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Re: Nightmare Experience - 26 days ago

know I will never drive in a city or on freeway again. Sorry about what happened. Definitely see a neurologist and I would consider changing any GP who says "I've done my part". And if you get another episode of confusion, weakness, speech, vision issues, etc, go straight to the ER. I also would not drive on any roads -- not just city and freeways --- until things are figure

by mjamesone - AFIBBERS FORUM

Re: Back on Flecainide? - 29 days ago

Sharp pill cutter starting with the 50mg. I've actually done 12.5 with two cuts. Jim

by mjamesone - AFIBBERS FORUM

Re: Back on Flecainide? - 29 days ago

Yes, Flecainide reduced my ectopics significantly. As long as you don't need it to stay in rhythm, why not trial lower doses for the ectopics? I had good results with as little as 25mg a day. Can always titrate up. Jim

by mjamesone - AFIBBERS FORUM

Re: AF ablation relationship to Pulmonary Hypertension tradeoff experience - 29 days ago

Yes, a tradeoff in your case, looking at it after the fact. But in general, PH is a rare complication, for those thinking about ablation. Jim

by mjamesone - AFIBBERS FORUM

Re: Does AF Ablations work? Outcome of Sham PVI study - 4 weeks ago

This trial concludes that a sham ablation results in the same quality of live (QOL) as a real ablation. The problem is that the trial is flawed in several ways. First, the “sham group’ was like a sham on steroids. In that many underwent electrical cardioversion (ECV) during the sham procedure, restoring sinus rhythm (SR). So in part, especially with a relatively short (6-month) reporting p

by mjamesone - AFIBBERS FORUM

Re: Starting new thread on Isolating LAA topic - 5 weeks ago

NonThumper; how would one find one of these elite EPs who get good results converting persistent A-fib without isolating the LAA? I would start by looking for EPs at the top ten-rated cardiac hospitals such as Johns Hopkins, Mayo Clinic, Mount Sinai, and Penn Medicine. Alternatively, in complicated cases, or where past catheter ablations have failed, consider surgical ablation such as the

by mjamesone - AFIBBERS FORUM

Re: Starting new thread on Isolating LAA topic - 5 weeks ago

George: After 24 months, about 76% of patients who had the LAA isolation procedure stayed free of irregular heart rhythms. George, that 76% includes repeat ablations. The single procedure success rate in the BELIEF trial was 56% Natale was listed as an investigator in both trials. I don' know how many of the ablations he himself performed. And even if he did incrementally better becaus

by mjamesone - AFIBBERS FORUM

Re: Starting new thread on Isolating LAA topic - 5 weeks ago

Carey: Last time I saw (Dr. Natale’s) published numbers, his success rates for LSPAF are a little over 90%. I get 56% and 63.5%. Sources: BELIEF and ADVANTAGE AF trials. As to LAA isolation increasing thrombotic risk. No one, even Natale. disagrees. That’s why his safety profile includes anticoagulation for life and/or Watchman. It's a trade off. Personally, I wouldn't take it an

by mjamesone - AFIBBERS FORUM

Re: Starting new thread on Isolating LAA topic - 5 weeks ago

Carey: He really doesn't ablate much of anything empirically. We both seem to agree that he does for persistent, which involves many of us, including myself and the Mayo poster who had successful ablations without the isolation, Carey: But here's the thing: I'm aware there are EPs who disagree with him on this, but I'm unaware of any EPs who can match his success rate

by mjamesone - AFIBBERS FORUM

Re: Starting new thread on Isolating LAA topic - 5 weeks ago

NonThumper: Natale only isolated my LAA when I remained in A-fib after he ablated the "safer" areas. Once he isolated my LAA, I converted to NSR. So that would make it appear Natale did no more than he had to. Not really. It just shows his approach is different. The fact that LAA isolation was the step that terminated your AF doesn’t necessarily mean it was necessary for success

by mjamesone - AFIBBERS FORUM

Re: Strenuous exercise after PFA - 5 weeks ago

seeing the recent post about the young soccer player returning in 6 weeks He's 25, makes $150,000 a game and his PFA sounds like a right-sided SVT without a septum puncture. I would not decide on what so and so does, or the callendar, but by how you feel and what the doctor says. Personally, I'd err on the conservative side to give the ablation its best chance of holding. Jim

by mjamesone - AFIBBERS FORUM

Re: Ablation EP - Toronto - 5 weeks ago

second; he does not induce AFIB if I am in NSR at time of ablation. He said that with PFA he can get to it.. This is standard for an initial PVI ablation and study data backs this as the best approach weighing benefits and risks. In general, no proven benefit inducing AF and chasing additional targets beyond the pulmonary veins on first ablation for paroxysmal, and in fact doing more can a

by mjamesone - AFIBBERS FORUM

Re: Starting new thread on Isolating LAA topic - 5 weeks ago

I brought this over from one of my posts on the other thread here: Unlike many elite EPs, Natale believes in empiric (Iwithout demonstrated LAA triggers) LAA isolation. I cannot speak to your case, and whether another EP could have achieved same result without the isolation, but can state that many other EPs weigh the thrombotic risks of LAA isolation differently from Natale. From a Natal

by mjamesone - AFIBBERS FORUM

Re: 29 yo soccer star to under go PFA - 6 weeks ago

One article I read said he will resume play in about 6 weeks - wow. He's 29 Jim

by mjamesone - AFIBBERS FORUM

Re: Afib Has Returned - 6 weeks ago

From a Natale authored paper in 2020: 'We feel that in patients with non-paroxysmal AF, especially longstanding persistent AF, LAA should be isolated (no focal ablation) without evidence of triggers " So in case any confusion still exists, Natale believes in empiric LAA isolation (Iwithout demonstrated LAA triggers) for many of those with non-paroxyysmal Afib, which is a very

by mjamesone - AFIBBERS FORUM

Re: 0 Chads vasc score and cardioversion - 6 weeks ago

Susan: Once I was on Eliquis religious at 5mg BID and went to the ER with AF requesting an ECV. Because I flew internationally the previous days or maybe it was weeks, I was required to get a TEE. Smart team acknowledging that continuous anticoagulation sometimes isn't a guarantee. One of the safety signals that came out of the AVANT GUARD trial was that a clot can be lurking prior to

by mjamesone - AFIBBERS FORUM

Re: Whats Working For Me - 6 weeks ago

Neck strain and movement was one of my primary AF triggers. Good luck with your exercises, I think they are well grounded. I looked into chiropractry at one point, but never pulled the trigger. There's definitely a connection for some of us. That said, I eventually got worn out avoiding triggers because I was avoiding too many things that improved the quality of my life. I got an ablatio

by mjamesone - AFIBBERS FORUM

Re: 0 Chads vasc score and cardioversion - 6 weeks ago

Yes, it's a special circumstance. But if you have a TEE prior to your electrial cardioversion (ECV), you don't have to wait. I've had two TEE prior to ECV after checking into the ER, but I had to ask, as it was not offered. Later, when I understood things better, instead of having a CV right away, I scheduled a TEE and ECV as an outpatient three days out. That's because most A

by mjamesone - AFIBBERS FORUM

Re: AFib after ablation - 7 weeks ago

Hi, You may be interpreting things too negatively. NSR with occadional SVE's and PVCs does not mean your ablation has failed. Those arrythmia's are fairly common and usually benign. I still get them at times, and it's not a problem. Yes, I only had one episode, but you only had two. My friend has had two as well, and no more since then. I'd still stay positive on this a

by mjamesone - AFIBBERS FORUM

Re: Afib Has Returned - 7 weeks ago

Cary: The EPs Shannon was talking about who stop short of isolating the LAA for rational reasons are EPs who understand how to know it needs isolating, how to do so, and what the risks and benefits are. Unfortunately, that doesn't describe the average EP even today, Carey, It looks like you were referring to my quote and not Shannon's. It was a confusing attribution. ie I wro

by mjamesone - AFIBBERS FORUM

Re: Afib Has Returned - 7 weeks ago

Gloaming: Over on Mayo Community Connect Forums, one person stated he dismissed Natale because he insisted on performing an LAA isolation without even seeing him. I pointed out to this person that his three previous failed ablations might have been the clue to someone as skilled and experienced as Natale. Nope, he was not having hit. Is this the discussion at Mayo Connect? Apparently the per

by mjamesone - AFIBBERS FORUM

Re: Afib Has Returned - 7 weeks ago

how might other EP's treat persistent A-fib without isolating the LAA? Other EPs may deliberately stop short of isolating the LAA, not because it wouldn't necessarily help, but because of the resulting stroke/anticoagulation issues.It's risk vs benefits. So instead they may ablate other areas that might also be driving the AF, It's about how aggressive you want to be. It&#

by mjamesone - AFIBBERS FORUM

Re: Afib Has Returned - 7 weeks ago

Natale only uses that tenchnique when required to solve the problem. I have a problem with the word "required". I'm sure he uses LAA isolation when he believes it's necessary to achieve a durable result, but other highly experienced EPs may treat the same patient without the isolation. My point is that his approach is different from many at the top level, not that it's

by mjamesone - AFIBBERS FORUM

Re: Afib Has Returned - 7 weeks ago

Glad things worked out. In case you're not aware, newer studies such as OCEAN and ALONE-AF are changing the way many EP's handle anticoagulation. The Readers Digest version is that where anticoagulation was once for life, now many of us are being let off of them after a sucessful ablation. If this is something appealing, I'd then reconsider the Watchman and also discuss with Dr

by mjamesone - AFIBBERS FORUM

Re: AFib after ablation - 7 weeks ago

Sorry about what is going on, but i would not throw in the towel yet and call the abatuon a failure. On a personal note, I had a single AF episode six months after my ablation, and no episodes in the two years afterwards. A friend also had a single episode six months post ablation and then one more episode two years later. They really don't know everything about why abations work and

by mjamesone - AFIBBERS FORUM

Re: Afib Has Returned - 8 weeks ago

MikeN: I myself would want Calkins and not a student doing it. I hear you, but that is not always possible. But there have been studies that show results are just as good at these teaching hospitals versus private. It's important to understand that you will not get an intern or resident doing anything difficult. It would tend to be a seasoned Fellow, who has probably done hundreds and Cau

by mjamesone - AFIBBERS FORUM

Re: Afib Has Returned - 8 weeks ago

Hopkins and Calkins are excellent. I came across his name when I was trying to get into the PFA trial and I believe he was running it. Hopkins is a top-rated and high volume center, exactly what you want. Jim

by mjamesone - AFIBBERS FORUM

Re: Ablation EP - Toronto - 8 weeks ago

No personal knowlege, but a quick look up shows you hit the jackpot. Munk is rated the best cardiac hospital in Canada and number 26 globally by Newsweek. Dr. Ah is the medical director. Good luck with the PFA. Don't give it any second thoughts. Jim

by mjamesone - AFIBBERS FORUM

Re: Texas, the law, and potential impacts to out of state patients - 2 months ago

No drug conspiracies. Just that many states have gone back to pre-Covid rules with Telemed. So the state boards are exerting their authority. It really is unfortunate. A couple of caveats. If you have Medicare, those restrictions are sometimes relaxed, so don't take what they say at face value. When I called Cleveland Clinic, first they told me no Televisits, then twenty minutes later the

by mjamesone - AFIBBERS FORUM

Re: Slowdown in Watchman sales? - 2 months ago

Carey: So what? It has no impact on your life whatsoever. You can't see it, can't feel it, ... You may not see or feel it, but Watchman has both procedural and ongoing risks, i.e. permanent. Anticoagulation, on the other hand, does not have to be permanent. As to ACs, yes, strokes can be devastating, but I personally know of two people, one who died, and one who became profoundly

by mjamesone - AFIBBERS FORUM