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I second what Jackie just said gleeloyd ... Cheers! Shannonby Shannon - AFIBBERS FORUM
(Thanks JakeL! For the link to Dr John Day’s outstanding summary of the real value of CABANA! I consider Dr Day’s response to the largely wrong-headed Cardio journalist initial knee jerk reports, to be required reading by all Afibbers! Very well done Dr Day 👍👍!!) I obviously fully support Dr John Day, quoted above and who is a friend of mine, in his very laudable efforts at encouraging life-stby Shannon - AFIBBERS FORUM
Hi Folks. The CABANA RCT is actually a solid and overall positive report on AFIB ablation versus drugs! The knee-jerk Cardio press got it nearly universally wrong .. .not surprisingly. The primary endpoint use of an 'Intention To Treat (ITT)' analysis that has its place for sure in statistical studies, but can give skewed results, as it does here, when the drug-only arm in mid-streamby Shannon - AFIBBERS FORUM
Not much luck getting Kaiser referrals to Dr Natale over the years from our group Kong! Alas, in our long experience on this forum few, if any, Kaiser insurance holders have been directly referred from Kaiser physicians to Dr Natale, and to my knowledge, few if any other non-Kaiser physicians in other specialties have been referred too when Kaiser deems they have 'adequate' physiciaby Shannon - AFIBBERS FORUM
As Class 1C AAR drugs, both Flecanide and Propafenone can trigger a pro-arrhythmia or ventricular tachycardia, especially when combined with certain other agents. And to a degree, both drugs can cause the dreaded 1-to-1 pro-arrhythmic Atrial Flutter, even though with propafenone the Aflutter tends to be a bit slower than with Flec, Preloading with a beta blocker, or in some cases a calcium channby 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
You are more than welcome Sam! Glad you found us all! Cheers! Shannonby Shannon - AFIBBERS FORUM
Hi Liz, keep in mind too that semantics and definitions are important here as well when defining ‘LAA’. For example, when describing ‘LAA Isolation’, aspirin has no role to speak of in LAA-based and/or AFIB-Related stroke/TIA reduction. There your two choices are full time OAC/NOAC drugs with NOT missing any doses ... and/or LAA Closure via LAA Occlusion or Ligation. And going for either tby Shannon - AFIBBERS FORUM
It’s also partly preference Mike, each have their pluses and minuses and both systems have seen significant advancements in recent years. These approaches definitively have their role, especially useful in access for some VT ablation techniques. But also some operators feel more comfortable using these guidance systems for AFIB ABL as well. Remote navigation also can help lower X-ray exposure forby Shannon - AFIBBERS FORUM
Many Thanks on sorting this out with the clear explanation Carey! I’m planning on using this image posting feature in the next several days to show some slides on LAA Ligation impact on neuro-hormonal changes, as I noted in the ‘LAA’ thread below last week. I’m still collecting more slides to go along with the few I have already from the most recent ISLAA 2018 (International Symposium on Leftby Shannon - AFIBBERS FORUM
Many thanks Carey and Andy for the heads up about the spammer. We dont get too many these days, but I much appreciate the quick help in letting me know so I can zap them relatively quickly. Cheers! Shannonby Shannon - AFIBBERS FORUM
SAFIB The evidence is strong for many people in our general age group (Mid-50s and above) who ALSO have a variety of Cardiovascular issues including AFIB/ other Atrial Arrhythmias such as Aflutter or ATachy which can be worsened and/or Triggered by a revved up RAAS system. Such folks, (and I'm obviously not talking about otherwise fully healthy folks with no CVD or Arrhythmia), in fact moby Shannon - AFIBBERS FORUM
Carey is totally right here, the uninformed comments by the afib patient who wrote a testimonial on A-fib.com is full of errors that are simply misunderstood speculation by those who have never worked with LAA isolation, ligation or closure first hand and resort to pure supposition and ‘educated’ guess work starting from the initial assumed mistaken premise that LAA isolation, ligation and closurby Shannon - AFIBBERS FORUM
Yes but Tsco, you’ve had a near life long battle, starting in your teens If I recall correctly, with a variety of atrial arrhythmias treated by various docs with the first couple of SVT ablations back in the early 2000’s not being successful, until you got to Dr Natale when he still at Cleveland Clinic, after which your SVT was quiet for years until the underlying condition progressed to AFIB, whby Shannon - AFIBBERS FORUM
Completely agree with Carey and Anti-Fib here, and Ive had 14 total TEEs including 3D Color Doppler TEEs as my last 5 or 6 such procedures done by TEE Grand Maestro Dr David Rubinson at Scripps Green Hospital in La Jolla CA. NO way I would agree to a ‘gaga-thon’ with a wide-awake TEE ... just tell your Cardio ... “After you Doc, you go first!” ... I’m sure he or she would instantly change theby Shannon - AFIBBERS FORUM
Yes Jackie and Carey, Genetic research is one of the, if not the, most active sub-fields of AFIB research focus now... and has been a key focus of front line scientific research into AFIB/All Arrhythmia Research for as long as I’ve been going to the major AFIB-related EP conferences each year! Genetic origins for AFIB are increasingly better appreciated and recognized throughout the fieldby Shannon - AFIBBERS FORUM
Send me your cell number and time zone and will give you a ring in the coming week to perhaps streamline things a bit Cheers! Shannonby 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
As I mentioned to SueChef on the phone the other day, A non-insurance funded stand-alone consult with Dr Natale and his staff at St Davids should run between $250 and $300. Exact confirmation must come from the St Davids Business office, but this came from pretty much the horses mouth as a close estimate. Hope that helps. My recommendation, if you cant get Kaiser to refer you out to Dr Nataleby Shannon - AFIBBERS FORUM
Exactly right Carey, at this point the still highly experimental non-invasive radiation ablation is strictly being look at to ablate scar-related VT. Plus, Kong the notion that transeptal puncture is something that is highly risky is not the case any longer, especially when done by highly-experienced ablationists, which I trust all of our readers are, by now, fully convinced is the number one priby Shannon - AFIBBERS FORUM
Yes Joe, Atypical left atrial flutter is an not uncommon manifestation when theirvis a recurrence post ablation. Look at it like an interim arrhythmia manifestation signaling typically only one more brief touch up with a maestro like Natale in the vast majority of follow up ABLs with him. People who only had a PVI only procedure(s) are not as prone to Atypical left Flutter since when they have aby Shannon - AFIBBERS FORUM
Very nice note Mike and great to hear you are doing so well!! It’s great to see Salwa is coming to Austin now too to direct the staff there as well. We saw each other and caught up and as well with Dr Natale last week in Austin at the EP Live 2018 Conference for some fun times including a very nice 6 course Italian dinner with Dr Natale and about 25 other EPs at a fancy Italian restaurant farby Shannon - AFIBBERS FORUM
It’s late almost midnight and closing eyes but will address your questions as soon as I can redalfa. I would definitely go with the Watchman in your case. The key is to choose only a truly elite EP Center like St Davids and chose only an elite highly experienced Watchman operator at such a Center. Then you will have high odds of extremely low risks even now and very high odds of getting off OAby Shannon - AFIBBERS FORUM
Yes Teddy, It is most certainly well worth the drive south for your ablation with Dr Natale! I’ve just returned from last week in Austin attending the always highly interesting and informative EP Live 2018 Conference, sponsored by Dr Natale and his staff at St Davids and held every two years to teach both long time EPs as well as younger EPs in the making who are still in their Fellowship traby Shannon - AFIBBERS FORUM
Ditto what Carey said New Yorker. The only two things you are required to do in an ablation with Dr Natale are 1. Don’t be late to the ablation prep ... be on time or even a bit early 2. Make Dang sure you take your last dose of Eliquis right on time like 5am on moringvof procedure for example , but they will tell you the day before when to take last dose. This is part of Uninterrupted Antby Shannon - AFIBBERS FORUM
Tim let’s talk later I want to be sure what terns your local EP is using here as it sounds like he is talking about bradycardia in need of a standard dual chamber pacer which is the most common need for a Pacemaker. But don’t be signing up for any AV Node ablation in the meantime, okay! I’ll be seeing Dr Natale next week at EP Live Conference in Austin and will bounce it off him, but the termsby 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
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
Anyone claiming the ‘cure’ ALS with any modality ... much less Sugar whether fructose or glucose ... is barking up against a very tall tree of proof in my view. Announcing ‘cures’ on YouTube for devastating illnesses such as ALS, that my grandfather happened to have died of, is borderline irresponsible, if not fully over the top, and requires a much better vetted argument and evidence, again iby Shannon - GENERAL HEALTH FORUM
It is my pleasure to announce that Salwa Beheiry, the long time Director of Cardiac EP and Arrhythmia Services at CPMC where she and Dr Natale have worked for so many years, today announced that she has accepted a key position at St Davids Medical Center, and thus will continue her long-term key association with Dr Natale in Austin at the ‘mothership’. March 10th will mark the last day for boby Shannon - AFIBBERS FORUM