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, 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
Yes, as Carey noted above, Dr Natale is right by the patients side during the vast majority of each of his ablations and, for sure, during the entire time the mapping and actual ablation lesions are being created, that is all solely done by Dr Natale ...100% .. and standing right next to the patient and in control of all catheters! The only, exception is during the roughly 20 minute's neby 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 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
SueChef, It’s often a daunting experience trying to find an EP to folllw you that can handle the whole nine yards of EP treatments you might require over time, and particularly with the EP having a high degree of excellence across the board. The numbers of EPs that can truly fill that strict definition of ideal doc to partner with, especially when you include being an excellent top-tier choiceby 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
Hi Chuck, Well that's a head scratcher as the two devices aren't addressing the same issue really at all. Unless there is more to the story that might somehow explain why your Cardio or Doc of another specialty is even discussing the two devices in the same breath, especially for a patient who has been AFIB free for 2+ years now after what sounds like was a successful ablation procesby Shannon - AFIBBERS FORUM
That all sounds like a perfectly reasonable plan Don, especially vetting your particular case and working through the best options for you long term with Dr Natale who did such an first class job on your index ablation that required LAA isolation to begin with. And I agree, Dr Natale absolutely has no incentive to push a procedure on you, or on anyone, that he isn't entirely confident isby Shannon - AFIBBERS FORUM
Shannon [ PM ] Dr Vivek Reddy: In Defense of LAA closure (Rebuttal of Dr Mandrola's comments and opinion on Watchman)-Medscape December 01, 2016 02:30AM Admin IP/Host: 47-215-236-94.sdoncmtk01.res.dyn.suddenlink.net Registered: 4 years ago Posts: 2,295 In Defense of Left Atrial Appendage Closure - Dr. Vivek Reddy (The above link, allows access to the article discussed below: In Deby Shannon - AFIBBERS FORUM
Tony, Nice talking with you again today, Thanks for the EKGs too, though it is not a complete 12 lead. The PACs are a residual of the underlying flutter circuit that caused the recurrence of arrhythmia 13 years after your very successful index ABL with Dr. Natale. This pattern is a classic very late recurrence after 10 plus years of a stable heart after an early years a the successful Natale Pby Shannon - AFIBBERS FORUM
Hi Tony, sorry you have to reconnect with us all due to a revisit from the beast again ... Please send me your cell number and your time zone now by PM above, or via my editor@afibbers.org email address. I assume you are still in AZ, as I am, but please confirm and will call you as soon as I can in the nextby Shannon - AFIBBERS FORUM
Hey Jay, Good to hear from you! What date will you be in Austin next month? You've done really well on this index go around, especially considering your long-term extensive AFIB prior to your index ablation. As we discussed before the ablation, I was pretty darn sure you would need a two part solution for long term freedom, and it seemed a near certainty when I saw your ablation reporby Shannon - AFIBBERS FORUM
Hi Jackie, This is a pretty good overall review of the LAA Closure issue. Dr Vivek Reddy's "In Defense of LAA Closure" editorial in Medscape a little over a month ago is also excellent! Regarding whether or not it is a good idea to perform, both a basic AFIB PVI ablation and install an LAA Closure system as part of the same procedure? While a couple of groups have done so asby Shannon - AFIBBERS FORUM
Dear Friends, I am at the annual AF Symposium 2017 here in Orlando through this weekend and it was with sadness in the hall this morning that the death Dr. Mark Josephson, a true pioneer and visionary from the early days of electrophysiology, was announced. while I never had the pleasure to meet Dr Josephson the outpouring of feeling and appreciation for his continued excellence in help thisby Shannon - AFIBBERS FORUM
Quotegmperf Interesting - I received a letter today from Scripps La Jolla. Letter says Re: Consultation regarding WATCHMAN left atrial appendage closure. "per Dr Natale, you are currently maintained on a blood thinner for stroke prevention, since your ablation procedure." In summary the letter goes on to invite me to make an appointment for a consultation. It says when making an appby Shannon - AFIBBERS FORUM
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
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
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 Speckles, The easy flutter ablation apache is referring too is typical right sided CTI-FLutter or Cavo-Tricuspid-Isthmus flutter. This is a rather simple ablation that any half-way decent EP should be able to perform with very high success rates at 98% as it's all laid out with a predicted anatomical only pattern in the right atria that requires no transeptal puncture. The type of fby 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
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
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
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
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
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
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 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