, at my six-week TEE, completely gone at the six- month one and, best of all, I take just an 81mg aspirin every other day. Now my 12-month TEE was a different story that shows just how finely tuned TCAI and St. David's have their routines. The local hospital treated me like a cardiac invalid who would croak if someone looked at me cross-eyed. Good luck, Travis!

I read your blog. It’s amazing! I honestly think they do more at Austin. I was weighed once pre procedure and when I was given a room and bed, they weighed the bed with the blankets. I was never weighed again for water retention. I was told to weigh myself at home and if I gained 5 pounds to take a Lasix.

You had excellent care!
PS I’m in a mood for a gluten free peanut and butter sandwich!

Wishing you a long long peaceful nsr heart

Here is an interesting video from Dr. Amin Al-Ahmad at Texas Cardiac Arrhythmia on considerations for same day discharge after ablation: [youtu.be]

Quote
Shannon
Hey Travis,

Regarding the overnight stays after a procedure at TCAI in Austin, be sure to keep in mind that a good number of TCAI EPs are often treating local patients who live within an hour or so of an easy drive to their own homes.

Plus, with the approximately 14 plus EPs working under Dr Natale, it is more likely for local patients, perhaps doing a follow-up PVI, to stay over night and thus can make for a more efficient all-around schedule for TCAI as a whole each day ... depending on the nature of their procedures of course.

In addition, Dr. Natale patients from out of town and out of state, tend to need more advanced ablations to begin with, and thus more often require a full nights stay compared to many local folks, and occasionally for a bit longer stays.

Cheers!
Shannon

That makes total sense! I forget that they are located in Austin, TX so it makes sense the bulk of their patients are local...lol. As an out-of-towner, I'm a bit biased, assuming everyone is flying in! Thanks for the perspective!

Travis



Edited 1 time(s). Last edit at 05/15/2023 10:34AM by tvanslooten.

Quote
susan.d
I read your blog. It’s amazing! I honestly think they do more at Austin. I was weighed once pre procedure and when I was given a room and bed, they weighed the bed with the blankets. I was never weighed again for water retention. I was told to weigh myself at home and if I gained 5 pounds to take a Lasix.

You had excellent care!
PS I’m in a mood for a gluten free peanut and butter sandwich!

Wishing you a long long peaceful nsr heart

Thanks Susan! Since my hospital stay I continue to eat peanut butter and jelly sandwiches for lunch. I can't believe I went all these years without eating one...lol.

Have a great day!

Travis