I am now one week past my second ablation with Dr. Natale in Austin, Texas. The biggest miracle of all was that when I went off of Flecainide five days before surgery, nothing happened and I stayed in sinus rhythm. My first ablation was nearly five years ago, and I tried unsuccessfully to go off of Flecainide three times during the first year post-ablation, but immediately had such miserable and chaotic rhythms that I had to go right back on it. I was so sure that the five days prior to the second surgery would be a nightmare, that I almost didn't want to get the ablation because I was so afraid that I couldn't stand that week. But, to my delight, I felt fine, except for a few weird random beats. This go round, Dr. Natale needed only 12 minutes of radiofrequency time to get the atrial tachycardia spots and to stop the circular rhythm that had developed with the A-V nodal slow pathway. Or, something like that. That was the gist of it. The previous ablation had been for afib and had taken hours. The bottom line was that when I woke up this time I had none of the chest soreness that I had after the first more extensive ablation, and by the time I could go home the next morning I felt nearly normal. The best part of all of it is that I am now no longer taking the Flecainide except as a PIP, and the hope is that I won't need to go back on it daily. I had advanced from 50 mg 2xday to 100 mg 2xday, and did not like that progression. I have been out walking the last two days, and still feel a little tired, but that may be as much from the 36 hours of driving time to and from Texas as the actual procedure. I feel so relieved and full of hope. Thanks to all here who offered me advice and encouragement, because it helped me to follow through with what I needed to do. I have nothing but praise for Dr. Andrea Natale and his team at Texas Cardiac Arrythmia. He has certainly helped get me back to normal. It was so worth that long drive to be back in his care.
Second Successful Ablation with Dr. N... - Atrial Fibrillati...
Second Successful Ablation with Dr. Natale
I am so happy for you. He is the expert of the experts in his field. I am one of his fans. 20 months of NSR after pulsed field ablation. No medication whatsoever. What else I can ask for. I keep repeating 90% of ablation success depends on the ep. Don't waste your time with ep who did not have enough volume of ablations a year. The first question I ask the ep is his/her number of ablations performed in a year. And I go from there. When I heard evasive answers as too many a year and I just ran away from them. Not only the number of ablations but also his/her mapping tools and percentages of success. He is so skilled in what he does and he is so gifted with his hands. And he came from Europe (Italy) too. And his team post op is highly professional and very close to patients. We do have choices in the States and we know Austin is far south but it is worth the trip.
hi Sean, can I get an idea how many ablations a year would a top EP do? I’m in Australia and want to do some research in case I need ablation down the track.
OK so I'm in the UK not Australia, but based on my extensive reading this last 20 years if I were in Australia top of my list would be Peter Kistler at Melbourne. 1000s of ablations during the last 15 years. Did post-doc research at the highly regarded St Barts here in the UK. A friend and colleague of Prof Pierre Jais from Bordeaux (videos of them discussing AF on Heart Rhythm TV on Youtube).
Dr. Natale (na-ta LAY) in Italian did more than 10000 ablations already. The mapping tools and the techniques play a huge role in the success of the ablation. Don’t forget he uses the tip of the catheter to ablate the rogue sources on a beating heart as a sharp shooter who aims on a moving target. Too much pressure on a same place it will cause damage and not long enough will not scar enough the heart tissue. All of that on a beating heart. You see what I meant.
I think as mcwf said 1000 ablations is very respectable number and he can be trusted.
I was so lucky to have the pulsed field ablation. No side effects whatsoever and the results are so perfect after 20 months.
As I repeat many times Afib is a progressive disease so I have an extremely healthy life style trying to manage the risk factors of Afib daily.
I am pleased to have contact with some one else who has had an ablation with Dr Natalie. I assume you have a watchman implant?
I don't have a watchman implant. I continue on my Eliquis which agrees with me very well. Maybe Seanjax has one?
I had no problems taking xeralro wrong spelling- was on from 2014-2019. He suggested it be best for me as I age- I am 75 afib officially since I was 67
that’s Dr Natalie who suggested I have the Watchman. I made three follow up TEE tests after the ablation. Had the Left appendage ablation and other touch up I. Covid year 2020-touch up 2921 and watchman, 21-22 follow up. Absolutely wonderful NSR for two years. Started Having some funky - extra beat only at night somewhere along the line- Natalie i m not worried about it But it progressed to more numerous bouts
I will continue this thread later
when you have the left atrial appendage ablated, it does not contract well after ablation and blood clot can form inside it easily. That is the reason of the watchman. The LAA is usually the source of intractable Afib and or atrial flutter. So the mapping is critical here too and the skill set of the ep is paramount here because it is tough spot to hit.
One more reason to see the expert of the experts ablationist.
Is it your understanding that you will always need a watchman if the LAA is ablated or can you decide to stay on the eliquis? I am considering an ablation with Dr Natale for the purpose of stopping the afib and getting off a beta blocker; the eliquis I take now does not bother me. I know he can't decide on whether a PFA will solve the issue until he has done the intervention and the mapping; thus, the possibility of RF for the LAA. I want the ablation but not the watchman. Thanks for any response
Yes, you can have LAA ablation without watchman and stay on Eliquis. Even with watchman baby aspirin is needed or half dose of eliquis. I don’t know if PFA is applicable on LAA. Please see with Dr. Natale. Good luck.
Hi JeanJax, I would like your opinion on watchman.
I’m scheduled next week for RFA after my failed PFA ablation 21/2 months ago (was my 3rd ablation). My appendage was ablated and has no contractibility and my CSN was also ablated: Appendage and CSN are not isolated, thusly the redo.
I’ve been on eliquis for 4 years with no problems. I’m 67, very fit and on a healthy diet for 30 years. No alcohol or smoking.
Dr. Natale wants me to get a watchman and I’m worried and would rather opt for waiting and do it at a later date…if at all.
Thank you for sharing your expertise and knowledge on this forum. I so appreciate reading your posts.
Thanks you so much, Jean
Watchman is required since LAA has no contractibility. Trust Natale, he knows what he is doing . It is a quick operation . They have exceptionally talented ep to do the watchman. Please don’t wait. Good luck
Thank you so much. Wow…required …so the stroke risk is that bad?
Natale will be doing it.
Oh…maybe that’s a ignorant question, but when you say „ required“ do you mean it’s protocol in hospitals, a legal requirement, or because it’s too dangerous otherwise, even if the patient is reliably on AC?
Thanks again…
Anticoagulant protect us 70% from stroke. Watchman adds an extra layer of security and allow you not to take i anticoagulant anymore. Trust him . .
Thank you
agree with SeanJax
Thank you inquiring foxchase15
…but, here is my not-so-good personal experience
My PFA ablation (10 weeks ago) by Dr. Natale included the LAA isolation and the coronary sinus node. I’ve have had the worst kind of arrhythmias and now permanent flutter since the ablation. The flutter is intractable so I’m on rate control. Before, I only had proxismal AF. Needless to say my quality of life has bottomed out.
In my meeting with him a week ago I found out that there is only an about 40% success rate in using PFA for the coronary sinus node, as the tissue to penetrate is too thick. He said that PFA needs to be practiced more to add data to figure out what works where. Currently, usually a follow up ablation is needed.
I didn’t know any of that since I was told that I would get a RF ablation months before the procedure. Consequently, I didn’t research PFA.
PFA became approved only in February of 2024 by the FDA (USA) …which was shortly after my meeting. Wayyyy too new for my taste, had I been given a choice.
In addition, he stated that generally the LAA is very difficult to ablate and it also tends to reconnect rather quickly after ablation…thusly requiring a follow up ablation.
My LAA is „dead“ now, meaning there are zero contractions. I was told that I now need a watchman for sure, since my stroke risk with a dead LAA while in NSR is the same as during AF.
So…I’m scheduled for a RF ablation in one week to do what the PFA didn’t do on the CSN and a correction of the LAA….plus a watchman.
…so I’m undecided and feel pressured. My concern is that there are going to be never ending follow up procedures to correct the „side effects“ of the previous procedure, each of which introduce another possibility of side effects on its own.…just like medications..except irreversible.
Readio frequency is older, well known, with a good successrate and I would have preferred it, especially since it was my third ablation.
Dr. Natale is probably the best there is concerning experience and skill level.
I do not like jumping on the bandwagon of the newest and most advertised procedures and medications that have no sufficient clinical track record and therefore the patients are providing the clinical data without being formally participating in research. I have read most available reasearch on the subject.
There is a cardiology symposium in London right now (ESC) and a publication for the new guidelines for AF 2024 ESC is available.. Great read and help with reference to research, applicability, and a guide how to manage and treat etc. in clearly outlined steps..
escardio.org/Guidelines/Cli...
I hope my very long story can help. 😊
I am 1000 miles from Texas. I had had three prior ablations, many cardio versions, on Flec, amoodarone, metoprolol and Ditalzam. Was i permanent afib/flutter for a tear after my third before seeing Dr Natalie.
It's good reading such a success story. I hope you continue in NSR and enjoy life -- spring's on its way!
Thank you. You too!
Needing encouragement to cut back on Flecainide, post ablation!
Rhythm control drugs after ablation
Successful ablation
