Natale's current ablation technique

Good morning all,
Here I am, alas, again after 20 years... guess why?
Correct, the afib beast is back replacing blessed normal sinus rhythm (BNSR).
I have had two Natale ablations, one in 2003 for continuous afib and one in early 2004 for supraventricular tachycardia.
As a general comment for the forum, the ablations helped me enormously, but it was not until I eliminated gluten that I truly became free of afib.
About a month ago, my afib began again largely, in my view, because my husband fell, broke his knee cap in half (ouch), and was diagnosed as needing a pacemaker and told to take eliquis permanently. Knowing that magnesium is eaten by stress, I upped the magnesium but am now in permanent afib. Basta for my background.
I am Natale centric because he was good and is here in La Jolla. Is he still one of the best?

My questions:
1.Is there a place on the forum describing Natale's current ablation technique?
2. Does Natale use twilight sedation or only full blown anaesthesia now?
3. Is it necessary to take eliquis permanently after ablations now?
4. What is Natale's current success and mortality rates?

Thanks to you all.

Please note that I am concerned about anaesthesia because my aunt had a hip replacement and ended up inchoherent and hip replacement surgery is likely shorter than are ablations.
And Jackie- I would love to hear from you and still remember that you called me after my last ablations. Bless you.
Lynn Penner

Just a quick thought Lynn. Kind of obvious, but you said, "Knowing that magnesium is eaten by stress, I upped the magnesium but am now in permanent afib".

So why not stop the magnesium as a trial? Magnesium has over the years been clearly helpful with my 20 + year afib; but recently, it has become a clear trigger for my afib. Maybe too much of a 'good thing', at some point, in the body's intelligence becomes a 'bad thing'. What do you have to loose... Jeff

Well, 'Hello' Lynn!. So good to hear from you after all these years... but sorry it's Afib-related.

Based on my ablation experience with Dr. Natale starting in 2003, I consider him the very best choice if it's possible to see him. In 2014, I had a second Natale ablation for flutter which involved LAA isolation; and, in 2015, a touchup. I'm on 1/2 dose Eliquis for life and (thankfully) my heart remains calm.
Time flies and I'm now 87 and in otherwise good health.

Blessings back to you...
Jackie

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Lynn Penner
1.Is there a place on the forum describing Natale's current ablation technique?

His technique wouldn't be a lot different than it was when he ablated you. He still uses RF exclusively, although he has been using pulsed field ablation (PFA) in clinical trials. But there have been huge changes in the technology, and PFA is one example. Although not approved by the FDA yet, word is that will happen soon. It's something you'd want to ask him about.

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2. Does Natale use twilight sedation or only full blown anaesthesia now?

Full blown. If you did okay with the anesthesia first two times then there's no reason to suspect you'll have any issues with it. Your aunt doesn't really enter into the picture.

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3. Is it necessary to take eliquis permanently after ablations now?

Depends. It depends primarily on your CHADS-Vasc score, but if he ends up having to isolate your left atrial appendage (LAA) -- which is likely if you're in persistent afib now -- that will likely be necessary. However, the Watchman device is now much more readily available and if you get one after the ablation, you could be off Eliquis forever.

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4. What is Natale's current success and mortality rates?

Success rate is better than it ever was, well above the national average and the last figure I saw was about 92%. I'm unaware of any deaths associated with one of his ablations.

Hi Lynne, I am a recent "graduate" of Natale ablations -- Index November, 2022, Touchup and Watchman--April, 2023. My initial ablation was extensive (because I had put it off on the advice of my EP) and he had to isolate my LAA on the first go-round but the put in a Watchman during the touchup. All went very well. He has perfected some of his techniques in difficult areas and is remarkably quick so that even that extensive initial ablation was only 2 hours. As Carey said, he uses full general anesthesia as it gives him the control he needs for these delicate maneuvers. The anesthesiologists he uses are tip-top (I went to Austin).

The new equipment (and not just the pulsed field choice) give him better control and "vision" and no doubt contribute to his remarkably high success rate. Best wishes.

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 I had put it off on the advice of my EP) and he had to isolate my LAA on the first go-round but the put in a Watchman during the touchup

Any reason you didn't have a watchman done originally when you had the LAA closed off?



Edited 1 time(s). Last edit at 03/07/2024 06:15AM by cornerbax.

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cornerbax
Any reason you didn't have a
Watchman done originally
When you had the LAA
Closed off?

Putting in a Watchman during the original procedure that isolated the LAA is dicey because of swelling that could occur from the ablation, which could make the Watchman too big at first but then too small later. Best to let everything settle down first.

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Putting in a Watchman during the original procedure that isolated the LAA is dicey because of swelling that could occur from the ablation, which could make the Watchman too big at first but then too small later. Best to let everything settle down first.

Ahhhh,.... Got lt. Let's say an Atria Clip was put the first time around would there ever be a possible benefit down the line to remove the Atria Clip and replace with a watchman?



Edited 1 time(s). Last edit at 03/07/2024 06:15AM by cornerbax.

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cornerbax
Ahhhh,.... Got lt. Let's say an atria clip
Was put the first time around would there
Ever be a possible benefit down the line
To remove the atria clip and replace with
A Watchman?

No, that would make no sense at all. An Atriclip cuts off the blood supply to your LAA so it just dies and withers away. There's no removing it.

Removing a Watchman is possible but it would be big open heart surgery with all the attendant risks and recovery period. Why would anyone even consider doing that?

These devices aren't things you can implant and then change your mind later and replace with something better. Once they're in, they in for the rest of your life.