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In Defense of Left Atrial Appendage Closure - Dr. Vivek Reddy (The above link, allows access to the article discussed below: In Defense of Left Atrial Appendage Closure by Dr Vivek Reddy, with only a simply free registration of your email address and username) Hi All, The above linked excellent article in Medscape by well-known and highly-regarded AFIB ablation EP and researcher Dr. Viveby Shannon - AFIBBERS FORUM
Ive had a Mag sulfate infusion with 12 of my 16 ECV and only two of those where pre-ordered by the ER doc at Queens Medical Center in Honolulu where I was a regular during the 14 months from the time my LAA trigger that we all knew I would have to have my second ablation to finish isolating the LAA that Dr Natale was unable to finish during my index ablation, once this LAA tachycardia began actinby Shannon - AFIBBERS FORUM
Mike will do just fine, We;ve had a number pf good conversations over the last months since the late summer and he is ready to go! As I told Mike too that with folks who have had an index procedure and then been golden with outstanding one and done type success for 10+ years and then recurrence happens, Dr Natale has found that a larger percentage have drivers from the LAA ( left atrial appendby Shannon - AFIBBERS FORUM
Mike and Jeff, The range of typical daily ablation activity at St Davids Medical Center, which is the largest volume AFIB ablation center in the world, ranges between 14 to 18 ablations a day in their 4 state of the art EP Labs and one hybrid EP + Surgical ablation lab. Dr Natale has done over 8,000 ablations personally, more than any other individual on the planet by a decent margin and heby Shannon - AFIBBERS FORUM
Great to hear things are going so well Smackman, You are on the aspirin along with the Eliquis mainly for your history of a PCI stent install in a coronary artery well prior to your index ablation. The aspirin is for the anti-platelet effect they like to see when you have foreign metal inside the heart. Though often that is not for life, especially if and when they are confident the metal havby Shannon - AFIBBERS FORUM
Hi Pamela, You should plan on a minimum of 5 days in Austin (same for out of town folks at eithe CPMC in San Fran and Scripps at La Jolla when getting ablated by Dr Natale at any of his three regular centers. First day is flying in, the following day is consult with your NP and doctor Natale and if at a minimum a blood test is done plus an updated echo if you have not had one recently. If yby Shannon - AFIBBERS FORUM
You're LAA was not ablated Ken. Only about 30 percent of persistent Afibbers are found to even have LAA triggers that require isolation and confirmed long term transmurality of isolating LAA ostium encircling lesion around the mouth of the LAA to achieve long term freedom from all atrial arrhythmia. It can sometimes require an extra touch up to the LAA isolation too, due to the very thickby Shannon - AFIBBERS FORUM
Hi Ken, JayBros did a pretty good summary above. And you are right to ask. AFIB ablation, as we have underscored here for years now is a complex affair with many variables defining what success looks like with various degrees and classifications of AFIB. Also its very important to keep in mind the variation in patient selection criteria and type of patient caseload a given EP ablationist workby Shannon - AFIBBERS FORUM
Hi Clay, Good question which brings up the issue of using a DeMRI for pre-screening prior to AFIB ablation. Certainly, a preliminary DeMRI as you apparently have had is good to see that is shows both atria with essentially zero fibrosis/scarring on MRI which is very likely a good sign you don't have much, if any, atrial fibrosis to speak of. But DeMRI is still quite controversial as a meby Shannon - AFIBBERS FORUM
Glad to see you are well versed Smackman and understand not to stop your OAC until after your 6th month post ablation TEE confirms you have robust enough LAA mechanical function to allow discontinuing all OAC for the long haul. Don't dare stop unless and until Dr Natale gives you the green light no matter how many well-menaing but misinformed cardiologist or even EPs might tell you that yby Shannon - AFIBBERS FORUM
The target emptying velocity out of the LAA is 40cm/sec or 0.4meters/sec. This is true whether or not you have had an LAA isolation. (Errata: thanks to Morpheus for alerting me about my 'fast math error' on the LAA emptying velocities listed below, the numerals are all correct, but in my haste in racing through the post I used millimeters and centimeters unit values in place of centiby Shannon - AFIBBERS FORUM
tmac52, Hang in there, this will all get sorted out with insurance and Watchman as well as with the next generation of these devices. It is part of being the rapid advances in this field that is sometimes takes a bit longer for all the pieces to fall into place. Nearly everyone at huge EP Heart Rhythm Society conference in May expressed total confidence this was all jsut a matter of normal vetby Shannon - AFIBBERS FORUM
Welcome back ajr1960!! But sorry its for a return of the beast, however what a great result you have had from your Natale ablations, one for AFIB in 2000 and another for PVC 15/16 years ago! Those were in the early dark ages of overall ablation technology and understanding. It is certainly worth scheduling a consult with Dr Natale if this continues at all or has been going on with increaseby Shannon - AFIBBERS FORUM
HI ROB, There has been some issues reported not commonly, but it does happen with mostly transient migraine aura symptoms post AF ablation .. or any left sided procedure after a transeptal puncture. Like your cardio noted with his somewhat loose description of 'dirty blood', it may be from atrial septal hole from the picture that has not sealed over yet. Or perhaps was made a bit tooby Shannon - AFIBBERS FORUM
Smackman, The reason for the TEE at 6 months is that is how long it takes for the average patient after an LAA isolation ablation for the mechanical function of the LAA to recover t what ever degree it is likely too. Keep in mind that anyone whose initial 6 month TEE is borderline low on the three main parameters that are measured to determine if the person can safely stop OAC drugs ... Or nby Shannon - AFIBBERS FORUM
Thanks for the info on Banner Health in Phoenix. sounds like their ablation marketing department in taking some liberties in trying to promote their center as for folks with all types of AFIB. If they try that with Cryo for non-paroxysmal cases, it will only result in big increase in multiple repeat ablation business there. Hopefully, those patients will learn of our website or other good resourcby Shannon - AFIBBERS FORUM
Smackman, it just means you had atrial Tachycardia .. i.e.CS/LAA-based atrial flutter in your case ... that brought you back for the follow up ablation and you are now 'post redo ablative left atrial procedure'. That means you have now completed your follow-up procedure that in your case did not require any re-ablation of any areas along the PV antrum, posterior wall or SVC done in yourby Shannon - AFIBBERS FORUM
Good to hear Afhound99, McHale is doing just fine and getting ready to take a trip back to his parents country of origin Greece, to visit one of the Greek isles that his family has property on and his aunt I believe lives there. I was there in Austin the first 6 days of March to attend the bi-annual Ep-Live 2016 conference for intensive training of EPs on how to do advanced cutting edge ablby Shannon - AFIBBERS FORUM
Yeah Afhound 99 (and good to hear from you!) ... Dr Mandrola is at it again , He brought up this crazy idea in an ongoing EP-oriented twitter conversation that a good number of top level EPs contribute too, including Drs. Natale, Amin Al Ahmad and Luigi DiBiase from St Davids most of us on this forum are familiar with, and EP Lab Director and elite level ablationist Dr Fermin Garcia and Dr. Paby Shannon - AFIBBERS FORUM
Mike how long has it been since your LAA Isolation and have you been arthythma free for a good long while now after that ablation. If so the watchman is not a bad idea either and even if you had an arrthymia recurrence from LAA Natale could touch it up with a short touch up ablation even some months after Watchman install. But for the real 'one and done' thing the Atriclip done byby Shannon - AFIBBERS FORUM
Great to hear your report Tsco, you put that all important 'take home message' very well, indeed. First hand experience is sure good at bringing such insights home, isn't it? And for others here, just a point of clarification, the first four ablations Tsco had where all for a challenging form of right atrial SVT with runs of junctional rhythm. His first three in 1999, 2000 andby Shannon - AFIBBERS FORUM
That is an option George, the only limitation there is that the LAA is only occasionally, and not that often, the only arrhythmia source for someone who has AFIB yet who has not yet had an ablation to eliminate all the prior active non-LAA trigger sources. If you had more sites than just the LAA driving your arrhythmia ... and one larger Natale study of persistent and LSPAF had, I think it waby Shannon - AFIBBERS FORUM
Hi Steve, The longer you go past about two and a half years without any arrhythmia breakthroughs from an index ablation, the greater the odds you may well be done for the long term, or at least for over 10+ years. If a repeat ablation is in the cards, it typically happens during the first 2 to 3 years tops with the earlier times ranging from 6 months post ablation through 2.5 to 3 years thby Shannon - AFIBBERS FORUM
Lynn, IV Adenosine is used to try to convert a high speed SVT to NSR in an ER setting usually, and it also helps confirm whether or not a high speed atrial tachycardia is, indeed, either SVT or rather left atrial flutter of either the typical right sided CTI flutter, or atypical left atrial flutter more commonly seen as a manifestation after catheter ablation of AFIB. If the Adenosine conveby Shannon - AFIBBERS FORUM
Just heard a while ago from Tammy, wife of David (Smackman), and also got a brief note from Dr. Natale as well. He is doing well after his ablation, and had a couple spots from the CS coronary sinus that he had to re-ablate which is a common area for having to touch up when it has not yet required full isolation of the CS in the first ablation. The main areas he had to address in this proceduby Shannon - AFIBBERS FORUM
Got off the phone with Tsco a while ago as he was just about to dive into his tasty salmon dinner at St Davids after his late start ablation today as the third case in Dr Natale's schedule this afternoon. They won't remove his groin bandages and get him up and about until around 11pm central (Austin) time. The great news is Tsco not only did fine but did not require LAA isolation todby Shannon - AFIBBERS FORUM
Good to hear Smackman, and the only thing Tammy needs to ask Dr Natale : "Is David still Breathing?" 😎 Just kidding of course, there is nothing at all to be nervous and worried about here, worry going into a follow up procedure after Natale did your first one is strictly optional on your part. This is a straight forward touch up and a relative walk in the park for not only Natale but yby Shannon - AFIBBERS FORUM
Hi Linda, Its usually around two months to set up both a consult and an index ablation with Dr Natale ( meaning a first ablation with him) at his Austin main headquarters. Normally for out of state folks you have the consult on the first day and ablation the next assuming you are pretty sure you need an ablation. That way you are not paying for trip all the way back and forth from home twiceby Shannon - AFIBBERS FORUM
Hi PJ, Tell us more about the type and duration of AFIB you have. Also, what kind of ablation did you have RF, Cryo or FIRM and who did it and where As TSCO said and your doctor noted it's not at all uncommon to have some post ablation activity during the 2 to 3 month blanking period while the inflammation from a full first index ablation heals and all those lesions in different partsby Shannon - AFIBBERS FORUM
It's also quite possible you might have been able to avoid a pacer altogether. I'm the next AFiB Report I'm wrapping up this coming week we share a first hand report from a quite physically fit 68 year old Calgary man who contacts me looking for suggestions on if anyone could help he long standing persistent AFIB of just over a full year duration. His AFIB had startd directly fby Shannon - AFIBBERS FORUM