Hi researcher, Natale's group primarily uses RF because they are highly skilled in it. The good news about cryo is it's easier and faster for the PVI portion of an ablation, especially for EPs not highly experienced in RF (highly experienced meaning at least 4 to 5 years of hands on RF training in a high volume center,) and still get roughly equivalent PVI only results. There are Aby Shannon - AFIBBERS FORUM
Mike how long has it been since your LAA Isolation and have you been arthythma free for a good long while now after that ablation. If so the watchman is not a bad idea either and even if you had an arrthymia recurrence from LAA Natale could touch it up with a short touch up ablation even some months after Watchman install. But for the real 'one and done' thing the Atriclip done byby Shannon - AFIBBERS FORUM
Great to hear your report Tsco, you put that all important 'take home message' very well, indeed. First hand experience is sure good at bringing such insights home, isn't it? And for others here, just a point of clarification, the first four ablations Tsco had where all for a challenging form of right atrial SVT with runs of junctional rhythm. His first three in 1999, 2000 andby Shannon - AFIBBERS FORUM
That is an option George, the only limitation there is that the LAA is only occasionally, and not that often, the only arrhythmia source for someone who has AFIB yet who has not yet had an ablation to eliminate all the prior active non-LAA trigger sources. If you had more sites than just the LAA driving your arrhythmia ... and one larger Natale study of persistent and LSPAF had, I think it waby Shannon - AFIBBERS FORUM
Yes Liz, some Docs use Adenosine with nuclear imagining but not to convert to NSR from a high speed tachy or flutter which usually required escalating doses to do the trick. And Jackie, Lynn when I look back on it all, it has been a very drawn out roller-coaster saga, which as of next year will be a 25 year quarter century since AFIB first triggered in my heart. Amazingly, even with all theby Shannon - AFIBBERS FORUM
Did you get my Email QUe? Luis Boersma in the town of Nieuwegein at the Cardiology Hospital there about 45 minutes south of Amsterdam by car or train. Dr Boersma is probably the most renowned active EP ablationist in Holland. He was my local EP the four years when I lived in Amsterdam from 2006 through much of 2010 including doing follow up for me, when needed, after my index Natale persistentby Shannon - AFIBBERS FORUM
Hi Steve, The longer you go past about two and a half years without any arrhythmia breakthroughs from an index ablation, the greater the odds you may well be done for the long term, or at least for over 10+ years. If a repeat ablation is in the cards, it typically happens during the first 2 to 3 years tops with the earlier times ranging from 6 months post ablation through 2.5 to 3 years thby Shannon - AFIBBERS FORUM
Lynn, IV Adenosine is used to try to convert a high speed SVT to NSR in an ER setting usually, and it also helps confirm whether or not a high speed atrial tachycardia is, indeed, either SVT or rather left atrial flutter of either the typical right sided CTI flutter, or atypical left atrial flutter more commonly seen as a manifestation after catheter ablation of AFIB. If the Adenosine conveby Shannon - AFIBBERS FORUM
Just heard a while ago from Tammy, wife of David (Smackman), and also got a brief note from Dr. Natale as well. He is doing well after his ablation, and had a couple spots from the CS coronary sinus that he had to re-ablate which is a common area for having to touch up when it has not yet required full isolation of the CS in the first ablation. The main areas he had to address in this proceduby Shannon - AFIBBERS FORUM
Got off the phone with Tsco a while ago as he was just about to dive into his tasty salmon dinner at St Davids after his late start ablation today as the third case in Dr Natale's schedule this afternoon. They won't remove his groin bandages and get him up and about until around 11pm central (Austin) time. The great news is Tsco not only did fine but did not require LAA isolation todby Shannon - AFIBBERS FORUM
Good to hear Smackman, and the only thing Tammy needs to ask Dr Natale : "Is David still Breathing?" 😎 Just kidding of course, there is nothing at all to be nervous and worried about here, worry going into a follow up procedure after Natale did your first one is strictly optional on your part. This is a straight forward touch up and a relative walk in the park for not only Natale but yby Shannon - AFIBBERS FORUM
Many thanks for clarifying your roller coaster story Linda, you are definitely in the right place here. Glad to hear they are not loading the Amio all the way to the ablation, yet it takes a good two months minimum to truly get all the Amio out of the system. What they are doing is basically a process Bordeaux has experimented some with this modification of Amio preload to increase odds of conby Shannon - AFIBBERS FORUM
Yes Dr Munger is a good one too Keith. Shannonby Shannon - AFIBBERS FORUM
Hi Linda, Its usually around two months to set up both a consult and an index ablation with Dr Natale ( meaning a first ablation with him) at his Austin main headquarters. Normally for out of state folks you have the consult on the first day and ablation the next assuming you are pretty sure you need an ablation. That way you are not paying for trip all the way back and forth from home twiceby Shannon - AFIBBERS FORUM
Hi Linda, Sorry for the difficulty you are experiencing now, I understand and remember it well. You have had some challenges. Dr Stevenson is a director at Brigham and Women's in Boston and Harvard Med School and is a very bright physician who does a good deal of VT work and is a true expert at device removal such as recovery of dislodged or infected pacemaker or ICD leads. Your ICD iby Shannon - AFIBBERS FORUM
Hi Tim, I left three messages in your Ohine since Thursday but didn't hear back so figured either that was you office phone only and not your cell or that you had already gone to Austin. Call me or email me your cell while in Austin. If you should trigger into Flutter between me and Wednesday you could take 25mg of metoprolol to tide you over and lower the rate to. More comfortableby Shannon - AFIBBERS FORUM
Hi researcher, Yes you are right, its not that FIRM mapping and ablation is entirely useless, one could surmise with sound logic that even with a potentially flawed algorithm, and low quality data due to the nature of the basket mapping catheter being too small to map more than about 55% of the LA in one shot, the problem is most EPs who help develop mapping tools at a good number of other toby Shannon - AFIBBERS FORUM
safib Wrote: ------------------------------------------------------- > George, > > I agree but the question is how to pick that > doctor. John Miller was recommended to me as the > absolute best guy for ablation by a well-respected > EP in Northern Indiana (someone who in fact > developed demand-responsive pacemaker > technology). I would have gone through withby Shannon - AFIBBERS FORUM
I prefer the Country Life Coenzymated B Complex taking two capsules a day, morning and evening and add extra doses of the Country Life P-5-P (which is coezymated B6 at 50mg twice a day morning and evening with breakfast and dinner) .. I also add their 5,000mcg sublingual Methylated B-12 lozenges and take two of Country Life's sublingual 5-MTHF Folate lozenges which are 800mcg each for totby Shannon - GENERAL HEALTH 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
Hi Tim, Really no reason to be nervous, this is the most experieced EP on the planet with an outstanding team. We know you have a unaddressed flutter circuit I know it's a natural feeling approaching anything like this. And you know too this is your best opportunity to put arrthymia in your rear view mirror for the long term. Call me when you get there after your consult with Dr Nataby Shannon - AFIBBERS FORUM
Hi Smackman, They are the same drug, just stick with Sotalol and ask for the brand name if you can. I trust too that you are still in the hospital now for four days only due to the three day ramp up period for first time Sotalol users and not because they are still wanting to observe you to see if you pop back into AFIB/Flutter after your ECV yesterday? You won't be in Sotalol too lonby Shannon - AFIBBERS FORUM
Yes George, that is the key always! As we have urged people for years here, never pick and choose what ablation technology we, as laymen, may get enamored with along the way. Do your best due diligence to pick the most experienced EP doing Cardiac Ablations as essentially their ONLY focus and not some one who mixes AF ablation in with most other EP procedures and such as just one service he or sby Shannon - AFIBBERS FORUM
Good to know Peter, that it isn't the norm to discuss algorithms or even outline their overall structure in the signal processing industry and this perhaps is part of the modus operandi used by Topera/Abbott. My info on algorithm trends in medical field comes from a close friend in the neuro-diagnostic monitoring field. When in Hawaii a week before last I was discussing this issue with FIby Shannon - AFIBBERS FORUM
Hi Peter, Firstly, I highly suggest you read the related studies noted above. I'll review some of your questions or suppositions. And keep in mind, I am NOT dissing Dr Miller in any way here. Im sure he is perfectly sincere and have no doubt he is getting the numbers via his retrospective analysis that he claims. What I am saying is that when you really analyze both the OASIS-RCT randby Shannon - AFIBBERS FORUM
You are welcome Clay, Below is a partial list of the more recent and mostly independent studies showing essentially the same disappointing results as shown in the OASIS-RCT, whether using FIRM-ONLY ablation in both paroxysmal and persistent/LSPAF or mostly with FIRM + PVI/PVAI published in peer-reviewed journals since beginning of 2015. You can read the details if you wish. 'Long-termby Shannon - AFIBBERS FORUM
Clay, bad timing for me to address this buried like I am but this is part of what Im writing for this issue of the AFIB Report so will share in rough draft format some of what Im sharing there. Recently, I was sent a link to the comments that a few FIRM backer EPs had shared with my pal Mellanie at, or after, HRS 2016 in San Francison last month regarding why the OASIS-Randomized Controlled Trby Shannon - AFIBBERS FORUM
Hi Smack, As noted on the phone just a while ago, Since your combination of AFIB/Flutter that they are now calling it got up to 150bpm prior to them bringing it down under 130bpm it is good that you went to the hospital. Alas, as so often seems to be the case these things happen on a weekend when your normal local cardio or EP isn't around and in a smaller town like yours it can take a wby Shannon - AFIBBERS FORUM
PS ask Curry to confirm the local diagnosis of intraday intermittent AFIB and not flutter, while you would think any cardio can distinguish between the two, I've seen diagnostic mix ups happen periodically. Shannonby Shannon - AFIBBERS FORUM
Smack, call Curry tomorrow morning for your plan of action which is setting up a trip to Austin in your case after two years of NSR. In the meantime, if you are popping in and of AFIB they will likely not be in a hurry to ECV you in any event. So rate control and 'possibly' an AAR drug like Multaq taken until 5 to 6 days prior to touch up ablation but stopped by then to insure it is outby Shannon - AFIBBERS FORUM