I very strongly second Jackie and Ken's advice Ken S. Please be in no rush to 'test things' with pushing exercise to the limit. Im all for getting back to doing moderate exercise gradually increasing after the first 4 to 6 weeks post ablation, but I would not try to go Iron Man style hard core for at least 6 months, and in fact would recommend dropping hard core from your vocabulaby Shannon - AFIBBERS FORUM
One more issue Peter, and for all others for who this is an important topic, Even though you showed a consistent A-wave at mitral inflow, the fact that you were not clearly in positive territory on the LAA empyting velocity but were only, at best, right on the borderline of 40cm/sec in one test and lower at 38cm/sec on the other, makes your result close, but not convincing long term. Had yourby Shannon - AFIBBERS FORUM
Peter, your question 5 above in the first post , you will Not be waylaid from exercise many months after an atriclip! They are not cracking your chest. You basically have two small main aceess ports for the laparoscopic tubes on the left side of your rib cage between two sets of ribs, and only even smaller drain spot temporarily for a day or so. The do have to deflate the left lung but that is vby Shannon - AFIBBERS FORUM
Hi Peter, I'm writing about this very topic in the new AFIB report right now and am so engaged in getting that finished over the next 5 to 7 days that I don't have the time right now to spell it all out in the typical detail , though I will do so here too after I get the newsletter sent out next week. In short though, DrNatale wants everyone to stay on the side of abundant caution anby Shannon - AFIBBERS FORUM
This post will be most relevant to a growing number of you, but is good for everyone to at least be aware of and keep in their back pocket. One issue that became abundantly clear during my 2nd follow up 3D-TEE after my Amplatzer ADOII plugging of my LARIAT leak last summer at Scripps ... as well as was emphasized at the ISLAA conference last weekend in LA ... was the need to only use a very exby Shannon - AFIBBERS FORUM
Unreal Nancy, you have documented atrial flutter and they didn't mske more of an effort to cardiovert you and just tried a few drugs? Depends on if it's typical CTI right atrial flutter which it may well be if you haven't had an ablation? If you have had a prior ablation then odds are higher it may be an atypical left atrial flutter and those are notoriously unlikely to self coby Shannon - AFIBBERS FORUM
I do think a lot of symptomatic Ectopy is electrolyte related, including skewing of sodium, potassium, magnesium balance by poor dietary choices . That being said EVERYONE on the planet has some degree of on going ectopy... Most 'normal' hearts average around 500 at least per month, but most normal none Afibbers only very rarely notice them as a once in a blue moon 'kaThump'by Shannon - AFIBBERS FORUM
Hi Ron, AS noted in my PM to you, with long standing case like yours of 13 years, even with the present decent control of Flec, you are better off getting your ablation process taken care of .. assuming you have a highly experienced ablationist on tap, as I assume you do noting that you have traveled out of state to set this up. Just know too, that not a lot of EPs are familiar with how toby Shannon - AFIBBERS FORUM
Many thanks Larry, Dennis, JohnB and Craigh, I appreciate the best wishes! Just finished the 3rd Annual International Symposium on Left Atrial Appendage conference here in Marina Del Rey along the LA coast near LAX airport. It was another really excellent conference. I really enjoy this conference best of all that I have attended so far in the AFIB world after having gone last year as wellby Shannon - AFIBBERS FORUM
Hi TSCO, Sorry to hear of your on going troubles. are you sure these are only ectopy and no AFIB or flutter/tachycardia runs? I know you don't want to have to consider another touch up. But if this is effecting you so much, please do consider discussing it with Dr Natale. He may well be able to tie up a last loose end or two once and for all, such that you share the experience of us hereby Shannon - AFIBBERS FORUM
Hi Charlotte, Thanx for sharing your very valuable 'learning' experience and I'm so glad you were able to discover this serious error before an embolic event happened. For anyone having had an LAA isolation, and they have not been cleared by a 6 month post ablation TEE confirming they have both sufficient LAA emptying velocity at or above 0.4meters/sec of blood flow out of tby Shannon - AFIBBERS FORUM
Hi Barb, you could have a bit high HR after the last ablation still but it will come down more over time ... Also, it's highly likely your HR was higher still from the 'white coat' effect of being in the Cardios office and being a bit nervous about what they might say to you or find. Even when you don't think you feel particularly nervous or concerned the white coat effecby Shannon - AFIBBERS FORUM
You are welcome David, In your brief ablation report having 'no effusion on TTE' means that no pericardial effusion was seen on 'trans-thoracic echocardiography' which is a good thing The GA is 'general anesthesia' and 'TOE' is what the rest of the English speaking world call a TEE or 'trans-oesophageal echocardiography' spelling esophagusby Shannon - AFIBBERS FORUM
Good summary of the LAA issue Bill, And thanks folks for the best wises for Magdalena, she has been a real trooper and takes great comfort in knowing she has a truely elite level kidney surgeon. All the other docs and staff at MD Anderson speak of Dr Christoper Wood there with a similar level of respect and reverance that may of us feel about art Natale. A resident physician who is workingby Shannon - AFIBBERS FORUM
Hi Mike, A quick note from Houston where my wife and I are resting tonight before our flight home tomorrow after a literal marathon week of endless testing, scanning, biopsy and doctor visits at the enormous MD Anderson Cancer Center her for planning my wife's renal cell carcinoma surgery on her left kidney, as well as other necessary evaluations. Her first step is the kidney cancer openby Shannon - AFIBBERS FORUM
Hi PhiS Once you have had an ablation, many EPs if they see any breakthroughs at all while they are monitoring things they will keep the person on a blood thinner. Which doesn't make much sense in a case like yours at 44 years old and I presume no other CVD risk factors with a CHADS2 score of ZERO in which case both the US and EU AFIB guidelines clearly state OAC/NOAC drugs are actuallyby Shannon - AFIBBERS FORUM
Great to hear Chris, another with LAA Isolation and not requiring long term anticoagulation. The overall stats seem to hold between 40% to 60% that may have too low a flow .. as I did .. after LAA Isolation and then there on the flip side around 60% to 40% who are home free ... as we have seen here as well a fair mix of both sides of the coin for post LAA isolation at the 6 months follow up.by Shannon - AFIBBERS FORUM
Hi Nick, You should do fine and thats a great crew there at Scripps Green at Torrey Pines, its very reassuring too that, once again as I have seen time and time and time again, when Dr Natale goes back in for a touch up of one of his prior ablations, especially when he did the first one and no one else has been in there, there are literally no reconnected spots that need addressing almost invaby Shannon - AFIBBERS FORUM
Thanks for the update Afjun, and good news you got this last piece of the puzzle covered now. You'll be up and about soon after only an LAA isolation. This is a common culprit especially for late appearing arrhythmia many years after a previously successful ablation, especially after a first one done by an EP as thorough and highly skilled as Dr Natale, where very rarely is there any at all,by Shannon - AFIBBERS FORUM
Hi Rita, A patient doesn't go into an ablation requesting an LAA isolation procedure, that is something that is done as a final step, typically only in more advanced cases that are highly unlikely to be effective with a straight PVAI/PVI with posterior wall isolation alone and for which even addressing other typical non-PV sources, beyond the anatomical PVI scope, still leaves very activeby Shannon - AFIBBERS FORUM
As noted on the phone just now Peter, you are good to go following the instructions from CPMC and with your good LAA emptying velocity reading as it is only that they just want to confirm that your doppler A-wave is consistently positive in the next follow up TEE in one more test before releasing you from anti-anticoagulantion needs as it is. Follow the new post colonoscopy recommendations asby Shannon - AFIBBERS FORUM
Hi Peter, That's actually not all that disappointing. 4.2 cm/sec is just above the 4.0cm/sec cut off point below which they don't want you to go without anticoagulation long term. In addition they have to confirm that there is a consistent Doppler A wave measured which each inflow into the Mitral Valve inlet of blood draining from the LAA at just above the minimum 4.0cm/s (or 0.4m/seby Shannon - AFIBBERS FORUM
Having just left La Jolla today to return home after my 3DTEE on Wednesday and a few other follow up meetings and tests after my LAA leak plug repair last July, I just missed Duke coming in this morning for his ablation with Dr Natale. The excellent news is that it was, just as predicted, a very easy straight forward paroxysmal AFIB ablation that Dr Natale completed and all in only one hour.by Shannon - AFIBBERS FORUM
Hi David, I'm sure you will do splendidly with Dr Ernst. And as I noted previously she remains my top choice in the UK. I also applaud her investigations into non PV triggers and GP ablatiion as its will very likely lead her into more productive and yet targeted extended ablation methods beyond just the PVI to the benefit of her more challenging patients going forward. It's certainlby Shannon - AFIBBERS FORUM
Hi gmperf, First off, the ocular migraines do happen on occasion four some people from the transeptal puncture but as you noted in your first ablation when you experienced that it was self-limiting and so too will this occurrence resolve on its own before long. The coronary sinus (CS) runs along the bottom border of the left atrium and upper border of the left ventricle passes close to theby Shannon - AFIBBERS FORUM
Wait a minute John21, I fully understand that docs are not always right about their prescriptions, and there are many cases where EPs and Cardios put people on blood thinners prematurely just to cover their behinds even when their own guidelines say such a drug is contraindicated, but in the case of needing a blood thinner after an LAA isolation ablation or even without such an ablation shouldby Shannon - AFIBBERS FORUM
Sounds good George, I would only add to the LAA portion, that most of the time Dr Natale will not ablate the LAA in the first procedure unless it is found to be the major, or perhaps only, remaining active trigger after he finishes the PVAI and other Non-PV trigger phase of the ablation. Only then, after all other possible trigger areas are rendered quiet and the LAA is the only or main remby Shannon - AFIBBERS FORUM
Hi Anti-AFIB, Thanks for clarifying what you were intending to convey in a couple of your posts above. And certainly OAC status at the time of ECV is a paramount question and concern of every EP doc and rightly so. I've had 16 ECVs total before my periodic left atrial flutter was put to sleep with an LAA isolation ablation. Those ECVS were done at hospitals from Holland to Hawaii as wellby Shannon - AFIBBERS FORUM
Yes Liz, there are limitations if you truly can't take blood thinners ... That's one if the big advantages of a successful ablation process if you have frequent episodes in that consistently continuous NSR is your number one protection from an AFIB related stroke. If you don't wan,t or need, an ablation then a Watcman or Lariat is also an option for those who truly can't toleby Shannon - AFIBBERS FORUM
Hi Duke, A point to clarify in Jackie's ablation report, it took a similar time frame to do as her first paroxysmal PVAI in 2003, but that's because it mainly involved CS and LAA isolation which are more time consuming to perform. But her overall procedure this time was not more extensive in burns overall. And Dr Natale had to redo only one single burn only to re-isolate one of hby Shannon - AFIBBERS FORUM