It really is more than a little surreal taking it easy now propped up on pillows in my hotel room bed and only just over 48 hours after the Lariat! Very dream like. I had no effusion at all on the last two Echo's so was good to go. They give you 0.6mg of Colchicine twice a day for the time in the hospital post Lariat and for seven days after release to help reduce any inflammation and loby Shannon - AFIBBERS FORUM
Thanks Barb and Tom, And Barb, I will try to get word to Hans or Jackie the same day of the Lariat next Tuesday via my wife or brother who will both be there at St David's if I am unable to access my Iphone or Ipad that first day and night since Ill have to spend that one in cardiac ICU where such electronic gizmos may not be allowed. I should be able to write something by the following dby Shannon - AFIBBERS FORUM
Hi Friends, Just a quick update from Houston where my wife and I are enjoying visiting some of my family before we head up to Austin by rental car day after tomorrow on Thursday. As posted previously here, I was originally scheduled for a Transesophageal Echocardiography test at 8:00am Monday Aug 5th in Austin followed immediately by the Lariat procedure with Dr Natale and Dr Burkhardt doinby Shannon - AFIBBERS FORUM
That's pretty quick Ken, Some where on the report they will show the total procedure time too. It could be they called your wife toward the end but it may still have gone around 2.5 hours as I know Dr N always waits a while after the burning part before doing the isoproterinol challenge to make sure everything is holding well with no breakthroughs. But however long it was, one of theby Shannon - AFIBBERS FORUM
Hi BruceS, Great news... You are truly in the best possible hands for a man in your shoes with 7 priors ... sounds like a rap sheet at the police station Ha ! In my many visits to Dr Natale's offices in both Austin and San Francisco over the years I've had the chance to meet and compare war stories with easily a couple dozen people at least waiting to see him, either as a first aby Shannon - AFIBBERS FORUM
Hi Barb, We can all certainly understand and sympathize with the difficulty of your decision in light of your husband's unexpected serious illness. We've discussed my view on the phone and I appreciate how it can seem overwhelming when the time comes to make a decision with your husbands treatment now getting started. I've heard of very very few .. none really ... where theby Shannon - AFIBBERS FORUM
Hi Iatrogenia. Some work on the back wall of the left atrium is a very common non-PV area for ablation. Most more advanced ablationist will look to do this for most patients unless they are confident they are truly only triggers from their PVs alone. Typically, either where they find some degree if fibrosis, or a longer history of AFIB and possibly with longer episode duration and definitely wby Shannon - AFIBBERS FORUM
Hi Betty , The last I checked in February they had done around 50 Lariats in Austin but there have been a good deal more since then , but I don't have an accurate number at the moment. Both Dr N and his highly respected EP colleague Dr David Burkhardt there do the procedure together. There have been zero deaths associated with the Larist out of the 1,200+ done so far world wide. It isby Shannon - AFIBBERS FORUM
You're welcome researcher, Yes the early work with the watchman had me concerned too, fortunately they seem to have improved things a good deal and the reported complications are a good deal less, with no deaths that I've heard of directly attributable to the device in the more recent trials. You are so right too that adding a wider array of sizes and improving implantation techniqueby Shannon - AFIBBERS FORUM
Lariat: Part -II After my choices became clear between a lifetime of anti-coagulant drugs or a still very new minimally invasive heart procedure to essentially remove a part of my heart that came as part of the original equipment, I've tried to learn and digest all that I could about the various pros and cons to be able to make the best informed choice. While conceptually I do prefer tby Shannon - AFIBBERS FORUM
Hi All, A few here have asked for more information on the new Lariat procedure for ligating ... or tying off ... the left atrial appendage which most of you are aware is 'stroke central' as far as AFIB related strokes are concerned. It is within this side pouch hanging off the upper anterior left side of the left atrium in which the vast majority (around 95% or more) of AFIB relatedby Shannon - AFIBBERS FORUM
Some are one and done Tom meaning a few years with not much action at all, but realistically to go for longer term success I think a substantial majority might require that skillful touch up. It all depends on the level of fibrosis to start with and the duration of AFIB. Those that have very sporadic paroxysmal AFIB that always converts within a few hours, they are very likely to get a long tby Shannon - AFIBBERS FORUM
Hi Tom, Yes, the doctor always will, or should, inquire into any past or present medical issues that might be important, and I suspect that was done by Natale's nurses when doing the intake questionare. Dr. N may well have also asked about Ken's health history some himself? The point being that its always a good idea as a proactive patient to make sure any thing going on with you isby Shannon - AFIBBERS FORUM
Hi Cindy, Sorry to hear that your Lariat procedure had to be aborted, but that can happen on occasion. Particularly if there is some adhesion scar formed between the LAA and the outside of the Left Atrium or other adjacent structure to the LAA. Also about 20% of people are not anatomically compatible with the Lariat due to too large or odd shape of the LAA relative to the pre-tied 40mm diametby Shannon - AFIBBERS FORUM
Hi TomB, Sorry to hear of the late breakthrough, but its very rare for anyone to be 'one and done' with persistent AFIB. Just too much structural remodeling and extra trigger sources outside the PVs have taken place in most persistent cases to be finished with one ablation. I strongly encourage you to seek out the very most experienced EP with persistent AFIB follow-up ablations tby Shannon - AFIBBERS FORUM
Gianfry59, Even is Dr N had to eventually go in and isolate your LAA, there is roughly a 50% to 40% chance you would not need to take blood thinners for life. Dr N now routinely tells everyone who might need an LAA isolation to expect to need blood thinners for life if he has to isolate the LAA as that is psychologically easier approach to expect it up front and then be told the good news asby Shannon - AFIBBERS FORUM
Hi Barb, Was nice speaking with you on Sunday and this morning, glad that your meeting went off fine with Dr Dr Natale, he is very easy to like. Questions, often even more of them, are par for the course after a first meeting. Lets review some of what we discussed on the phone this morning for the others here following this thread. 1. I can imagine the initial questions of Natale'sby Shannon - AFIBBERS FORUM
Thanks George My mistake was starting to type on my I-phone to begin with last night. By the time I realized this was going to take some explaining it was too late to shift to the computer and start all over again so I slugged through it. I don't claim to have good manual dexterity with these tiny virtual keyboards and I'm still working out the finger cramps today! Anyway, gladby Shannon - AFIBBERS FORUM
Hi Steve, I have warfarin resistance, a genetic issue, and currently must take 12.5mg of brand name Coumadin a day (generic Wafarin has too much variability in INR and creates even faster INR swings in me than does Coumadin ... A common finding for many with a sliding variable INR range. I definitely have significant GI issue on Coumadin, don't like taking it at all, but not switchingby Shannon - AFIBBERS FORUM
Hi Bruce, Sorry to hear of your long ablation history without success as yet! Nope, I don't work for Dr. Natale, I'm just a very satisfied and grateful long-time customer and have gotten to know him well over the years spent in the trenches as he has greatly helped dig me out of a couple of deep holes. I had a pretty extreme case, and thus working through all that, coupled with my owby Shannon - AFIBBERS FORUM
Depends on which anti-coagulant and how soon after the flip back into NSR they stopped Anti-coagulation. There is a heightened risk with Xeralto and Eliquis if one abruptly stops these drug without switching back to Coumadin or Lovenox for some time, regardless if you are in NSR or not. With Coumadin, if you had been in AFIB and also been in a therapeutic INR range for less than a month leadinby Shannon - AFIBBERS FORUM
Hi Ken, You are welcome, there is a lot to learn and digest with this business for sure. Keep in mind too that in the event your AFIB is advanced enough to require a second touch up procedure at some point down the line, and he does find then that your LAA is the last remaining culprit, there is still a roughly 50% chance that even after an LAA isolation your emptying velocity may well be aboby Shannon - AFIBBERS FORUM
Hi Ken, That is par for the course that Dr, Natale to tell you that he would not target the LAA in the first ablation, unless the mapping indicates your LAA is either a major, or even the only, trigger source for your AFIB. Especially, at the relatively younger age of 55. He usually reserves any possible LAA isolation work for any possible second ablation, if that turns out to be needed? And wby Shannon - AFIBBERS FORUM
Hey Steve, good to hear its all over but the healing! Welcome to the Foley club .. where its no fun all the time :-)! I've had that unique displeasure to have had a Foley four times in my life and the first two were a bit of an adventure, while the last two during my first persistent AFIB ablation with Dr N there in Austin at St Davids in 2008 and again with my LAA isolation ablation withby Shannon - AFIBBERS FORUM
You are welcome Bruce, Nel and Murray, I've had a total of 16 ECV shocks in my day ... 14 in a period of 15 months ... and hopefully have seen the last as well. But it wasn't until that last one a year ago next month, in which I was wide awake when they hit the button and felt like having a 480 overhead power-line thrown on my chest with a mini-atomic bomb going off through my head aby Shannon - AFIBBERS FORUM
ECV Youtube video I know some of you have asked about what an electrocardioversion (ECV) is like and this link to a YouTube video is a well done example. I had one on my 14 ECVs, that I had over a year and a half period prior to my LAA isolation ablation last August, filmed as well on my I-phone showing much of the same thing, only with a little bit more flopping around with my arms once tby Shannon - AFIBBERS FORUM
HI Mike,' I realize their stats sound great up front, but keep in mind this is from a very much smaller pool of patients and , and while the whole mini maze approach has its assets for sure, don't let anyone kid you that it is a walk in the park. I know now of six people now who have had a mini maze from one various surgeons plus the detailed reports of Five Box here with his good reby Shannon - AFIBBERS FORUM
Hi Ron, Theoretically, there is supposed to be no real added consequence to having to take higher doses of warfarin to achieve a therapuetic INR. However, in my personal experience, since I have demonstrated genetic warfarin resistence and have needed anywhere from 15mg/day as during my first period on Warfarin in 2008 for 6 months both pre and post first ablation and now going on 9 months stby Shannon - AFIBBERS FORUM
Hi Neroli, I just saw your PM and will try to answer it in detail in the coming days. I just returned from a week in Santa Fe to help out my brother who was suddenly hospitalized with a serious diverticulits perforation emergency. He is doing slowly better now and I am getting ready for a long series of trips starting with seeing Dr. Natale week after next in SF for my follow up TEE after my LAAby Shannon - AFIBBERS FORUM
It depends on where you get it and what kind of procedure .. to a degree. My follow up was around $48,000 billed to insurance. Of that around $12,800 was for Dr Natale specific procedural steps. My first longer and more complex ablation in 2008 at St Davids for persistent AFIB was billed to insurance at $80,650 in total, but I had to stay there four extra days in the hospital due to so mucby Shannon - AFIBBERS FORUM