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Hi Jake, It's great to hear from you and there are far more folks who visit the forum and glean good advice and info without posting than there are those of us who post here. So you have been in good company, but I hope you won't make yourself a stranger here now that you are up and running on the forum. A good question to ask is was the increased pain & swelling more from tby Shannon - AFIBBERS FORUM
In a regular PVI it doesn't really matter whether or not AFIB is induced, though, most EPs like to so as to count the stats for how many either convert or do not convert to NSR from the ablation itself. But the end point of a PVI is simply confirmed isolation of the pulmonary veins which can be achieved and confirmed with either an entrance block, or more preferrable these days both entranceby Shannon - AFIBBERS FORUM
Hi Peggy, While researcher is right that you can access the Medscape article on the OASIS - Randomized Controlled Trial presented at HRS 2016 Conference last week in San Francisco, I imagine quite a few others here might also find it easier just to read a summary of the OASIS trial that Dr Natale's group conducted and that he reported on the results of last Friday at HRS. As such, I expaby Shannon - AFIBBERS FORUM
Thanks Researcher, I was just getting ready to write my own review of this major OASIS Randomized Control Trial presentation, as I was there too at the Heart Rhythm Society Scientific Sessions 2016 Conference all last week in San Francisco, and as a member of the media I attended the lifting of the press embargo on the Oasis trial as well as several other interesting late-breaking clinical trby Shannon - AFIBBERS FORUM
I'll start with that last question first which answers all the rest. YES, the results of achieving durable NSR are more than worth the possibility of having to deal with anti-coagulation which, if you do need full LAA isolation because that is the prime remaining source driving your arrhythmia ( which is the only reason you would get full LAA isolation in the first place) then you actuallyby Shannon - AFIBBERS FORUM
Smackman, Sorry to here about the flutter but keep in mind you had long-standing persistent AFIB for an unknown but over a year of duration and have now enjoyed over two years of arrhythmia-free living from a single ablation by Dr Natale! That is robust success as the first step of your expert ablation process! The vast majority of those who started out having had LSPAF , even if they were ablby Shannon - AFIBBERS FORUM
Good idea researcher to ask for the specifics behind that new claim, will be interested in any data and quality thereof that you receive. And thanks for the link to Kaisers two page overview summary of AF ablation which is a quite good overview I feel, though rather general in nature and we don't know if these are specific stats from the full Kaiser network or specific center or just usiby Shannon - AFIBBERS FORUM
Hi Ted, Was nice speaking with you from Austin night before last, sounds like your all locked and loaded for Monday, and you will find things really have progressed light years since your very successful index ablation with Dr Natale ten years ago at CPMC. Having the opportunity, once again, to watch Dr N close up in the EP Lab while he performed McHales follow up ablation last week as wellby Shannon - AFIBBERS FORUM
Thanks Jackie, Now that McHale has spoken with Dr. Natale and McHale has given me permission to discuss his case, he is gratefully resting tonight in NSR after a very thorough follow-up procedure that Dr. Natale feels very good about. Instantly after Dr. Natale had started to pace inside McHales Left atrium his tachycardia/flutter kicked into full throttle even without any isoproterenol challeby Shannon - AFIBBERS FORUM
Barb, Having been highly symptomatic throughout your AFIB career, its highly unlikey you will now go asymptomatic. It can happen but in those very rare case when a breakthrough happens that switch to a symptomatic after having been hihgly symptomatic msot of your AFIB 'career' its a persistent AFIB in which case you can easily catch it. Typically those with silent AFIB they dont cby Shannon - AFIBBERS FORUM
Hi Barb, No you won't trigger AFIB after an LAA Isolation with an occasional pina colada if the LAA was your last unaddressed trigger source and your LAA isolation (and the rest of your ablation areas and focal spots) remain transmural and without gaps that are functionally 'leaking' for lack of a better term. With a solid ablation process completed you are not going to fly offby Shannon - AFIBBERS FORUM
Hi Smackman, Great to hear from you! Glad thinks are working out with your back and the meds. Regarding the LINQ .. Ideally being able to track any possible events of actual arrhythmia for a full three years is very handy just to insure you are not having any intermittent silent short events. However, since you have had longer term asymptomatic persistent AFIB that is the main reason St Davby Shannon - AFIBBERS FORUM
The key reality in my experience Apache is to live in and for the present. This 'explosion' I speak of has been going on for the last ten years in AFIB research. One thing that was obvious too there was how much at the forefront Natale's group has been all through this time... Two years ago only Dr Natale, Haissaguerre/Jais and Univ of Penn were really focused on Non-PV triggerby Shannon - AFIBBERS FORUM
Hi All, I'm writing this from Orlando Florida having just completed the big annual international 'AF Symposium 2016' held here with a very big field of top EPs from around the world presenting all the latest insights from research and technology developments in this exploding field of understanding core AFIB associated contributors and possible causal relationships as well as thby Shannon - AFIBBERS FORUM
My apologies for not being able to finish up addressing some of these issues above until now, but Ive just now finally got the time to address a few of the questions and comments on LAA ligation and the Atriclip and LARIAT from above. Several of these questions, though certainly good questions and logical sounding speculations, are simply not a concern at all on any level, and thus I hope not toby Shannon - AFIBBERS FORUM
Hi Cass, Sounds like you had seven great years free of AFIB after your first Natale ablation which is a very good outcome. I highly suggest you stick with the most experienced operator you can which is your original ablationist by a huge margin. It is not at all uncommon for a late developing Atrial flutter triggers years after a successful PVAI or PVI, with perhaps a few other non-PV triggby Shannon - AFIBBERS FORUM
Thanks Folks for the kind words, This was a difficult article for me to write and I certainly never anticipated, nor ever wanted, to have to rebut someone else's writing on a mutual topic of interest. I want to underscore, too, that I respect Dr Mandrola's efforts to inform his readers in his regular blog space, and I do agree with quite a few of his ideas and viewpoints and realizeby Shannon - AFIBBERS FORUM
Hi Anti AFIB, Another poster sent me your post above with a question about if PACs that trigger AFIB all originate from the PVs. Just to clarify, while PACs do indeed also come from the PVs they are not at all only from PVs. The main extended portion of of the most successful advanced ablation methods by Natales group, Bordeaux and others is to do first a PVI or PVAI and then seek out at zap Nby Shannon - AFIBBERS FORUM
Hi Que, Don't go off Eliquis until you get the specific green light to do so. It doesn't really require tapering either, though you always can if you like that way better. Great to hear the good news and many thanks too in the other thread for the offer to help and will call for a pow wow soon. Travis has been compiling the current site to understand exactly what will be morphed iby Shannon - AFIBBERS FORUM
Another option that can be a good fix too, if you have had some time ( a full year at least) after your LAA isolation and you are solid NSR then the odds are very high you will not need another LAA isolation touch up ... and then you could go with the Watchman device which a few Docs have gotten to be real experts in too. the top Volume Watchman installer these days is either Douglas Gibson atby Shannon - AFIBBERS FORUM
Hi Barb, will call later, but I agree completely with George...if Dr N thinks it's safe to stop Eliquis he will. He is not a doc who will park someone on a blood thinner unless they really need it. And for the time being having to take a Med that you have said has no side effects for you and with reasonable precautions that I know you are aware of should be okay certainly for now ... No bby Shannon - AFIBBERS FORUM
Perfectly well said Researcher, right on the mark! I am just back home from Kansas City and returned home last night and am reviewing both this article, and a follow up shorter one on the same topic that Dr. Mandrola put out yesterday that is even more in need of rebuttal in my view. I am writing a formal rebuttal to both right now and will post them here too in this thread likely tomorroby Shannon - AFIBBERS FORUM
Lynn, The good news is that there truly IS a tremendous amount of in-depth basic metabolic and biochemical science being done at large centers around the world focused on uncovering the many contributions towards different people getting AFIB at different times, circumstances, genetics, environmental and life style influences and from various triggers etc etc. This idea that no one out therby Shannon - AFIBBERS FORUM
Thanks Don, Taking a half hour break here from working on my little talk for Friday. Sorry to hear of the added scrutiny for the FAA issue.. those medical records can follow you a long time for sure,,, Luckily Ive been formally retired a good while... with my long roller coaster med history it would be a long shot for any grace being granted at all. To me its not that grey on going with theby Shannon - AFIBBERS FORUM
researcher Wrote: ------------------------------------------------------- > Shannon, looking at the Circulation article > referenced above, the following are the LSPAF > stats and LAA firing prevalence. > > The total patient population for that study was > N=3966 > > Out of that total, LSPAF population was N=1145 > (100%) > Out of the LSPAF population,by Shannon - AFIBBERS FORUM
HI Researcher, In answer to the first post above here is my reply which I first added by mistake to your own post and have since moved it here after realizing I clicked in the wrong box :-). They use Carto 3D and ICE .. CT, MRI or 3D-TEE is used for LAA morphological classification when needed, such as before any ligation or exclusion device or procedure. .. or also just to type the morphoby Shannon - AFIBBERS FORUM
Hi Folks, Just a update here on a very important international multi-center fully randomized controlled trial (the most rigorous and typically useful kind of study) called the BELIEF Trial of 4 years running on Left Atrial Appendage Isolation that was presented on Monday at the huge European Society of Cardiology 2015 Congress in London. And this seminal trial showed a very powerful impact onby Shannon - AFIBBERS FORUM
Regarding Travis Ablation report, Nice report and you must call me to tell me how you posted the photo inside the forum post alangford :-) Those were not 'red flags' in Travis ablation reports you pointed to Ted, simply variations in how their AFIB had manifested. And Travis has been in perfect NSR ever since his ablation going on 6 months now. While it's nice to finish upby Shannon - AFIBBERS FORUM
I was misdiagnosed as having endogenous sick sinus syndrome, when in fact is was largely drug induced, but during the EP study I wisely was advised to have the day before my pacer install and which was my very first introduction to the world of electrophysiology, the EP discovered I had the rate dependant infrahisian left bundle branch block whis totally unrelated to AFIB, but may have been causeby Shannon - AFIBBERS FORUM
Plus Ted, your last proposition that you might be better off with a somewhat lessor but more boring EP who is not driving advances in this field is answered in favor of the top dog by the very low rates of serious complications in spite of the degree of highly challenging case load Dr Natale addresses every week. Working in such cases a less experienced EP is sure to find him or herself over theiby Shannon - AFIBBERS FORUM