Wednesday, January 15, 2020

Ablation Summary from July 2019

Back at the hotel after a fairly restful night.

Yesterday was a long day. Checked into St David's @ 0530. Was in the EP Lab @0600. As always the EP crew was upbeat and fun right up until the point I was out and woke to pleasant nurse in recovery. I really thought I would be able to get to sleep early last night but as usual that wasn't the case. I finally requested a sleep aid and was out shortly after.

My wait for a room was going to be a while so once I was fully awake she ordered me lunch and brought my family back to visit while I was waiting.
I can't say enough about the atmosphere at both TC&A or St. David's as the staffing is fabulous.

Dr Natale was very pleased with how things turned out. He confirmed all pulmonary veins were isolated from previous procedures. And successful isolation of posterior wall of the left atrium using roof and inferior posterior lines. He also ablated along the left atrial septum, floor of the left atrium, left atrial lateral wall and interior roof of the left atrium. He also isolated the coronary sinus and left atrial appendage.

For those that have been following along since last year you will remember that Dr Natale did work on my coronary sinus and LAA at that time as well. I also had an organic afib episode that originated in my LAA while he was working his craft on my coronary sinus. This was after he had already done some work on the LAA.

As you who are veterans to this process here will already know how difficult the LAA is to ablated due to its consistency and proximity to other vital organs. This limits the the time that he can spend there. So even though he had twice visited my LAA there was still a little work to be done.

Also, most benefit greatly from a single LAA procedure which may or may not completely isolate the LAA. The plus side to that is that not only does this eliminated Afib in some patients. It also increases the possibility that the LAA will still function properly eliminating the need for long term anticoagulants.

He did have some issues ablating my LAA as he normally uses a 15 mm lasso but it could not be engaged because the entrance to my laa is too small. So he just used the regular catheter and went into the left atrial appendage and isolated it that way by moving the the catheter around the interior.

When we talked this morning we went over everything that he did as well as possibilities for the future. Chances are at this point I will either be on long-term anticoagulants or we need to have the laa isolated with either of watchmen or a lariot sutcher approach. His concern at this point with a watchman would be sizing as there only two sizes and the fact that my laa entry is so small could be an issue. But that's all down the road.

He sent me home only on 25 mg metoprolol and 5mg Elequis twice a day. He does not want me taking the Flecainide unless I need it.

No comments: