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Then don't ask him what to do. Ask Natale's staff and do what they say. The only reason you need a local EP at all is for things like cardioversions. You shouldn't be consulting with them about your ongoing post-ablation care and they shouldn't be intervening without consulting with Natale first.by Carey - AFIBBERS FORUM
QuoteSkford Also, they didn't want to treat my flutter unless my heart rate was higher. Lose that guy. Leaving you in flutter indefinitely just because your rate's not super high is bad medicine. Go see the other one you've had recommended and although he'll likely see it in your records from your current EP, tell him up front about the ablation. If he's got a probby Carey - AFIBBERS FORUM
QuoteNot_in_Kansas When B.F. Skinner trained his pigeons with rewards they would often show superstitious behavior, repeating whatever they were doing when they got a reward. So maybe they would raise their right wing or look in a certain direction and bob their head, none of which had anything to do with the reward. I do think that people in the first stages of Afib are a bit like Skinner pigeonby Carey - AFIBBERS FORUM
Yes, I did say that. An ablation puts a fence around the areas in your atria that are producing arrhythmic signals. If done correctly and competently, nothing within those fenced areas will ever be able to cause afib again. It doesn't matter what triggers you indulge in, those areas are silenced forever. But it is possible for new sources to arise outside those fences because afib is a progrby Carey - AFIBBERS FORUM
Remember, you're not looking for an ablation maestro, and almost any EP can manage afib medically and do all the things you might need from a local EP. Since the U. of Wisconsin is in Madison, that makes the choices easy. I would suggest Jennifer Wright. She's a board certified EP, member of the Heart Rhythm Society, good educational background, solid clinical and research credentials,by Carey - AFIBBERS FORUM
Aspirin has a higher bleeding risk than the anticoagulants, especially GI bleeds, and it's less effective at preventing afib-related clots than the anticoagulants. So it's not ineffective; it's just not as effective. But keep in mind that in 2011 the only choices would have been warfarin, aspirin, and Pradaxa. I'm a bit surprised he didn't go with Pradaxa, but the data onby Carey - AFIBBERS FORUM
Quotecolindo Not just PACs plus about 10 afib events this month that I can detect. Did your ablation cure them or do you still get them? My final ablation in 2017 ended afib and PACs entirely, but that was ablation #6 and it was quite extensive. The previous 5 left me with all the sorts of crap you're dealing with now. How long do these afib episodes last? Are these just brief blips oby Carey - AFIBBERS FORUM
What you're experiencing is PACs in a trigeminal pattern. Trigeminal means ectopic beats in a pattern of threes. There is also bigeminal and quadrigeminal (patterns of 2 and 4). It's not uncommon and it's not dangerous. It is, however, highly annoying, as I'm sure you've discovered. I lived with bigeminal PACs for months. The one positive thing I observed was that after aby Carey - AFIBBERS FORUM
QuotePompon Is afib a "vascular disease"? No. Vascular disease would include atherosclerosis, small vessel disease, and similar. Basically, diseases affecting the blood vessels. And to be clear, the point for being female was removed in the ACC guidelines in 2019.by Carey - AFIBBERS FORUM
QuotePixie I have more to add to my recent post. The EP I had for several years performed 2 ablations on me. Both failed and she did not consider my case complicated. I find that extremely ironic. That's like saying, "I couldn't solve the two problems I was given but I don't consider the problems complicated." So what is she saying, that she can't solve easy prby Carey - AFIBBERS FORUM
Quotebettylou4488 So that is exactly my concern. Natale manages it but if you need a cardio version, you would have to go with an established EP that isn't following your case and might not if you chose to not do the procedure with them... That would be extremely unreasonable of your EP. So just tell them in advance what you plan to do and if they have a problem working with Natale, I wouby Carey - AFIBBERS FORUM
QuotePixie If there are issues during the blanking period and beyond would one still be Dr. Natale’s patient? Yes. Natale and his staff will continue care as long as needed. I know people who had various issues post-ablation and spent over a year under the care of him and his staff.by Carey - AFIBBERS FORUM
Shannon and I have helped dozens and dozens of people get through ablations with Natale and I can only remember 1 or 2 whose local EP objected, and those objections reeked of ego and jealousy (snarky comments about Natale, etc). Mine certainly had no problem with it and fully approved of my decision. As long as everyone understands that immediately prior to the ablation and throughout the blaby Carey - AFIBBERS FORUM
Pretty simple really. I told my local EP prior to the ablation that I was going to Natale. He was actually relieved and gave it his full blessing. I told Natale's office to copy him on everything, which they did. Natale called all the shots on follow-up care, prescriptions, etc. It just happened that I didn't really need my local guy for anything, but had I needed something like a cardiby Carey - AFIBBERS FORUM
I can't imagine any reason why Medicare would impose such a rule. All that would do is increase risk and significantly increase cost. I suspect the cardiologist didn't tell the whole story or glossed over something more complicated.by Carey - AFIBBERS FORUM
QuoteSearching9 but by no means should be the basis for medication or surgical intervention ! Oh, I promise you no doctor is going to use results from a Fitbit to make any decisions whatsoever. You shouldn't either. My wife has one and loves it. But she has no cardiac issues and loves it simply for the exercise measuring stuff. I utterly despise it because I'm the "tech suppoby Carey - AFIBBERS FORUM
Quotesusan.d YOUR link. Scroll down to gastrointestinal. Try professional and not consumer So it does. My bad. I didn't switch to professional. But I don't really believe it based on anecdotal experience. This is the very first report of GI issues from metoprolol I've ever heard, and like I said, I've known hundreds of people taking it. Going by the 1-10% numbers, I shouby Carey - AFIBBERS FORUM
Quotesusan.d Says it’s 1-10% common (not rare) to get diarrhea. Maybe Afibber20 falls into this category. Someone has to. Gastrointestinal Common (1% to 10%): Diarrhea, nausea, dry mouth, gastric pain, constipation, flatulence, heartburn, abdominal pain, vomiting Says it where?by Carey - AFIBBERS FORUM
I've never heard of anyone experiencing that from metoprolol and I've encountered literally hundreds of people who've taken it, including myself. It's also not listed as a known side effect on drugs.com.by Carey - AFIBBERS FORUM
And this is the rabbit hole you go down when you start looking up drug interactions. All your drugs interact with all your other drugs and everything you eat and drink. Unless you find things with actual warnings about combining them, you're going to drive yourself insane worrying about things that just don't matter. All things in moderation. Stick to that and you'll probablby Carey - AFIBBERS FORUM
QuoteDaisy Thanks, but I'm going to ask for clarification: is there a difference between ablating the LAA and isolating it? I had been under the impression that isolating the LAA was a 'once and done." No, there isn't. I'm probably guilty of using the term "ablating" when I should have said "isolating" but the two terms are synonymous. It shouldby Carey - AFIBBERS FORUM
Susan, we're not talking about other drugs. The only question here is fish oil with Eliquis, and the answer is known. We don't need to obsess about consulting pharmacists.by Carey - AFIBBERS FORUM
You don't need to be a pharmacist to answer this question. The literature is readily available, and the literature says it's a modest interaction that shouldn't be a problem for most patients taking reasonable doses of fish oil.by Carey - AFIBBERS FORUM
It's just a modest interaction. Unless you have a high bleed risk or you take fish oil by the bucket, I wouldn't worry about it. I've been taking fish oil daily along with anticoagulants for 12 years now. All my EPs know and not a single one has ever even mentioned it. Incidentally, I don't take it for heart health reasons (I'm not convinced it has much value in that rby Carey - AFIBBERS FORUM
QuoteDaisy I am interested in this question too as I'm being evaluated by Dr. Natale for a 1st ablation and if he finds it necessary to isolate the LAA, it would seem easiest to put in a Watchman at the same time. Does anyone know if it would be "routine" for Dr. Natale to do this if the patient has requested it, or whether there are some special circumstances necessary for him toby Carey - AFIBBERS FORUM
Yes, he will ablate the LAA if it's a source of afib whether you're persistent or not, and he won't ablate it if it's not a source. My point was that for a large number (possibly a majority) of persistent patients their LAA is a source, and the reverse is true for paroxysmal patients. That probably explains why ablations have such a miserable success rate with persistent patiby Carey - AFIBBERS FORUM
That all sounds perfectly normal. Like Susan said, the sotalol was lowering your heart rate artificially. Following an ablation it's normal for it to be elevated for months afterwards. So now that the sotalol is gone, that's what it's doing. You're fine.by Carey - AFIBBERS FORUM
Yes, it's possible. I know a couple of people on this forum who've had both done in a single procedure and another on another forum who will be having it done soon. I don't understand his reasoning unless he thinks your LAA will need to be isolated in your next procedure. But if he gets in there and doesn't find any arrhythmias originating in the LAA, I don't understand wby Carey - AFIBBERS FORUM
No, you don't need to schedule anything with him at this point. You can do that after the procedure if you feel it's necessary. Natale's staff will take care of you in the following months. They're very experienced at dealing with remote patients. If you run into problems, they will probably tell you when it's time to visit your local EP. That would probably be because yby Carey - AFIBBERS FORUM
No, that's not true at all. Not sure where you got that idea. In fact, there are only a few EPs in the country capable of isolating the LAA so most ablations never touch it even when they should. The most likely candidate for LAA isolation is someone with longstanding persistent afib who would either be rejected by most EPs for an ablation at all, or would face extremely low odds of succeby Carey - AFIBBERS FORUM