Hey KenKy, Please send me your cell number and time zone (I assume it is Kentucky and thus EST time zone I believe?) and let's discuss this by phone so I'm clear whether or not Dr Natale did the LAA isolation in your index procedure and then did a touch up of the LAA in second ablation? After I have a more complete overview of exactly what was done in each of your two Natale ABLs weby Shannon - AFIBBERS FORUM
Hi Susan, You should not need to apply any pressure to the catheter access site in the two groin areas at this stage after your LAA-iso ablation. It's not unusual to have a minor temporary 'pearl-like' lump where the groin punctures and Vascade plug were used. A mild to moderate hematoma is typically no big deal either from the two femoral vein groin sites and typically any sby Shannon - AFIBBERS FORUM
Hey NLAMA, My take is that this issue isn't nearly so consequential as it my appear to you at first glance, this back and forth between Dr Natale and Dr Ousamma Walid (a former colleague who worked under Natale when Dr N. was Director of Cleveland Clinic's AFIB program during the early 2000's) is easy to misunderstand when read out of context and with the limitations of twitterby Shannon - AFIBBERS FORUM
Hi Nlama, In addition to the great advice Carey offered above regarding assessing an experienced Watchman operator, another key factor is in knowing roughly how many transeptal punctures (TP) has an EP done (mostly during AFIB ablations for the EP), or the number of transeptal punctures an expert Interventional Cardiologist (IC) my have done during various vascular plug installs in the left atrby Shannon - AFIBBERS FORUM
Hi Susan, Flutter can and does self-terminate at times, but it also more commonly requires an ECV to terminate a flutter. This is especially true for Atypical left atrial flutter which is most commonly seen after an AFIB ablation. And an atypical left atrial flutter originating from the ostium of the LAA will almost certainly require an ECV to terminate in the short term and a successful flby Shannon - AFIBBERS FORUM
Hi Susan, With RF being used as the energy source for all RF ablation, it is technically correct to say that burns are made in the ablation process ... but in describing : "one's LAA as having been burnt" as if the entire LAA had been cooked or torched, the choice of words inadvertently conveys a more destructive impression than what actually occurs during a full LAA isolation.by Shannon - AFIBBERS FORUM
Hi Folks, Apparently, there was a mistaken choice of words used that inadvertently conveyed the wrong impression to Cienepurzalot implying that he was required to return to Austin for a TEE at 6 months after his index ablation. As it turns out, Robert does NOT have to return to Austin for a 6 mo. TEE to evaluate his LAA mechanical function after all. It's easy to see how by inadvertentby Shannon - AFIBBERS FORUM
Hi kbog, An atypical left atrial flutter can, indeed, appear at this stage after your index ablation. It happens less often at the1.5 year mark and later, assuming there were no to very few breakthrough episodes during that first year or so after an index ablation. What we have learned over the last two decades is that after an advanced expert index ablation by a top operator, such as Dr. Nby Shannon - AFIBBERS FORUM
There can be changes in post ablation EKGs for some Afibbers that can get misread by some docs and (even some EPs), and especially by ER docs, as indicating the post ablation patient has some 'ST elevation' when that is only a benign artifact and not at all related to actual ST elevation nor is it, in any way, related to a prior myocardial infarction finding. Hence the need for an experby Shannon - AFIBBERS FORUM
Hi Carola, As George and Carey noted above, it is not that your trusty ablation failed, once ablation lesion lines hold up with zero recurrence for at least a full year and a half, it's highly unlikely for those scar lines to ever fail, and thus allow AFIB/aflutter to trigger again from the same previously ablated spots that were solid so long. The old adage that AFIB can't cross a dby Shannon - AFIBBERS FORUM
Hi Barb, To be sure, for a straight up Watchman-only procedure there are a good many more well trained EPs at doing Watchman’s to make ones job easier to pick a high volume experienced Watchman installer that can do a good job. Typically, such an experienced Watchman installer would be found around a larger metropolitan area, with some exceptions, that can also do a solid reliable job. Hoby Shannon - AFIBBERS FORUM
Hi Pamela, good to hear from you! I what to strongly second Carey’s excellent summary above! Your no doubt well-meaning cardio is unfortunately misinformed. As Carey emphasized above, he simply doesn’t understand the risks, or the options. Did he define your added bleeding risk? Also, a good solution, even if you do have an actual elevated risk for bleeding, is a Watchman FLX, which you could easby Shannon - AFIBBERS FORUM
Yes Callydex, This preliminary approach to Pulse Field Ablation is limited to only doing a PVI ... so far. No doubt, as the technology matures, the developing companies will expand the catheter designs and overall supportive systems to allow more flexible ablation for more challenging cases of AFIB like so many of us on Afibbers forum have either required, or are waiting to have a more comprehby Shannon - AFIBBERS FORUM
Great to hear IDBill, I just returned from St Davids too! Wish I had known you were there this past week What day was your ablation? I was in the EP-Lab with Dr Natale most of each day this past Monday and Tuesday, donning the smock scrubs plus lead vest & apron watching close up as Dr Natale performed his usual magic with a handful of several challenging cases two of which were from our fby Shannon - AFIBBERS FORUM
Hi Gordon, I recall those days too, as I was just the 11th patient on which Dr Natale used the original irrigated Thermocool catheter when it was not yet fully FDA approved, but was ok’ed for human use by FDA under their investigative clinical trial protocol around 12 yrs ago now. And I haven’t had a single blip of actual AFIB since that index procedure as confirmed on my dual chamber pacer tby Shannon - AFIBBERS FORUM
Hi Liz, As Carey noted above my stroke was from a very different mechanism 11 months after my LARIAT LAA Ligation procedure, back before Watchman was FDA approved ( and thus I do not have Watchman device) but I did have both a LARIAT procedure, plus I had an Amplatzer Duct Occluder-2 vascular plug installed to plug the central ‘pucker’ very late leak in my LARIAT procedure, even though my thrby Shannon - AFIBBERS FORUM
Hey Rich. Good talking with you the other day! And for the sake of many newer readers here, I wanted to underscore that you had two prior ablations before your, so far, one 'index' ablation with Dr Natale. In addition, you have had struggles with the beast off and on since your 20s and you are in your early 50s now, all of which indicate a strong likelihood of a genetic influence inby Shannon - AFIBBERS FORUM
A robustly consistent A wave as seen at the mitral valve inflow is one of the three main confirmations required on the 6 month post LAA-Isolation TEE scan for the patient to be considered eligible to possibly stop their OAC drug after an LAA-iso. They also need to pass the LAA emptying velocity measure with at least 40cm/sec flow velocity from the LAA to possibly get a pass on absolutely needingby Shannon - AFIBBERS FORUM
Hi Barb, first it is important to emphasize that a left ventricular ejection fraction is an entirely different messurement than is the LAA emptying velocity and the two numbers have very little correlation. And a 58.5cm/sec LAA emptying velocity is not “too high” it’s very good, but you would still have to pass the Doppler A-Wave into the Mitral valve in-flow test that requires a robust and coby Shannon - AFIBBERS FORUM
Hi Beach Bill,. The convergent procedure is not as consistently effective as Natale's all endocardial approach for persistent and LSPAF ablation with many thousands more patients having undergone successful Natale Extended PVAI plus Posterior Wall Isolation, SVC Isolation and Non-PV trigger detection and ablation along with, as needed, LAA/CS isolation, and as underscored in the BELIEF rby Shannon - AFIBBERS FORUM
Hi Liz, Your assumption that (in paraphrase) "undergoing a successful LAA closure, if stroke risk scores were 2.0 or greater, would offer no benefit" is not the conclusion at all I would draw. First of all, most experienced EPs and even Cardio's will tend to determine your stroke risks not just on the cookie cutter CHA2DS2-VASc numbers alone .. these scores form the basis fby Shannon - AFIBBERS FORUM
(Please forgive any typos for the time being as I’m typing this parked in my car on an Iphone with my currently impaired right eye vision and will try to correct any mistake later when I get home to my computer screen) Carey we do have a long history of tracking Bordeaux patients from EU and Canada. In fact, from the 2005 through 2009 period (perhaps into 2010) Hans Larsen the creator of thiby Shannon - AFIBBERS FORUM
Dr. Vijay Swarup is certainly one of the most, if not the most, experienced ablation EPs in Arizona and a nice man as well with last time I checked over a year or so ago he posted that he had done approx. 3,700 atrial ablations I believe it was ... He also is very familiar with LAA Closure with Watchman and LARIAT. Cheers! Shannonby Shannon - AFIBBERS FORUM
You are almost certainly going to do best by doing both long term. Clean up your diet and adapt to better quality exercise for sure, plus stress reduction and adopting any life style risk reduction too you might individually need are key steps. These can all help a good deal for many afibbers, but likely will not be enough to avoid another ablation for true freedom, and my philosophy is to inby Shannon - AFIBBERS FORUM
Hi Mike, Yep your hunch is right, with an LAA emptying velocity of 21cm/sec that will preclude stopping a blood thinner but you are not necessarily on a blood thinner for life. You will have the option of having LAA Closure, for which LAA isolation patients who have too low a sustained LAA mechanical function on 6 month TEE, are ideal candidates for LAA Closure in most cases. With a Windsocby Shannon - AFIBBERS FORUM
Yes, Carey's point is well taken on not letting the kind of ablation docs who do 100 or 200 or less, max, in a year and who do not focus much of their work on persistent and LSPAF ... then for sure if you have not made some real success after the second one with such an EP, dont sign up for another one without seeking out a far more experienced operator doing far more numbers and with an outby Shannon - AFIBBERS FORUM
MikeF, I’ve personally witnessed Dr Natale convert a 68 yr old man who had endured 36 YEARS of symptomatic LSPAF to NSR is only 43 minutes of his index ablation. The man did require one touch up of his LAA isolation ablations 8 months after his index LSPAF ablation, but he is enjoying very much life in normal rhythm now in spite of literally no other EPs he had consulted with over the yearsby Shannon - AFIBBERS FORUM
Mac, Dont go by BCBS guidelines alone, that’s what they are general guidelines not immovable lines drawn in the sand and the guidelines themselves change too over time. Work with St Davids staff when, and if, after your index ablation you require LAA isolation and then after the 6 month TEE if it is found you do need to stay on OAC or go for LAA closure, then at that point the support staff wby Shannon - AFIBBERS FORUM
Hi Elizabeth, Your case is really the kind in which LAA Closure is primarily aimed at addressing, so long as you choose a highly experienced operator for installing a device like the Watchman at a high volume center. In such cases, and with such experienced physicians, the installation risk is quite low and there is little to no longer term risk once past the peri-procedural minor to modest riby Shannon - AFIBBERS FORUM
Welcome Deb, There has indeed been real progress in the field of LAA Closure over the last 4 to 5 years, not only in improved design but in significantly improved installation methodology and refinement that has greatly lessened some of the very early stage learning curve issues that are not uncommon in any relatively all new procedure in medicine in its gestation period. The field has maturedby Shannon - AFIBBERS FORUM