That's a good suggestion, George. The ISLAA presenters are all leading edge EPs who subscribe to at least some of Natale's approaches and many of them trained under him. They are the creme de la creme of the EP world.by Carey - AFIBBERS FORUM
QuoteIatrogenia Thanks, Carey. Who would you recommend at Cleveland Clinic? Pasquale Santangeli.by Carey - AFIBBERS FORUM
I don't think there is such a thing as the Natale ablation procedure, or at least not formally. It's not something you'll find anyone advertising that they do. The only way I know of to determine if an EP does as Natale trains is to find out if they trained under him, and that's not easy. You'd pretty much have to contact them and ask directly. I can recommend one EP butby Carey - AFIBBERS FORUM
That rhythm is remarkably regular when you look at it as a whole. Every six-second line has between 11 and 13 beats (one 14 beat outlier). And P waves are clearly visible, and the tachycardia isn't all that high. I don't think that rhythm would make you feel physically awful (mentally maybe), so my guess would be it's the propafenone. I know that doesn't help much because you&by Carey - AFIBBERS FORUM
I agree with George. Those are PACs.by Carey - AFIBBERS FORUM
The sick sinus syndrome may mean there's a pacemaker in your future if it's confirmed.by Carey - AFIBBERS FORUM
As my father would have said, you can't win for losing.by Carey - AFIBBERS FORUM
Refresh my memory. Why weren't they able to ablate the ectopics?by Carey - AFIBBERS FORUM
I'm not really up on what testing is available, but it's certainly more than just CYP 2D6. The word you want to look for is pharmacogenomics. Quest Labs has a webinar and links to a couple of papers that might be helpful.by Carey - AFIBBERS FORUM
I think you need a full workup to find out how your body processes drugs. That should give you some clues as to what drugs to avoid, how to dose the ones you can take, and so forth. It seems clear you're body doesn't process drugs like most people do.by Carey - AFIBBERS FORUM
Quotekliving We broke up my diltiazem 120mg cd x2 instead of 240 mg x1 I don't understand. How is that a doubling to 480? But if they did raise your total daily dose to 480, that would be my prime suspect. That's a pretty hefty dose.by Carey - AFIBBERS FORUM
Quotegloaming When I told him I just wasn't able to muster the zip I used to have, he said I couldn't blame metoprolol or the statin for that. I'm not so sure. Oh man, one of my pet peeves: Doctors who wave off the effects of drugs they've never taken. I'm pretty sure you can blame the metoprolol. Tell your cardiologist to take the dose of metoprolol you're takingby Carey - AFIBBERS FORUM
QuoteMadeline Oops, looks like I am a 3 then. Maybe you did not add my age (which gives me a point). Huh? I don't recall calculating your CHADS-Vasc score for you.by Carey - AFIBBERS FORUM
Not counting the point for being female is because of a change in the guidelines published in 2019 (I believe it was 2019, too lazy to look it up right now). The point for hypertension is counted when a doctor writes hypertension in your record. If they didn't, then don't count it. But prescribing an antihypertensive is proof they did that, and not prescribing it suggests they didn'by Carey - AFIBBERS FORUM
You're correct not to count the point for being female, but you should count the point for hypertension. I'm afraid the prescription for Farxiga probably means you need to count the point for CHF also. The PH isn't actually a criteria so nothing for that. I think you're a CHADS-Vasc 2. If I were you, I would stay on the half-dose Eliquis. Nah, you didn't hijack the thrby Carey - AFIBBERS FORUM
It's almost certainly 2.5 cm long, not wide. I've seen videos of clots a foot long being removed from legs. They take on the shape of the vein, so they're like ropes.by Carey - AFIBBERS FORUM
The first thing you need to do is calculate your CHADS-Vasc score. You can do that here. If your score is 0 or 1, talk to your EP about stopping the Xarelto. If it's higher than 1 then you shouldn't stop it. However, you could be a candidate for an LAA closure device such as the Lariat, Watchman, or AtriClip. There's a good description of them here. You're the type of patientby Carey - AFIBBERS FORUM
Yeah, it's perfectly reasonable that if they prescribed a med and you want it changed that they should handle it. An email or call to your nurse navigator should get a response within, say, 2 business days. If it's a more urgent issue, it should be 1 business day. If that's not happening, let Shannon know.by Carey - AFIBBERS FORUM
George is correct. Anticoagulants don't dissolve clots. If they did you'd see them being used in stroke treatment, but they're not. They can stop them from forming and stop them from enlarging, but your body has to do the dissolving.by Carey - AFIBBERS FORUM
What Daisy said. I got wonderful follow-up care, but a year later we began to hear a lot of complaints about this. We heard so many, in fact, that we went to Natale about it. He had no idea there were issues, but told us that there had been some turnover in nursing staff and they had lost a couple of key people to retirement. Things started to improve after that, but it took a while. It soundby Carey - AFIBBERS FORUM
Probably. You'll find a lot of discussion of vagus nerve involvement here. You're by no means alone in finding that eating and drinking affect your afib.by Carey - AFIBBERS FORUM
Quotesusan.d Why didn’t 2.5 Eliquis BID dissolve this thrombosis? It is a big 2.5cm clot..Eliquis should had stopped its growth in its tracks. Taking any anticoagulant -- or any preventative drug at all -- is a game of playing the odds. There are no guarantees the drug will accomplish what it's supposed to do for any given person. What is guaranteed is that if you give it to a large numbeby Carey - AFIBBERS FORUM
There are also devices now that allow clots to be removed by catheter. They're literally sucked out. I would consult a vascular surgeon ASAP.by Carey - AFIBBERS FORUM
Sure, if the Carvedilol is for hypertension then by all means continue it. But the Multaq and diltiazem don't seem to serve any purpose.by Carey - AFIBBERS FORUM
As far as the Eliquis goes, your EP won't recommend stopping that unless your CHADS-Vasc score is 0 or 1. They might even not recommend it for a score of 1. Personally, I wouldn't even ask about that if I were you. I'd just continue it. After 9 months I don't know why you're even on all the other stuff. I'd say it's time to find out if the ablation truly wasby Carey - AFIBBERS FORUM
I can see a few P waves and if you ignore the PACs it's fairly regular, so PACs.by Carey - AFIBBERS FORUM
QuoteNewMexican It's the BP7900 Omron Complete and 47 is the lowest value it's given me. 57 is common. No matter, I wouldn't trust its numbers because it was just plain wrong in at least one case. Numbers in the upper 50s are of no concern.by Carey - AFIBBERS FORUM
I have questions about that Omron. It says your HR was 47 but by my count it was 58. I don't even know where it got 47. Most consumer devices are really bad at counting HRs with irregular rhythms, and I suspect that's the case here. Get a Kardia if you want a more accurate count. Also, are you on any meds? Rate limiting drugs in particular like beta blockers or diltiazem?by Carey - AFIBBERS FORUM
I have no doubt it's very individual, but I always think back to my experience with MSG. I became convinced that it was a trigger for me after two incidents of afib immediately following a Chinese lunch. So to find out for sure I went to the store and bought some "Accent." Accent is really just pure MSG. So I went home, dissolved a teaspoon of it in water, and drank it. Nothing hapby Carey - AFIBBERS FORUM
But how many of those triggers were just coincidence? Remember, every time you go into afib you were doing or just did something.by Carey - AFIBBERS FORUM