Cured at the Cleveland Clinic
By Susan Richards, 2005
Steve [Ryan] asked me if I would write about my ablation with Dr. Natale. I am honored to do so, because Steve’s site was the first I found on the net after I was diagnosed with A-Fib. His description of his own ablation in France, and the excellent information he gave, as well as links to other websites, were very helpful to me.
I was diagnosed with A-Fib on October 23, 2001 at age 51. The trigger for me was the events of September 11. I had a very bad anxiety reaction to those events—not helped at all by the fact that my husband had left the evening of Sept.10 for a business trip to Europe, and couldn’t get back for some time. I started having episodes of breathlessness and a pounding heart. I thought I was having panic attacks. Most people who know me well would describe me as being a strong person, and I have always thought of myself as a person who could handle crises without becoming unglued. So, stupidly, I waited until my scheduled check-up appointment with my PCP, Dr. D. in October. Meanwhile, I tried to exercise myself out of these “panic attacks”. I went to work as usual, did all my normal activities, but I knew I was in trouble.
When I went for my appointment with Dr. D in October, I didn’t want to tell him about the symptoms I had been having, because my husband and I were planning on leaving the following day for a relaxing road trip through Vermont, and I desperately wanted to go on that trip. For some reason, he took one look at me, and checked my pulse rate. It was too high for him to count. He listened to my chest and said, “You are in atrial fibrillation. Can’t you feel that?” An EKG confirmed the A-Fib, and I had to come clean about the symptoms I had been having.
He sent me directly to the hospital to be admitted by a cardiologist he knew, Joseph Pennington here in Wilmington, DE. Dr. P turned out to be a young cardiologist who had only been in private practice for two years, after completing his EP fellowship with Frank Marchlinski at the University of PA. Dr. P has taken excellent care of me ever since.
My heart rate was over 200 bpm in the ER. Dr. P put me on Cardizem and heparin drips, and ordered the normal tests, echo, nuclear stress test, blood work. Everything checked out well, except for some enlargement of my left atrium. He offered to do a TEE and cardioversion before I left the hospital, but I just couldn’t get my mind around all of that. I needed time to think. So I went on Coumadin, to be cardioverted a few weeks later.
Two cardioversions in the month of December only lasted for a few days. So I went back to the hospital to start sotalol. Dr. P tried sotalol first, because I was having a problem keeping my heart rate down. After two days in the hospital and a number of doses of sotalol failed to convert me, my EP performed another cardioversion before I was discharged. This CV only kept me in sinus rhythm for a few hours. But I kept taking the sotalol; and within 10 day, I was converting on my own.
To make a long story short, Sotalol kept me in NSR only a few days out of a week. I was grateful even for that, but I felt like a zombie on Sotalol. We tried Rythmol, which seemed to make me worse and caused severe GI distress. I then went off all drugs except Coumadin for a period of about 6 months and had an episode only 3 or 4 times a month. When my episodes and heart rate started to increase again, we tried flecainide in March of 2003, and that worked best for me. Unfortunately, I developed A-Flutter in late 2003, probably caused by the flecainide, and my EP performed a successful right sided A-Flutter ablation in October of 2003.
But despite the drugs, I never went without an A-Fib episode for longer than two weeks.
Fortunately for me, My EP had been trained to do PVIs during his fellowship with Dr. Marchlinski. He and another former fellow were the first to do them here in Delaware. He had only done 10 in private practice the day I met him. He told me that I was an excellent candidate for the procedure which, he said was new and revolutionary, but not experimental. And he offered to do one for me. His success rate then was 60%, that is 6 out of his 10 patients were cured, and he described each one of them to me. Or, he said, you can go up to Penn and have it done by Dr. Marchlinski.
I decided to go for a consult with Dr. M. in March of 2003. He agreed that I was an excellent candidate, and I got on his list.
Meanwhile, I had found my way onto these A-Fib websites. I was primarily interested in hearing about who had gone for an ablation and where, and who was having success. Not a lot of people were going for ablations back then, but the name that kept coming up was Andrea Natale at the Cleveland Clinic.
I talked this over with Dr. P. He suggested that I might also want to check out Dr. Morady in Michigan, who was having a lot of success with the Pappone procedure. But Dr. Morady was out of network with my insurance company. But I did go down to Baltimore to see Dr. Calkins, who was doing the same Pappone procedure.
But before I went to see Dr. Calkins, I went for a consult with Dr. Natale. Dr. P had written letters with my history to all three of these doctors. Dr. Natale walked into the exam room, and the first thing he said to me was, I am so sorry for your long struggle with atrial fibrillation. My husband was in the room, also Dr. Natale’s nurse, Christina, with whom I had talked at length just before. But Dr. Natale never took his eyes off mine, as he answered all of my questions and described his procedure. He called it a pulmonary vein antrum isolation, a PVAI. He stayed far enough away from the openings of the pulmonary veins to try to avoid pulmonary vein stenosis, that is constricture or narrowing of the pulmonary vein. He told me he had done over 1000 ( I later learned that he had done over 2000), and that he did 3 per day, every day. He told me that he would be happy to do an ablation for me if I was agreeable, and I said yes. I went for an echo while I was there, and it showed my left atrium measurement at 5.0. I was worried about this, having heard that the size of the left atrium was a factor in the success of the ablation, and I emailed Christina. She told me, we don’t just measure the diameter, we also measure volume (and another measurement that I don’t remember), as well as your overall health, and you are well within our parameters.
I did go and see Dr. Calkins. I liked him, but he told me that he had only done 300 A-Fib ablations total. That was in July of 2004. He told me that I should go on amiodarone immediately to prevent any further remodeling of my heart, and he even wrote me a prescription for amiodarone, which I never filled.
I went and talked all of this over with Dr. P, who agreed with me that Dr. Natale was the one to go to.
That was in July 2004. Fast forward to February 14th, 2005. A very cold and rainy Valentine’s Day when we arrived back in Cleveland for my ablation the next day. Soon after we had checked into the Intercontinental Hotel and Conference Center, I received a call from the A-Fib nurse telling me that I would be the first case the following day, and that I would need to check in at 6 am the next morning at the Heart Center. My husband and I were very tired, but went out anyway for a very nice meal at the historic Chop House in downtown Cleveland.
I didn’t sleep very much that night, but was quickly processed through at the Heart Center in the morning. I got up onto the table in the EP lab at 7:30 am as scheduled. All of the nurses and techs came in to introduce themselves to me and explained what would happen to me. My nurse/anesthetist, Eric, told me what to expect with the conscious sedation. Dr. Sergio Thai, who was Dr. Natale’s fellow and assistant that day, also came in to introduce himself. And then we got underway.
I was somewhat surprised to find myself sedated, yet awake and aware. Dr. Natale had told me that he would be in for the ablating only, so I was surprised to see him come in early, and he put my catheters in himself. Very quickly, it seemed to me, they started the ablating. Dr. Thai and Dr. Natale worked very quickly and quietly together. At some point, I went into A-Fib and they were not able to cardiovert me out of it. But they continued with my procedure, now on my beating and fibrillating heart. Eric kept telling me to breathe shallowly during the ablating, because my deep breathing would make it more difficult for the docs to manipulate the catheters. I did my best to comply, but kept falling asleep. And Eric kept waking me up.
Finally, it was done and I was allowed to sleep. I woke up when the nurses were putting pressure on the catheter sites at the femoral veins. I was transferred to the recovery area and had to lie on my back and keep my legs straight and still for six hours. I slept through most of that. I did not have to have a Foley catheter for the procedure, but I did need to use the bedpan towards the end, but that was not nearly the ordeal I thought it would be.
I was soon transferred to a very nice newly renovated room, where I spent the night. Once the six hours were up, my nurses removed the pressure bandage at the groin catheter sites. My nurse told me she could see nothing but three tiny pinpricks, no bruising, no bleeding. I was then able to be up and around. My nurses checked on me very frequently, and they all seemed to be so happy for me. The monitor over my bed registered nothing but strong NSR. I was discharged early the next morning, just after breakfast.
I was discharged with a trans-telephonic monitor with which I could transmit my ECGs directly to the nurses and doctors at the CC. In the first four weeks post ablation, I had 3 to 4 episodes of A-Fib, then some episodes of PACs during the following 2 weeks, then nothing but wonderful normal sinus rhythm to this day.
I went back to Cleveland for my follow-up in June of 2005. I had a number of tests. Blood work, an EKG, an Echocardiogram, a chest CT scan. All tests results were very good, no pulmonary vein stenosis, and my left atrium had shrunk, for lack of a better word, back to 4.2, with more shrinkage expected.
I am fully back to my life now. About a year ago, I joined a gym, hired a personal trainer for a couple months, and have been working out ever since. Because my CT scan at the CC showed some plaque in my coronary arteries, my EP sent me for a nuclear stress test last January, which I passed with flying colors and an ejection fraction of 70%.
I am very grateful to Dr. Natale and his team for my successful procedure. Dr. Natale told me at my follow-up that he did not think that I would ever have A-Fib again. He told me at that time that he had only had 14 late recurrences out of the thousands he had done.
But I am also very grateful to my own EP, Dr. Pennington. He gave me hope at the very beginning when I was so frightened. Hope that there was a cure for me. He pretty much single-handedly pulled me through 3 1/2 years of very symptomatic A-Fib and kept me functioning to the point that I was able to go to work every day. And even go on some far away vacations, to Hawaii and the Caribbean.
I am almost 56 now, and I am feeling great. I have and will continue to recommend to anyone that they should go to Dr. Natale, if they are considering an ablation. Dr. Natale now thinks that ablation can be the first order of treatment in certain patients.
It remains a mystery to me why people continue to go for ablations with inexperienced EPs and sometimes have disastrous consequences, when many of them could have gone to Dr. Natale, just as I did.
My very best to any of you who may have been recently diagnosed and are looking for some answers. This site is a terrific place to start.
(Dr. Natale has moved to Texas Cardiac Arrhythmia in Austin.)