![]() |
![]() |
![]() |
![]() |
![]() |
![]() |
Iatrogenia Wrote: ------------------------------------------------------- > The Redwood City office of Silicon Valley > Cardiology is about 30 miles from the California > Pacific center where Drs. Natale, Hongo, and Hao > practice. For those in particular with more challenging persistent cases, that is a valuable thing to know Iatrogenia. And StephenL, if your prospective Eby Shannon - AFIBBERS FORUM
Nancy, The list I mentioned above includes a fair number of reliable EPs spread fairly evenly across the country so you might want to confirm that none of those would work with your HMO first before considering that they are out of the question for sure. Also, you can search the archives above for Hans' ablation surveys conducted here some years back, I think the last one was 2009 toby Shannon - AFIBBERS FORUM
Hi Phil, As I note above, of course there are some good EPs with a natural gift for performing this procedure that have less overall experience out there. And whether you chose 1,000 ablations or 1,500 to 2,000 as your rough guideline for the minimum number you will be comfortable with is, itself, a a personal choice to set for yourself and is only one of the criteria to be sure. If an ablatiby Shannon - AFIBBERS FORUM
Chuck, Karen and StephenL ...Below are two new abstracts of interesting studies published in the latest issue of the Journal of the Heart Rhythm Society that touch on this issue of timing around ablations. Shannon _____________________________________________________________________________________________________________ 'Increasing time between first diagnosis of atrial fibrillatiby Shannon - AFIBBERS FORUM
Hi Karen, A 45 minute drive is in your back yard and would absolutely be very well worth it to see Dr Pinski, especially if traveling to NYC, Texas or California and being willing to wait a few months for 'the man' who mentored Dr Pinski is out of the question for you. In any event, you are lucky that a very proficient ablationist lives in your area such that if the travel issue is aby Shannon - AFIBBERS FORUM
Chuck, Kekora, StephanL, I realize you are all relatively new here and at this daunting process of getting up to speed with how to digest and interpret the mountain of information floating around out there. But all the lousy figures you are getting quotes on above are almost entirely from run of the mill centers and average EPs that simply underscore the very strong urging that us old-timerby Shannon - AFIBBERS FORUM
When I had my pacemaker replaced two years ago this coming January the anesthesia triggered my LAA Flutter .. This was prior to the LAA isolation 7 months later.. They zapped me after I came out back in my room at Queens Med Center in Honolulu at the time since I could never get out if those flutter episodes except with ECV. No big deal. Shannonby Shannon - AFIBBERS FORUM
Hi Cindy! Great news on the smooth Watchman procedure!! I'm very happy for you. Sounds like a big success to me if there are no leaks at all right after installation it usually stays that way. I am set for my confirmation TEE for my Lariat two weeks from today on Monday Sept 23 at CPMC in San Fran with learning the final verdict the next day in my meeting with Dr Natale.... And yes heby Shannon - AFIBBERS FORUM
Hi Barb, I'd be a little careful with the ginko for now Barb while on the Xeralto ... Not sure that's a great combination. Zyaflamend should be okay for inflammation and Theanine (maximum 200mg three times a day, one every 8 hours) is a very good relaxing supplement for the body, mind and heart without drowsiness. Rest up and take it easy! Shannonby Shannon - AFIBBERS FORUM
Hi Chuck, Just make sure you take a good dose of magnesium before you go to the ER or Cardio for ECV, take a good dose of potassium too if you have been low in Potassium in the past and/or have benefited by adding extra potassium to your diet or via supplementation. Request Propofol anesthesia , its much cleaner with far less hangover than versed + fentanyl that is often used for ECV. Ifby Shannon - AFIBBERS FORUM
Hi StephenL Is that four moons showing before or after a cuticle manicure ?? :-) Interesting observations from the Chinese, but for stroke risk as an Afibber I wouldn't lose a lot of sleep over it. Shannonby Shannon - AFIBBERS FORUM
Spoke to Barb again this morning and all seems well. Dr. Natale spoke with her as well, and she was trying to record it on her I-phone , but alas didn't realize she had to press two buttons instead of just one to start whatever Voice memo recorder she downloaded to make those recordings. Nevertheless, all went well and she only needed two PVs isolated apparently, though I'm not suby Shannon - AFIBBERS FORUM
Spoke with Barb again around 8:30pm NY time and she is doing well, just has a little sore throat from the anesthesia intubation tube, which is typical but not much pain in the chest she said just that little feeling in the chest like something was going on inside there today ... which of course there was ... She is in NSR and Dr Natale will either stop by later this evening or, more likely, tomorby Shannon - AFIBBERS FORUM
Hi All, I just spoke briefly with Barb in her hospital room at St. Luke's in NYC and she sounds clear and quite good. Our first conversation got interrupted after only a few minutes when the nurses came in to remove the compression bandages on her two groin puncture sites after having laid still for 6 hours after the procedure. She got started roughly around 8am though the actual proceby Shannon - AFIBBERS FORUM
Good for you Barb! We will all be sending a warm Bon voyage on Thursday morning for your little sail to the other side of the fence where hearts stay quiet and steady for the long term. Its all downhill from here, you made the best possible decision for yourself with the best ablationist you could, so just relax now these last two days as your job is truly done and its all on autopilot from herby Shannon - AFIBBERS FORUM
Hi Hans, I did read through the much larger study by Natale's group with Luigi Di Biase as the lead investigator listed in the authors listing on the LAA Morphology and stroke issue in low CHADS2 score afibbers. There was something like 932 patients evaluated by CT or MRI for LAA shape and size versus only 90-patients in the Japanese study. In the Natale group study they used a bitby Shannon - AFIBBERS FORUM
Hi Hans At the moment I only have the full Japanese study on hand called 'Anatomical Characteristics of the Left Atrial Appendage in Cardiogenic Stroke with low CHADS2 scores' Also there is not a clear demarcation between Lone Afibbers and those will one or more of the co-morbitities that certainly complicate the stroke risk picture for sure. And I agree it is not age, per se, buby Shannon - AFIBBERS FORUM
Hi George,McHale, Betty, I will try to answer the three questions/comments in order... George, that's a good question.. Dr N said he noticed some delay already in my LAA, no doubt from the TEE I had just before that first ablation in 08 in Austin, and that there was some further progress in that slowing velocity noted during the LAA Isolation ablation last Aug 2012. As such, we both kby Shannon - AFIBBERS FORUM
Most definitely for the vast majority of Afibbers in the Lone paroxysmal category the stroke risk is very low.. no doubt a good deal lower than Big Pharma would have us believe. Also, I'm convinced that when it really is early to middle stage ( meaning roughly within the first 5 to 8 years of AFI the vast majority without other co-factors like CVD, Hypertension, Obstructive Sleep Apnea, pby Shannon - AFIBBERS FORUM
Not at all Chuck, The vast majority are Paroxysmal ... thanks goodness. Persistent and Permanent AFIB is generally a more difficult kettle of fish to control. Using the supplements that can be so very valuable for so many with Paroxysmal AFIB, are very much less often effective alone when the person has progressed to persistent or permanent AFIB. Same is true with ablation which also typicaby Shannon - AFIBBERS FORUM
You're welcome Janet, I understand the difficulty in coming all the way from NZ... Please send me a personal message here with a summary of your three ablations .. What you know was done in each one and how long you had NSR before AFIB returned etc., what year was each of them done and what your current pattern ... If there is one ... Of you're episodes now. I will try to find ouby Shannon - AFIBBERS FORUM
In my experience Janet, I haven't found the supplements to work so well with taming later post-ablation left atrial tachycardias/flutters. At times they can if your activity truly is from a temporary mineral imbalance or some kind of viral or inflammatory process, but far more often the things you are discribing They are still very much worth doing but after three ablations if you are stby Shannon - AFIBBERS FORUM
Yes Bruce, I agree 'SOB' is the prefect acronym for shortness of breath for sure ... No fun at all. But your's will subside soon. Regarding atrial scar and fibrosis, its not so much that having more scar predicts the likelihood of AFIB/Flutter breakthroughs as Is implied, misleadingly in my view, with the way the data is misinterpreted in the definition of Utah Stage IV cateby Shannon - AFIBBERS FORUM
Thanks George and Hans, That's fine to use my recollection from the AZ ECV experience might be useful in your ECV report Hans. Take care Shannonby Shannon - AFIBBERS FORUM
Hi Barb, You've got about everything you need from the handy posts about including Roberts excellent summary, For the Flec at 300 , don't worry about going off but you can start to taper two days before the 5th day from the procedure by cutting the dose in half those two days and then stop it on day 5. they want the Flec ( and other AAR and rate control drugs too) our of your sysby Shannon - AFIBBERS FORUM
The best rule of thumb Chuck if you really want to do this right is to insist for yourself that you will do whatever it takes within your means, to put your heart in the hands of THE most experienced EP you and possibly and practically arrange for yourself .... similar to what RonB and McHale's did in their thorough investigation. If you can make it to Natale, that makes it easy as heby Shannon - AFIBBERS FORUM
Hi Bruce, Great to hear you've taken the first big step toward a much better ablation result in this repair process your situation necessitates. Don't worry about the shortness of breath nor the water retention, it will all get better with the passing days and within a couple weeks for sure. Sounds like Dr N needed to do the whole kitchen sink scenario on you which is not surprby Shannon - AFIBBERS FORUM
Hi Barb CABG means Coronary Artery Bypass Graft surgery. Most often just referred to as Heart or Coronary Bypass surgery in much of the lay press. And yes researcher did bring up a very good point about radiation dosing and duration of procedure as well as the fact that the most experienced operators not only do their work in less time relative to the difficulty of the work needed on a givby Shannon - AFIBBERS FORUM
Stroke risk related to AFIB is almost entirely related to thrombus clot formation in the LAA that then gets embolized and travels .. either to the brain most commonly or as a Pulmonary embolism. Such a clot in the LAA can become embolic after conversion from AFIB/Flutter to NSR or a jolt from an ECV or even a hard fall or thump on the chest and even from spontaneous dislodgement over time.by Shannon - AFIBBERS FORUM
bstevens Wrote: ------------------------------------------------------- > Awake for 150 joules of electricity to the > chest!! Think I would rather be chased by a Taser > gun. No wonder you got right on the phone to > arrange your ablation. Yep Betty, That will surely get you moving and stop trying to adjust one more magnesium dose etc, before deciding its time to hit tby Shannon - AFIBBERS FORUM