to ablate or not ?

Hi everyone, I went into Afib yesterday after 9 months in NSR after my second cardioversion. After my first Cardioversion, I was 5 months in NSR. I am getting cardioverted again on Wednesday.
I am 59, so I am wondering should I postpone an ablation and get cardioverted every 9 months or so, or should i do the ablation asap.
Would you go to Natale for your first ablation or look for a local EP? I live in Houston so Austin is close and Natale is on my insurance,

Right now I am leaning toward doing the ablation with Natale and hopefully get it over with .

PS
Any good ablation people in Houston ?

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Willy
Any good ablation people in Houston ?

~10 years ago, I learned my best friend from childhood, who lives in Houston had persistent afib. I insisted he go to Natale. He thought I was crazy to insist. I normally would not pursue it, but he was my friend, so I pushed it hard. Turns out he had a very difficult case and required two procedures, including LAA isolation on the second. Subsequently he's been free of afib and is off all meds (there is a 60% risk of requiring lifetime anticoagulation or the placement of a device like the Watchman after LAA isolation). Now, we see each other once or twice a year as we live several states apart. Whenever we see each other, he and his wife continue to profusely thank me for being so insistent he go to Natale.

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Willy
Would you go to Natale for your first ablation or look for a local EP?

I went to Natale for my index ablation, even though that meant traveling. I am glad I did! Everything went very smoothly, couldn't be better.

Willy, in the recesses of your mind you know your AF is typical; it's progressing. Even though you have many months free from it after a cardioversion, the fact is that you do have it, and it tends to evolve, not in a good way. So, you understand that you might only be putting off the inevitable, and this is your question: now or put it off while the life is relatively good and the cardioversions seem to hold.

There was, for me, more than just the thumping and bumping. I felt anxious, and it really began to affect my quality of life when I was finally referred to a local EP. Then, I had to endure it until I got the call to a first meeting, and then some diagnostics, and finally a date for my index. I could have hugged every nurse and orderly when I finally got my name called and taken into the ward. It was nine months.

Maybe you aren't so wound up about it. You do have long intervals, and that counts for something. I just don't know when you'll understand that the slide slope has steepened and you're accelerating toward more frequent runs of AF, like once a week. Or every other day.

Also, there is something to be said for being in a worse state and being in AF when you go into the cath lab. That state makes the work of the EP a bit easier in terms of working to stop the AF with each positioned zap of the RF emitter. It also makes more zaps necessary because there are more evolved foci or re-entrants for the spurious signal.

I don't know how much remodeling your heart has undergone since you first developed AF. If you are rarely in AF, probably not much. Those of us who were in persistent AF by the time we got the nod would have had substantial remodeling...which is not desirable for one's prognosis and for the EP's sake.

If you were to pin me down, I'd say you're probably fine for the time being. If you can stand the cardioversions every few months, that's not so bad. If you're not in AF more than 15-40 hours a year until you get the cardioverson, that's not so bad. But if/when you become more active that way, and it amounts to 50-150 hours each year, now we're talking some risk that you will have notable atrial enlargement, and with that comes the dreaded 'progression' and remodeling.

So, I think you needn't worry unduly just yet, but I would strongly advise you to have an EP's visit in your back pocket, and some assurances that you could have workups done for screening and then the actual ablation inside of maybe three months if you sense that you're beginning to lose ground. You really want to spend as little time in actual AF as possible, so you need that 'insurance policy' of a quick look-see by an EP and then a proximal date for an ablation.

In 2020 I was all set to have my ablation by a highly rated local electrophysiologist. However, after going on this forum and seeing the wonderful results people had with Natale I decided to go to Natale. I have been afib free since then. If you have access to Natale, I would highly recommend that you go to him for your ablation.

You’re near Natale? Your insurance will pay? So you decide on Natale. Can’t see him for 6 months? Now what? Perfect world: have your local EP get you back in rhythm. Go on a med. Insurance will dictate which one perhaps. Some meds require you to be monitored for three more days in the hospital. But the hospital may not be set up for that. Now what? You’ll start off on a beginner drug like flecanide. Amioderone may wreak havoc on your thyroid, so watch that one. Your mantra becomes GET ME TO NATALE. Why? Look at the data. Your yokel local probably can’t compete with the afib guru!! Seriously, TIME is of the essence. I repeat, TIME is of the essence. The meds that you take should get you thru the six month window. Keep everything crossed that they do. And if they don’t, start all over again. Another snafu: you’re not treated in a timely manner. What happens now, possibly? You may develop a clot in your heart. A TEE will diagnose that before the next CV. If that happens, that truly will set you back. Your condition will become persistent. Not that its the end of the world. You’ll always have options. My parting shot is I feel fantastic. In 7.5 years I’ll be ready for a new pacemaker. I didn’t settle on a device because I had substandard treatment. I actually had an opportunity to see Dr. Natale’s protégé, I just got tired of being the hamster on the wheel. I hope it works out for you.

A little late to respond to your question.......but live in the Houston area.

Long story......but had a Natale ablation in March 2011 after great advice from many on this site. Wanted to get a local EP cardiologist in the event I needed to see a doctor quickly. Thanks to Shannon and Natale referred to John Seger and have seen a couple of times to establish a relationship.

No issues and no medication since my ablation.


Steve
Klein, Tx

Thank you very much for your input everyone. I decided to have an ablation and was able to get in with Natale in the Middle of October.

I am very grateful to have found this forum , thanks everyone