Hybrid procedure or Natale?

Hello Everyone,
It's been 3 years since I've been on the forum, heart was good during this time after my second ablation at Emory. I had to stay on Flecainide the whole time to stay in NSR, and now I can tell my heart is going to "break through" back into afib. Already had a couple runs of some SVT, etc. Obviously not a good ablation. My first ablation was at Cleveland Clinic with Dr Pinsky, and lasted 15 years! I moved so I could not use Cleveland for the second unfortunately. Dr Pinsky is one of the best I believe except for Natale maybe.

Obviously I am NOT going back to Emory... so my question is concerning my path forward from here if/when this progresses? Emory was talking about the Hybrid procedure as my next option if needed... but I'm wondering if I would I be better going directly to Natale or Pinsky and doing an ablation with the best...or doing the hybrid procedure somewhere else? Does anyone have any thougts on this? I think the hybrid has a higher success rate than just an ablation? Any thoughts are greatly appreciated!



Edited 1 time(s). Last edit at 09/24/2023 01:38PM by Carey.

Go to Natale and be done with it. I would absolutely not do a hybrid procedure.

PS- I corrected the spelling of Natale's name. A lot of people think the name is pronounced the same as the English female name Natalie, but it's an Italian name and it isn't. It's pronounced na-TA-lay (not NA-ta-lee).



Edited 1 time(s). Last edit at 09/24/2023 06:43PM by Carey.

Thanks Carey...can I ask why you would never do a hybrid?

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Sdweller
can I ask why you would never do a hybrid?

This is Shannon's response from a few years ago: [www.afibbers.org]

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Sdweller
Thanks Carey...can I ask why you would never do a hybrid?

Shannon's response from a few years ago that George helpfully linked to is why.

Is this the hybrid procedure where one week they pierce the area below the sternum and probe up behind the heart to ablate the sub-pericardial tissue near the LA? And a couple of weeks later they do a normal catheter ablation inside the LA? I don't know if it is a particular procedure for a particular problem (I have seen the very excellent video titled 'New Fixes For An Old Problem' or whatever the exact title is, and it is intriguing.). But is is vastly more invasive, and doubles the amount of anesthetic, body openings, etc, not to mention the expense.

I have personally resigned myself to having the adrenalin rush one day, months or years from now, when my heart announces that it is back in the driver's seat and taking me for a ride. It seems to be widely the case across cases. If you have been free of AF for anything longer than a year, with having to take only a statin and/or NOACs, you DID have a successful ablation. But the disordered heart continues to sleuth and scout for new pathways for the spurious signals.

The very best EPS, and there are many, will know how to find these breaches or new paths, and deal with them. That's about the best most of us can hope for. But I would need a strong argument for why doubling up on the procedure would double my time AF-free...or even the same length of time as before.

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gloaming
Is this the hybrid procedure where one week they pierce the area below the sternum and probe up behind the heart to ablate the sub-pericardial tissue near the LA? And a couple of weeks later they do a normal catheter ablation inside the LA?

That's not what I understand a hybrid procedure to be. I understand it to be a Maze procedure combined with an RF ablation.

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Carey
e. I understand it to be a Maze procedure combined with an RF ablation.

My understanding is a mini maze combined with RF

For what it's worth, I had maze in 2021, and recently RF with Natale, and so far I don't feel any improvements lol. If anything I am probably worse off given palpitations are now breaking through my max dosages of Flec and Met, which is something that before never happened.

Just hoping for a miracle to happen after the blanking period but the fact they are happening every. single. day. gives me very little hope at this point.

Thanks for the info, I appreciate it. I do want to say that Dr Natale will not live forever, unfortunetly for all of us LOL. So eventually we will have to face the fact that technology moves forward, and many of these procedures keep getting better and one day, Natale's amazing skill WILL be surpassed by these advances. We may even be on the cusp of this reality right now. This is good for all of us, let's keep an open mind and hope!

For example, here is another innovation being done in Chicago, possibly better than the Hybrid technology. Certainly if his success rate is accurate, it's already better! Let's hope!

[www.uchicagomedicine.org]

This sort of explains the difference between Maze and Hybrid at least for the Cox Mini Maze. Other MiniMaze techniques may differ in some respects such as the one Dr. Wolff performs. In any event, the MiniMaze procedure appears different from the non-catheter portion of the Hybrid.

[med.stanford.edu]

My familiarity with the term 'hybrid' with respect to ablations came from this video:

[www.youtube.com]