Bundle Branch Block?

I've been around this forum for 20 or so years, had 2 Natale fib ablations, the last 2 years ago, LAA isolated and sealed, with no watchman, still in NSR, but my regular Cardiologist appointment yesterday came up with a Right Atrial Branch Block developing. I'm 86 y/o.

I don't remember ever seeing that discussed in these pages so maybe its not an appropriate topic and should be in the General Health Forum; however, researching it a little bit shows that RF Ablation can be one of the treatments for it, along with some rate control drugs.

I am without symptoms now and my next medical step is to go back to my Cardiologist in a month to repeat the 12 lead EKG. My last one was 4 months ago and was normal.

I have sent a copy of the EKG to Natale's NP who handled my last ablation and she said they could see me so it must not be that infrequent.

Does anyone on this forum have any experience or personal knowledge about this subject?

Right bundle branch block is very common, particularly as we age. At your age, about 10-15% of the population has it. If you're experiencing no symptoms, there's no reason to do anything about it. I wouldn't go see Natale about it.

My 93 year-old father fainted at the dinner table about three hours after being released for an angiogram procedure. The EMT emerged from the ambulance to report, after running an ECG, that he was in NSR, but that he has a right bundle branch block. This was news to us.

After four hours in emerg to ensure he was stable, they released him late that evening. So far, so good...six weeks later. In fact, he was cleared to have a TAVR last week which went without a hitch. After an over night stay, which all patients must do, not just the elderly, he was released just prior to 1000 hrs and has been home and walking for a week now.

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ggheld
I've been around this forum for 20 or so years, had 2 Natale fib ablations, the last 2 years ago, LAA isolated and sealed, with no watchman

Maybe I read things incorrectly, but are you saying you had your LAA "sealed" by Natale in the sense that you no longer need thinners, as would be the case with Watchman? I was under the impression that the only way to "seal" the LAA without a device like Watchman, would be with a surgical ablation like MiniMaze where the LAA is either clipped or stapled.

Jim

Yes, that's what happened. At athat time, Feb., 2021, Natale sealed my LAA as part of my ablation, then I took Eliquis for 6 months, went for a TEE performed by another EP, the results of which Natale determined showed no leakage so I was taken off all blood thinners.

As I remember, at that time some 24% of similar results were like me, the rest needed to continue NOAC's or a Watchman.

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ggheld
At athat time, Feb., 2021, Natale sealed my LAA as part of my ablation, then I took Eliquis for 6 months, went for a TEE performed by another EP, the results of which Natale determined showed no leakage so I was taken off all blood thinners.

An ablation can't seal the LAA. The process you describe sure sounds like a Watchman. Can you explain what he did if it wasn't a Watchman?

Thanks for mentioning, Carey. It looks like I jumped to the wrong conclusion when Natale's NP said to discontinue NOAC's.

Looking up my 6 montth after ablation TEE, I see that my LAA was not isolated but was normal, summary below. I must have been still groggy when talking with Dr. Natale after the ablation.


SUMMARY:

- Left ventricle: Size was normal. Systolic function was normal. There were no
regional wall motion abnormalities.

- Left atrium: Size was normal.

- Right ventricle: The size was normal.

- Right atrium: Size was normal.

- Aortic valve: The valve was trileaflet. Leaflets exhibited mildly increased
thickness. There was trivial regurgitation.

- Mitral valve: There was trivial regurgitation.

- Tricuspid valve: There was trivial regurgitation.

- Pulmonic valve: Leaflets exhibited normal thickness.

- Atrial septum: No defect or patent foramen ovale was identified.

- Pericardium: There was no pericardial effusion.

- Aorta, systemic arteries: no major atheroma seen in the descending aorta or
distal arch.

- Pulmonary veins: Significant blunting of pulmonary veinous flow pattern in
the left upper pulmonary vein.

MEASUREMENT TABLES

DOPPLER MEASUREMENTS
Left atrium (Reference normals)
LAA peak vel 60 cm/s (--)

LEFT VENTRICLE: Size was normal. Systolic function was normal. There were no
regional wall motion abnormalities. DOPPLER: Left ventricular diastolic
function: blunted a wave in the mitral inflow signal

LEFT ATRIUM: Size was normal. No mass was present. No thrombus was identified.

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ggheld
LAA peak vel 60 cm/s (--)

There's your answer. You have adequate flow velocity in the LAA to make anticoagulants unnecessary. When I received my Watchman in 2018 the lower limit was 45 cm/s (mine was 32 cm/s).