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You are welcome AFhound99, Yes I had several normal echos over the years prior to the first ablation, the last of which had the lowest EF but that was after a more active AFIB period the prior six months to a year before that last echo which, in turn, was the last one prior to the one in Austin done in Aug 2008 two days immediately prior to my first ablation and it was that one that showed thby Shannon - AFIBBERS FORUM
Hi McHale, Silent TIA like events are a lot more common than most people think and most resolve without incident or lasting damage (or so the story goes). When they get to a certain size and or number there is some indication of possible increase in dementia which would make since once there is a fair number of these that don't resolve. Getting older is a real crap shoot, no?! Regaby Shannon - AFIBBERS FORUM
Hi McHale, Its not that all persistent AFIB has its origins in the LAA alone. The majority of persistent Afibbers have triggers sites and areas all through the left and right atrium at many of the usual suspect focal points and the ostium of the PVs as well. However, what Natale's group has found is that once the condition progresses to a persistent/permanent AFIB state, by then a suby Shannon - AFIBBERS FORUM
You are welcome Laura and McHale. I'll try to address your pertinent questions below McHale. LAA isolation ablation is now becoming more common, largely due to Natale's group of EP's and the Bordeaux group which, until recently, has tended to ablate around and focally within the LAA but not full isolation unless necessary. That is pretty much what Natale does as well. He onlyby Shannon - AFIBBERS FORUM
Hi Cindy O, Just back from Chicago last night. .... I know the feeling ... one more step required ... but for those of us with challenging AFIB/Flutter histories including persistent AFIB ... close to 30% wind up having to address the LAA in order to be free of the beast in the form of AFIB, or its equally unwelcomed twin Left Atrial Flutter, for the long haul. So many EPs wont even go therby Shannon - AFIBBERS FORUM
Hi Monte, Sorry to hear of your rough spot right now, but sounds like you have a fairly good handle on why it likely happened this time and you are mostly doing the supplements.right, Be sure and add in the 3 grams of L-Taurine, Co-Q10, D-Ribose and L-Carnitine to the Mag & K as well as a good quality mostly DHA Omega 3 (two to three gram of DHA with some EPA but mostly DHA). You haby Shannon - AFIBBERS FORUM
I think both approaches are right ... at the right time ... and I think that is what Hans is trying to convey. Hans agrees that making a concerted effort to manage the beast nutritionally and with supplements is a key primary step and one that should be followed even after a successful catheter ablation or surgical ablation to give your heart, considering the still as yet not fully understoodby Shannon - AFIBBERS FORUM
Hi Lynda, Sorry to hear you are having some skipped beats which are usually PACs (premature atrial contractions) and which are common after an ablation during the healing process. Also, do you recall what areas of your heart were ablated in this second go around?? Was the Left atrial appendage isolated too? Dr. Natale told me that the LAA is a delicate structure that requires more careby Shannon - AFIBBERS FORUM
P.S. Bruce, Here is the link, mentioned above, to the Natale group study on the LAA as a fairly common source of AFIB on repeat ablations.: Left Atrial Appendage: An Underrecognized Trigger Site of AFIB'by Shannon - AFIBBERS FORUM
Hi Bruce, Can you tell us how many ablations you have had and by whom and where and also what years you had each one? This might help glean the history and give a better feel for whether you may have run your course with catheter ablation or perhaps you just haven't found the right EP yet to finish the job more satisfactorily? If your early ablations were quite a few years ago and/or wby Shannon - AFIBBERS FORUM
This is mostly for those who are soon to have an ablation. One thing I would highly recommend is to discuss with your EP beforehand if he is planning on already ... and if not would he consider your request ... to add in a 100mg dose of IV Hydrocortisone during the ablation and give an oral anti-inflammatory dose of Prednisilone or Medrol (note: not Prednisone) for the first two days post ablatiby Shannon - AFIBBERS FORUM
Many thanks too Steve, Jackie, Researcher, TomC and Trent, Jsut back online after traveling back home to Sedona from San Fran this weekend. Was an uneventful flight and all except for the 114 degree heat on landing in Phoenix. Jsut walking through the Jetway from the place to the terminal my wife and I started laughing as surely we were being cooked from the inside out as if in an Easy-bakeby Shannon - AFIBBERS FORUM
Thanks Tom P and George for the kind thoughts ... am really resting tonight. Good to ube in a comfortable hotel king bed instead of the hospital with the poking, prodding and blood pressure measuring all night... Makes for some scarce deep sleep. Pulse is a little on the high side but pure NSR and no PVCs or PACs and no drugs, of course the high pulse is typical after some burnIng but it'by Shannon - AFIBBERS FORUM
WOW!!! ... many thanks to all my Afibber friends here for the outpouring of Good wishes for my ablation with Dr. Natale yesterday. And Mahalo to Jackie for telling you all aboUt it and to Hans for letting you all know that it went as smoothly as possible and that Dr. Natale is pleased with the initial results. I was really touched last night reading all of your kind words of support and veryby Shannon - AFIBBERS FORUM
Thanks EB for the outline of your experience, I can well imagine why you would be a particularly good candidate for Dr. Sirak with the added atrial fibrosis. Had his technigue been more developed and with a longer track record 4 years ago, i mgiht well have interviewed with him as well, in addition to Dr. Haissaguerre and Dr. Natale, and possibly would have gone that route too, but I think Iby Shannon - AFIBBERS FORUM
Thanks for the link to the Dutch study on hybrid ablation Researcher. I can imagine in that setting with skilled surgerical and EP ablation teams working together they can get better outcomes, than most typical ablation only operators. Certainly the bipolar and quadripolar clamp ablation tools used epicardially are a plus for transmural PVI and isolation of the CS and SVC, particularly wheby Shannon - AFIBBERS FORUM
Many thanks Jackie, I too feel confident, as does Dr. Natale that he can finish it up this next go around. Referencing the article above Buster kindly posted from Natale's group titled: "Left Atrial Appendage: An Under-recognized Trigger Site for AFIB' .. out of a total study sample of approximately 3,800 total ablations in a 2 year time span chosen for this study period and donby Shannon - AFIBBERS FORUM
Hi Neroli, Best of luck with your ablation. You had the best so its a good place to start. I too am up for my second ablation in eraly August with Dr, Natale to complete what he wasn't able to finish in my first very long ( 2 hours or actual burn time) hybrid ablation for what was at the time persistent AFIB. I havent have one blip of AFIB since, as Natale said at the time I likely wouby Shannon - AFIBBERS FORUM
I had my ablation for persistent AFIB in Aug 2008 in Texas with Dr Natale and have not had one blip of AFIB since. Going from 24/7 very difficult and symptomatic AFIB to so much NSR made it one of the better decisions of my life. Dr. Natale wasnt able tto actually finish my first procedure when a left bundle branch block triggered near the end when he was going to work in and around the LAA, aby Shannon - AFIBBERS FORUM
Hi Cindy, You can confirm with Dr. Natale if he actually isolated your LAA or if he just did a lot of focal burns within the left atrial appendage? Those can be too very different things. Focal ablation of Complex Fractionated Electrograms within the LAA ( if indeed such focal trigger points are called CAFE's technically when found within the LAA ?) might not necessary result in full isolby Shannon - AFIBBERS FORUM
Hi Nic, Dr. Natale told me the odds are 35% up to 40% of possibly reguiring indefinite anti-coagulation in the event of a LAA during a second and third ablation to deal with Atypical left flutter subsequent to the first ablation. Assuming full isolation of LAA is needed AND the LA ejection velocity is less than 4.0 on a 6 month post ablation TEE test. That's a real risk for needing Anti-by Shannon - AFIBBERS FORUM
Michael, What do you mean by Hybrid ablation from your research? I had a hybrid ablation with Dr. Natale in 2008 for very symptomatic persistent 24/7 AFIB and it helped greatly in quelling my AFIB itself. I have had zero AFIB since. Though after three years of mostly quiet NSR I now have had a number of episodes the past 6 months of atypical left atrial flutter which was predicted by Dr. Nataleby Shannon - AFIBBERS FORUM
Hi Maria, Sorry to hear of you continued problems. It sounds like you simply need to speak with Dr. N to set your mind at ease ..and demand it! I know who you are speaking of in his SF office. She is well-meaning and a very knowledgeable nurse in this area, but at times her forward manner can feel a bit off-putting just in the way she tries to screen questions and wanting to answer them herselfby Shannon - AFIBBERS FORUM
Absolutely right Maria, Atypical left atrial flutter is a major known possible 'side effect' of ablations and the more burning required to shut down the AFIB the greater the likelihood of some atypical left flutter. .. no matter who the doc is! Dr Natale told me all about that prior to my first one as he anticipated a long one for me and was right, with a few minutes shy of 2 hoursby Shannon - AFIBBERS FORUM
Had one so far for persistent highly symptomatic high speed Afib/Flutter 3 years ago..At the time Dr. Natale said I would likey need one more to deal with a potential atypical left atrial flutter ciircuit they were not able to do during eht intital very long ( for him) procedure with 2 full hours of actual burn time required. I havent had on blip of AFIB since and have a pacemaker recording everby Shannon - AFIBBERS FORUM
I saw Natale two months ago for a follow up and we talked about the possiblity of going after that left atrial flutter trigger he was not able to get to in my first hybrid ablation for persistent afib. I've only had two LAFlutter episodes in two and a half years and zero AFIB and he said in my case the recurrance wasnt nearly frequenntly enough to go back in due to a roundly 25% added riskby Shannon - AFIBBERS FORUM
Well its all locked and loaded and I'm heading down the chute now! :-) Saw Natale again yesterday here in Austin where I am now (after a with him meeting in San Fran last week), got a Echocardiogram (thorasic) and other pre-op stuff and even got the event monitor for the 5 month period after the ablation. George, Hans and Jackie those Polar RS800 chart reading I sent you that we thought migby Shannon - AFIBBERS FORUM