Ablation with Natale

Hello,
So, after waiting a year or so I am scheduled to see Dr Natale in San Francisco for what will be my 2nd ablation. The first was performed in April 2006 at UCLA with Shivkumar with zero success.
I am 41 years old, work out and run 5 days a week and have been suffering with a-fib for about 5 years. My heart function and overall health are excellent other than a-fib. I went through the normal list of drugs which had no posiitve effect and also tried the supplement route which unfortunately did not work either. I tend to get a-fib when both at rest or exertion and have not found any specific trigger other than red wine.
So, my questions are:
1) Has anybody recently seen Natale in San Francisco and what was their impression of the hospital, service etc.? I was originally scheduled at the Cleveland Clinic but Natale has since departed so I am curious how things are in San Francisco?
2) Has anybody stayed at the Cathedral Hill Hotel in San Franciso? This is the hotel Natale's firm recommends. I have never heard of it and was wondering what other people have experienced or may have stayed elsewhere?
3) Also, if you have stayed at the Cathedral Hill Hotel and had someone stayed with you, what type of room did you get? Reason I ask is that my mother-in-law will be staying with me and so I was thinking about a suite but also need a place for her to have some space. Is the room big enough?
4) When Natle does his ablation does he use general anesthesia and put you completely out or use some form of twilight drug?
Thanks in advance.
Scott

Scott: I believe Dr. Natale is now doing ablations at California Pacific Medical Center, (CPMC), in San Francisco, about a mile from the Cathedral Hill Hotel.

There was a story in the newspaper that CPMC has purchased that hotel and will eventually renovate it into a hospital so they probably want to keep it full now as a hotel. It is a big place and I'm sure they have many options for rooms, suites, etc. Probably preferred rates for patients as well.

There is a Holiday Inn almost directly across the street. Either is an easy bus ride to and from the hospital. there are also many small hotels inb the area but they tend to have fewer options.

CPMC is an excellent hospital with a perhaps three year old new heart wing.

When Natale did my ablation he used Versed and Fentanyl with a Valium starter. At the time I was told that he doesn't want you completely out as you tend to breath heavier when asleep and they want as little motion as possible during the procedure. Having said that, I remember nothing of my procedure until the recovery room and his face telling me that all went well, and I have been in NSR for the two plus years since.

Gordon

I was out mostly but they did bring me around a few times to ask me to stop the heavy breathing.

You asked and I am telling:

I had my ablation at the CCF with Dr. Natale last September and had ONLY Valium, nothing else. I am here to tell you that it was the worst thing that I have ever been through, far worse than giving birth. The pain through my chest was intense, the equivalent of having about five separate full blown heart attacks, according to someone staying at the CC Guest House. I screamed and yelled from the pain, but all I got was Valium. I was wide awake the WHOLE time, saw the x- ray machine going up and down, saw the EP's on the other side of a plastic shield, felt them tapping the catheters, felt my heart triggered into very, very fast tachycardias, felt my diaphagm go crazy when they hit the phrenic nerve, etc. It was a horror show. Although constrained by the straps, I was practically leaping off the table. At the end the nurses told me that I did a "good job. "

Interestingly, I went directly from the procedure table to my room - never went to a recovery room, I guess because there wasn't any sedation to recover from.

Demand up front that you get "conscious sedation," which is what I had during my first ablation in Boston. That worked fine with me. I came through only a few times when the pain was intense. Then they put me under again. No problem at all. That is the way I thought it was going to be with the second ablation.

I haven't mentioned this before on this web site because I didn't want to scare people away.

I don't know why this happened. I went in at 4 PM - the last procedure for Natale that day; he was teaching another doctor; and who knows, maybe the recovery room wanted to close up early. When I asked about it by email, all Dr. N. said was "I wasn't aware of it." He had to have heard me screaming from the pain.

Carol

Scott - not long after Dr. Natale relocated to the SF area, one of our posters was able to have ablation there... check this and ws very satisfied.

[afdave.blogspot.com]

You canprobably contact him directly.

Good luck.

FWIW - when I had my ablation 4 years ago, I had light sedation. They don't want you to be totally under because you need to be able to respond if they need you to do that. There were a few painful moments but not horrendous. The resulting NSR is worth anything I may have suffered.

Jackie

Carol- I'm just guessing but because of your previous history of having a stroke, I would think that is why they didn't risk putting you under anesthesia - so they could be able to give you immediate attention should you suffer another moving clot.

Others have told that at Bordeaux the anesthesia is also minimal and the pain is fairly significant and I believe the one from India said there was no anesthesia either.

I'm sure it was uncomfortable but if it was the safety issue in play, then that would seem to be a wise precaution.


Jackie

When I had my ablation at the Cleveland Clinic in feb 2005, I was given fentanyl and versed. I was awake while Dr. Natale inserted the catheters, but that was not painful to me. I was also awake during the ablating. I kept falling asleep, just to be woken up by my nurse and instructed to "breathe shallowly". I could feel the burns being made, and while I was not entirely comfortable, I don't think I even said "ow" out loud. Someone has said that he's had much worse days in the dentist's office that undergoing his ablation consciously. I agree.

Apparently, we have had differing experiences during our ablations with Dr. NAtale. While anesthesia affects people differently, it also appears that Dr. Natale adjusts his procedure to suit each patient.

Please don't worry. In one sense, I was happy that I was awake because it was very reassuring to see him standing there next to me, inserting the catheters himself, and then doing the ablating himself.

Susan R.

My ablation with Dr. Pinski was under general anesthesia. I felt nothing.

I am sure each pt. is treated according to their specific situation and what is used for one is not necessarily the rule for all.

I had my ablation at the CCF in June, 2007 with Natale and it was not painful at all. He used Versed and Fentanyl and I did not feel or remember anything until the recovery room. I would just tell them you want to be put out, I am sure they will honor your request, thats what I did.

No, I don't think that was the case.

When I asked Dr. N. why it happened, why did he say that he wasn't aware of my pain? He was standing about two feet away from me.

When I was sending in monitor recordings, I asked the telemetry unit about it and they said something about "breathing patterns."

However, my breathing would have been a whole lot quieter if I had been put under, rather than when I was struggling with the excrutiating pain.

C.

Jackie,

I didn't have a "stroke."

I had two tiny TIA's in March of 2005 that reversed themselves within an hour; there was no permanent damage.

C.

Carol,
thank you for your report. It is important to know the facts about pain level before making decisions if one can handle an ablation. After reading your report I doubt if I would have had been able to handle this torture.

Was the ablation successful?

I had severe detached retina surgery in both eyes. The first time I was out and had paper cuts that were worse. The second time, a different doctor, had me awake for the whole 4 hours and I felt every cut. When I asked him at my follow-up why he did not put me out, he said I seemed to tolerate it well. I told him I hated every second of it.

Hello Scott (and anyone else considering an ablation with Dr. Natale):

I had my ablation with Dr. Natale on December 21st, 3 weeks ago today in fact. My wife and I are keeping the blog that Jackie mentioned at [afdave.blogspot.com]. My procedure was done at Marin General Hospital located in Greenbrae, just north of San Francisco. Dr. Natale performs procedures at Marin and at CPMC, both Sutter Health hospitals.

I can't tell you anything about the CPMC facility or the area hotels. I can tell you about the wonderful staff that we had the pleasure to meet. From corresponding with other future Natale ablatees, it sounds like some of the same support staff are involved at both locations. Everyone that we met (and probably many others that we didn't) were pleasant, compassionate, professional, and very knowledgeable about afib.

I was given conscious sedation consisting of Versed and Fetanyl. I had asked beforehand about the sedation meds because I had both those meds before for cardioversions so I knew what to expect. I remember very little after the nurse told me she was giving me some medication in my IV to relax me. I did "awaken" a couple of times during the procedure but the only discomfort was a dry throat.

During my consult with Dr. Natale, he was concerned that my sleep apnea might cause some deep breathing that would make the ablation more difficult. The solution was for me to bring my CPAP machine with me for the procedure.

Feel free to e-mail me or post comments on our blog if there are any questions I can help with. Take care and best wishes for a successful ablation.

Dave M.

Susan,

I am in NSR, which is so great! There is no question that Dr. Natale did a fine job with the actual procedure.

I just don't have a clue as to why I was put through such torture. It was unbearable.

I am a real "stiff upper- lip" New Englander and I have been taught to endure discomfort and pain without complaining. But, that was absolutely the worst pain that one could imagine.

I went to the CCF expecting the same "conscious sedation" that I had for my first ablation at Brigham and Womens in Boston. That worked so well - it was a proverbial "piece of cake." What a surprise when the severe pain hit time and time again over four hours at the CCF!

Carol

had ablation in july 09 with Dr. Natale and did not feel a thing. he did a great job

I had an ablation with Dr. Natale in August and was out cold - never felt a thing. I am planning to go to SF for my follow up the end of the month. I am going to stay at the Cathedral Park Hotel because it's close to the hospital/clinic and they have a shuttle. Also they have a concierge who is just for patients. Her name is Gloria Ware and her number is 415-674-4558. You could speak to her regarding the kind of room to book and to get the patient discount. That sounds good to me. Good luck - I know you will have a wonderful experience. Dr. Natale will certainly surround himself with the best staff and assistants, like he did in Cleveland. Barbara

I had the same experience as Susan. I did keep waking up - I felt some pressure and let him know that and I recall being told that it was normal. I would then fall back asleep.

I didn't go to a recovery room - went right to my hospital room.

My ablation was very extensive - overall it took 7 hours. Dr. Natale told me that he did a great deal of work on me.

Give up the insane training regimine and read my posts about Dysautonomia and the ANS .