Watchman Experience

Greetings all,
I've been absent from here for a while, life got in the way and after two successful Natale ablations I've lived my life.
My first ablation was 11 years ago in New York- St Lukes Hospital with Dr Natale.
Three years later followed up March 1 2016 in Austin with another ablation with LAA isolation after a flutter breakout with Shannon at my side in the OR.
My LAA emptying velocity is 16cm/sec and filling is 24cm/sec similar to the 2016 TEE.

Was on a list for a Watchman, but then Covid broke-out......

Now need a biopsy, but being off blood thinners Xarelto for more than 2 days is dangerous, already had a TIA before any ablations.
My urologist would prefer I get the Watchman first so in the process of scheduling one at St David's along with a touchup abalation,about maybe early May.
My understanding is after 45 days of device placement, I should be good to go.....

I don't want to put off the biopsy longer than 3 months.....

Any insight or experience would be appreciated

McHale

Quote

My understanding is after 45 days of device placement, I should be good to go.....
I don't want to put off the biopsy longer than 3 months.....

I got a Watchman last April from Natale after an LAA isolation 6 months earlier and immediately after placing the Watchman, he put me on a half dose of Eliquis. When I returned for a TEE 6 to 8 weeks later he said I could hold that half dose of Eliquis for as much as a week after that if needed for a procedure--so yes, I think your information is correct.

I have a Watchman but mine wasn't placed under time-sensitive conditions like yours will be. My general experience was it's a very quick, easy procedure. I couldn't tell anything had been done other than the one insertion site in my groin.

My understanding is that 45 days is the minimum time before you can stop anticoagulants, but they're going to want a TEE at that point before they clear you, so figure that in. It's a 30-minute procedure but obviously it has to be scheduled and it will take a day or two to get results.

Do the folks in Austin know why you're getting the Watchman? They might be able to prioritize you if you let them know the details.

Hey Carey,
Yes they know its a priority, I spoke with Norma Natale's Nurse today and Shannon last week who was going to speak with Natale.
I gave them my Prostate MRI report and they aware of my time restraints.

I also saw Dr DiBiasi Natale's Protege here in the Bronx who did my TEE last month who mentioned 45 days too.
This place has always been a place of reassurance and comfort!

Thank You All,

McHale



Edited 1 time(s). Last edit at 03/26/2024 11:31PM by McHale.

Quote

Yes they know its a priority, I spoke with Norma Natale's Nurse today and Shannon last week who was going to speak with Natale.
I gave them my Prostate MRI report and they aware of my time restraints.

Tip: if you go to Austin for your 6 week TEE after the Watchman, you usually get the results the same day. There were several of us scheduled for TEEs the day I was there and we had them right in our prep rooms. The anesthesiologist and cardiologist just went from room to room. Right after, we were given a hot breakfast while we waited for Natale to read our TEEs. He and Shannon NP came in an hour or so later to explain results and give us our instructions and our written reports. If you have the TEE done locally and sent to Austin it is likely to take much longer.



Edited 1 time(s). Last edit at 03/27/2024 12:17PM by Daisy.

Booked for April 11, someone just canceled!
Nice to have connections!
I'll see where I'll have the TEE, I can always fly back to Austin.
Why am I even excited about this.....I fully Trust Natale with my heart!
He's giving me 11 years of NSR bliss!

Simply the Best!

McHale

Carey,
Is it protocol to have a redo touch-up ablation before Watchman placement especially after 8 years?
I'm AFIB free but I have been getting more and more unclassified Kardia readings lately with one 30 sec reading of AFIB which looked more like PVCs....maybe the algorithm misinterpreted.

I did have some some short AFIB recorded on my implantable LINQ the first three years noe dead battery and did have a 4 day flutter episode 2 years ago after high stress but self converted.

Thoughts.....

McHale

No, that's not standard. With no documented afib, I seriously doubt that Natale would be willing to do an ablation. You could ask for another monitor if you have doubts, but a few unclassified readings from Kardia doesn't mean much.

Good to know!
I have a Telemedicine call with him or a PA on April 2.

Thanks,

McHale

Quote
McHale
Greetings all,
I've been absent from here for a while, life got in the way and after two successful Natale ablations I've lived my life.
My first ablation was 11 years ago in New York- St Lukes Hospital with Dr Natale.
Three years later followed up March 1 2016 in Austin with another ablation with LAA isolation after a flutter breakout with Shannon at my side in the OR.
My LAA emptying velocity is 16cm/sec and filling is 24cm/sec similar to the 2016 TEE.

Was on a list for a Watchman, but then Covid broke-out......

Now need a biopsy, but being off blood thinners Xarelto for more than 2 days is dangerous, already had a TIA before any ablations.
My urologist would prefer I get the Watchman first so in the process of scheduling one at St David's along with a touchup abalation,about maybe early May.
My understanding is after 45 days of device placement, I should be good to go.....

I don't want to put off the biopsy longer than 3 months.....


Any insight or experience would be appreciated

McHale

Everyone is different. I had a GI bleed so Dr. Natale performed an urgent watchman (he was in town and squeezed me in) and after 24 hours I went half dose eliquis. I was given permission from Dr Natale to go off eliquis for 5 days for my colonoscopy.

Dr Natale did a couple of TEEs right after the Watchman and before he pulled out the catheters he took another peek..extremely careful to see it was sealed so i could get off eliquis for the colonoscopy.

Wow that's amazing Susan, that's exactly I want to hear.

Best,

McHale

Carey,
Actually it is a standard protocol with Natale to have a touch-up or redo ablation right before a Watchman is installed to check for any atrial arrhythmias that still might be lingering from prior ablations.

McHale

Checking for lingering atrial arrhythmias isn't an ablation. It's called an electrophysiology study, although it can lead to an ablation. So I'm not surprised he does that because it only makes sense, but he's not going to do an ablation that's not needed. That was my only point. Anyway, you're in good hands.

Gotcha! Understood, his office called it a redo or touch-up ablation, my last ablation was 8 years ago.
I did have that 4-5 day 110BPM flutter 3 years ago and my chest implant LINQ did catch a brief a few episodes.
Yes it's good practice, I'm totally confidant with Natale

Thanks,

McHale

Quote
McHale
Gotcha! Understood, his office called it a redo or touch-up ablation, my last ablation was 8 years ago.
I did have that 4-5 day 110BPM flutter 3 years ago and my chest implant LINQ did catch a brief a few episodes.
Yes it's good practice, I'm totally confidant with Natale

My situation was similar and pre-procedure they termed it as a probable touchup plus Watchmen. I had not had Afib since my extensive ablation 6 months earlier though I had had a couple of runs of tachycardia and my resting heart rate was 90 - 95. In fact he did 12 more minutes of ablating before place the Watchman and coming out of it my resting HR had dropped to my pacemaker set of 70 and has stayed there. Yay!

Daisy,
Nice to hear! Natale is simply the Best I look forward to seeing him again!

My story quick,12 years ago I had a (stroke) TIA micro-vascular last about 15 minutes where I couldn't speak at work.
I was going in and out of AFIB pretty regularly by this time, flecainide was barely working anymore Multaq failed me so I knew I was screwed.
Shannon calls about a 6 months later right before Labor Day Weekend and tells me Natale is in New York, he's opening up three brand new state of the art EP labs at Saint Lukes in Manhattan.
He knows all about you and is waiting to see you this coming week. Shocked he tells me you always said if only Natale was closer you'd get ablated.

Now reality hits me in the face, I make the appointment go see Natale on Monday, throw the kitchen sink at him and he patiently answered all my questions and concerns.
He gives me a bit of bad news and tells me won't be able to ablate me tomorrow Tuesday because of scheduling backups and commitments but tells me he'll do it on Friday......upset and disappointed I had to wait..... I ask him I thought you were flying out Thursday....Yes I am but I'll stay and reschedule my flight out.......

Then he looks at me and asks...did you eat or drink anything....I said no just some coffee earlier in the morning.
He said you want to go now....I said hell yeah and he runs out and tries to grab the anesthesiologist team and staff.
He comes out into the elevator Lobby and gives the thumbs up.....I'm on the phone and wave to him to come over and hand him my phone....confused I said you have a call.....Hello....Shannon how are you LOL!!!

One hour later I'm prepped and in my gown being walked and into this beautiful operating room and next thing you know the propofol is running thru my veins.......

Simply the Best.

Yeah he's that good!

McHale

Great story!!!

He sounds better and better with each anecdote.

Quote

Yeah he's that good!

Thanks! A great story showing his commitment to patient care.

Quote
McHale
Shannon calls about a 6 months later right before Labor Day Weekend and tells me Natale is in New York, he's opening up three brand new state of the art EP labs at Saint Lukes in Manhattan.
He knows all about you and is waiting to see you this coming week. Shocked he tells me you always said if only Natale was closer you'd get ablated.

Yes, Natale is wonderful, but the quoted part of the anecdote highlights how blessed we are to have @Shannon associated with the site!!!! He has helped so many people, not just with Natale, but in many other situations as well. Much of this is not visible to the group as a whole. Likewise, with all the work @Carey does as well. Visibly here on the forum, but also a lot that is not visible!!

Hey GeorgeN,
I see your still here old friend........are you still doing the supplemental regimen keeping the BEAST at bay or did you finally get ablated....?
Yes Sir Shannon is also one of a kind...priceless, and you provide great support yourself as does Carey.

Part 2 of my AFIB journey was March 1 2016, Natale fit me in right before his EPLive 2016 Texas Arrhythmia presentations and his live ablations. Shannon was flying out on March 3 for the EPLive but after I told him I was stuck going alone, he rescheduled his Flight and met me the day before my ablation and roamed the EP lab during my ablation and then took me back to the to my Hotel the next day.

This is such a scary disease, I don't know where I'd be without this place.
That stroke I had was surreal, I was at my desk typing gebberish,I couldn't answer anything my boss was asking me...nothing came out of my mouth...yikes!

Yes we are so blessed to have Shannon, such a wonderful and caring human being and friend!

God Bless

McHale

Quote
McHale
Hey GeorgeN,
I see your still here old friend........are you still doing the supplemental regimen keeping the BEAST at bay or did you finally get ablated....?

McHale, I am unablated. I still use my regimen. So far, flecainide has never failed to convert me when I've used it.

What I've noticed over time is I see a lot more of what appears to be flutter (high rate very low heart rate variability) in the RR (beat to beat) data stream. As well I've been having more frequent & "unprovoked" episodes. As Carey and others have noted, flutter is a very stable rhythm. My assumption is that I need to convert back to afib from flutter for the flec to work. Various breathing approaches (like Wim Hof method) as well as things like valsalva (bearing down) appear like they are working to do this, but they induce fast & slow ectopics around a still visible flutter baseline in the data. What I've found works consistently is to put myself in a mild state of hypothermia (i.e. soak in 50 deg F water for >20 minutes), then, when I'm rewarming a state of "afterdrop" is induced. I don't shiver soaking in the water, but will when afterdrop sets in. This then puts me back in afib & I'll convert after a while (I do have flecainide on board). At 68, it is possible there will come a time where I won't be up for doing this. Hence, I'm considering my options now. I'm glad I can view these RR data in real time as well as after the fact to understand the patterns. This has allowed me to ask the question of what can I do to change the episode character, then try various approaches and see what happens.

Re: George’s post:
I was a fan of sudden cold conversions.

I converted many times when going outside barefoot in the winter, just enough to get my feet really cold. But California winter is mild compared to George shoveling snow in his shorts and flip flops.

During the month of November 2022, I was hospitalized 12 admissions in one month spanning almost the entire November. They couldn’t convert my flutter. I remember sticking my body out of the hospital window (hooked up to iv) and while barefoot was able to convert when I got my face cold enough. The window didn’t open entirely..the hospital doesn’t want jumpers..but this trick worked temporarily until it didn’t and I needed an av node ablation.

Now I’m fine and my pacemaker is doing its thing. Recently I was in a hot hot store in the desert and I could just feel my chest having arrhythmias (I feel them but my ventricles are at a steady number) and I got dizzy. I must had looked awful because someone turned on the AC and I felt better. Same story in Venice walking in rubber boots during high tide in August and my feet were so hot being encapsulated in rubber boots that I went into afib even while hydrated. I had to remove my boots to get relief.

I suppose for my situation hot feet are not cardiac friendly while really chilling cold feet helps my symptoms.

Good evening all,
Arrived at Saint David’s at 5:00AM today for A touchup Ablation and a Watchman implant.120 minutes under, was in my room and walking a few hours later.
Natale stopped by for a quick chat, good seal minimal burn time no AFiB detected but PVCs might be a burden.
Was totally at ease and calm,….no fear …. there’s a special place in Heaven for Natale.

McHale

Quote
McHale
Good evening all,
Arrived at Saint David’s at 5:00AM today for A touchup Ablation and a Watchman implant.120 minutes under, was in my room and walking a few hours later.
Natale stopped by for a quick chat, good seal minimal burn time no AFiB detected but PVCs might be a burden.
Was totally at ease and calm,….no fear …. there’s a special place in Heaven for Natale.

McHale

Glad it went so well! His little post-procedure chats are so reassuring.