Re: Natale success?

[Guest guest]

In a message dated 7/27/04 9:15:39 PM Eastern Daylight Time,

susanr20z03@... writes:

> Rich, let me try agian to reply---I agree with you, but your Ep was

> obviously no slouch either!

>

>

,

I for one appreciate your insights and thoughts. Thanks for stirring the pot!

Good job.

Rich O

[Guest guest]

In a message dated 7/27/04 9:15:39 PM Eastern Daylight Time,

susanr20z03@... writes:

> Rich, let me try agian to reply---I agree with you, but your Ep was

> obviously no slouch either!

>

>

,

I for one appreciate your insights and thoughts. Thanks for stirring the pot!

Good job.

Rich O

[Guest guest]

> .........................

> I've told by every EP I've seen that success is defined

> as " maintaining a NSR six months after the procedure without the use

> of anti arrhythmic drugs.

>

> P <MI>

>

That's great it there's some consistency out there, research articles

appear to have quite a variation. Some consider meds that work post

procedure that didn't pre-procedure a success too e.g.

http://www.pulsus.com/ccc2003/abs/a668.htm

Perhaps we should make sure we ask the EPs what their numbers are for

both procedural and clinical success rates?

--

D

[Guest guest]

> .........................

> I've told by every EP I've seen that success is defined

> as " maintaining a NSR six months after the procedure without the use

> of anti arrhythmic drugs.

>

> P <MI>

>

That's great it there's some consistency out there, research articles

appear to have quite a variation. Some consider meds that work post

procedure that didn't pre-procedure a success too e.g.

http://www.pulsus.com/ccc2003/abs/a668.htm

Perhaps we should make sure we ask the EPs what their numbers are for

both procedural and clinical success rates?

--

D

[Guest guest]

> .........................

> I've told by every EP I've seen that success is defined

> as " maintaining a NSR six months after the procedure without the use

> of anti arrhythmic drugs.

>

> P <MI>

>

That's great it there's some consistency out there, research articles

appear to have quite a variation. Some consider meds that work post

procedure that didn't pre-procedure a success too e.g.

http://www.pulsus.com/ccc2003/abs/a668.htm

Perhaps we should make sure we ask the EPs what their numbers are for

both procedural and clinical success rates?

--

D

[Guest guest]

#1]

<<<<and good as he is I'm still suspicious that he's got such a high

rate because he doesn't take on high-risk cases.>>>>

Kathleen

......................................

......................................

#2]In a message dated 7/27/2004 6:58:04 PM Eastern Standard Time,

james@d... writes:

<<<<Also, why do most others EP's report

significantly lower rates of " success " , " cures " than Dr. Natale?- I

have never been able to figure this out--He is certainly very

talented but the ablation

procedure and equipment are also being used by other very talented Eps

also-Statistics can be manipulated to show anything and I have never

been ableto medically understand the diffference in Dr. Natales rates

and others->>>>

......................................

......................................

Let me start by saying I'm not defending Natale or any other EP. And

I'm not endorsing any one of them. As a matter a fact I'm not even

sure where I'll have my future ablation done...but the CC and Natale

are definitely one of my choices. Right now I'm just hoping the

poison Amiodorone will buy me some time and keep me in NSR without

killing me.

Secondly, Natale's numbers are not all that different from other

experienced EP's.

As a matter of fact they are all quite close. If there was that much

difference I wouldn't have used the phrase " the CC and Natale are

definitely one of my choices "

According to a couple of top EP's I've talked to the best guy is Dr.

Papone in Italy who claims to have an 90% success rate on the first

try. How does a two week vacation in Italy sound? My wife didn't

buy it either......

Now I'm sure numbers are sometimes skewed in the medical profession.

I keep remembering what my GP told me: " Medicine is a business " and

what my EP told me: " There's a lot of hype in the EP field right

now " But I really believe that playing with the numbers is not SOP.

And definitely the exception not the rule.

OK, with that said, here goes:

I don't know if I'm considered high risk or not but this is exactly

what Natale told me:

#1) He has an " 80% success rate "

#2) He's had no fatalities. 2% chance of stroke. 1% chance of PV

stenosis. <basically the same numbers as I got from other EP's>

#3) He said " depending on how much scarring I have inside my heart

from my previous heart bypass surgeries that it would also determine

the success rate. " It could be only " 50% " depending on that factor

and he wouldn't know until he goes inside and takes a look. The

other EP's I've seen did not mention that little fact.

Now I'm pretty sure if he wanted to skew his numbers he sure wouldn't

want me as a patient with a possibility of only a 50% chance of

success. Wouldn't you agree?

[Guest guest]

#1]

<<<<and good as he is I'm still suspicious that he's got such a high

rate because he doesn't take on high-risk cases.>>>>

Kathleen

......................................

......................................

#2]In a message dated 7/27/2004 6:58:04 PM Eastern Standard Time,

james@d... writes:

<<<<Also, why do most others EP's report

significantly lower rates of " success " , " cures " than Dr. Natale?- I

have never been able to figure this out--He is certainly very

talented but the ablation

procedure and equipment are also being used by other very talented Eps

also-Statistics can be manipulated to show anything and I have never

been ableto medically understand the diffference in Dr. Natales rates

and others->>>>

......................................

......................................

Let me start by saying I'm not defending Natale or any other EP. And

I'm not endorsing any one of them. As a matter a fact I'm not even

sure where I'll have my future ablation done...but the CC and Natale

are definitely one of my choices. Right now I'm just hoping the

poison Amiodorone will buy me some time and keep me in NSR without

killing me.

Secondly, Natale's numbers are not all that different from other

experienced EP's.

As a matter of fact they are all quite close. If there was that much

difference I wouldn't have used the phrase " the CC and Natale are

definitely one of my choices "

According to a couple of top EP's I've talked to the best guy is Dr.

Papone in Italy who claims to have an 90% success rate on the first

try. How does a two week vacation in Italy sound? My wife didn't

buy it either......

Now I'm sure numbers are sometimes skewed in the medical profession.

I keep remembering what my GP told me: " Medicine is a business " and

what my EP told me: " There's a lot of hype in the EP field right

now " But I really believe that playing with the numbers is not SOP.

And definitely the exception not the rule.

OK, with that said, here goes:

I don't know if I'm considered high risk or not but this is exactly

what Natale told me:

#1) He has an " 80% success rate "

#2) He's had no fatalities. 2% chance of stroke. 1% chance of PV

stenosis. <basically the same numbers as I got from other EP's>

#3) He said " depending on how much scarring I have inside my heart

from my previous heart bypass surgeries that it would also determine

the success rate. " It could be only " 50% " depending on that factor

and he wouldn't know until he goes inside and takes a look. The

other EP's I've seen did not mention that little fact.

Now I'm pretty sure if he wanted to skew his numbers he sure wouldn't

want me as a patient with a possibility of only a 50% chance of

success. Wouldn't you agree?

[Guest guest]

#1]

<<<<and good as he is I'm still suspicious that he's got such a high

rate because he doesn't take on high-risk cases.>>>>

Kathleen

......................................

......................................

#2]In a message dated 7/27/2004 6:58:04 PM Eastern Standard Time,

james@d... writes:

<<<<Also, why do most others EP's report

significantly lower rates of " success " , " cures " than Dr. Natale?- I

have never been able to figure this out--He is certainly very

talented but the ablation

procedure and equipment are also being used by other very talented Eps

also-Statistics can be manipulated to show anything and I have never

been ableto medically understand the diffference in Dr. Natales rates

and others->>>>

......................................

......................................

Let me start by saying I'm not defending Natale or any other EP. And

I'm not endorsing any one of them. As a matter a fact I'm not even

sure where I'll have my future ablation done...but the CC and Natale

are definitely one of my choices. Right now I'm just hoping the

poison Amiodorone will buy me some time and keep me in NSR without

killing me.

Secondly, Natale's numbers are not all that different from other

experienced EP's.

As a matter of fact they are all quite close. If there was that much

difference I wouldn't have used the phrase " the CC and Natale are

definitely one of my choices "

According to a couple of top EP's I've talked to the best guy is Dr.

Papone in Italy who claims to have an 90% success rate on the first

try. How does a two week vacation in Italy sound? My wife didn't

buy it either......

Now I'm sure numbers are sometimes skewed in the medical profession.

I keep remembering what my GP told me: " Medicine is a business " and

what my EP told me: " There's a lot of hype in the EP field right

now " But I really believe that playing with the numbers is not SOP.

And definitely the exception not the rule.

OK, with that said, here goes:

I don't know if I'm considered high risk or not but this is exactly

what Natale told me:

#1) He has an " 80% success rate "

#2) He's had no fatalities. 2% chance of stroke. 1% chance of PV

stenosis. <basically the same numbers as I got from other EP's>

#3) He said " depending on how much scarring I have inside my heart

from my previous heart bypass surgeries that it would also determine

the success rate. " It could be only " 50% " depending on that factor

and he wouldn't know until he goes inside and takes a look. The

other EP's I've seen did not mention that little fact.

Now I'm pretty sure if he wanted to skew his numbers he sure wouldn't

want me as a patient with a possibility of only a 50% chance of

success. Wouldn't you agree?

[Guest guest]

Sorry D....I my previous post I erroneously attributed a quote

by " jerrynmn1 " to you. Sorry.

P <MI>

[Guest guest]

Sorry D....I my previous post I erroneously attributed a quote

by " jerrynmn1 " to you. Sorry.

P <MI>

[Guest guest]

Sorry D....I my previous post I erroneously attributed a quote

by " jerrynmn1 " to you. Sorry.

P <MI>

[Guest guest]

Natale is sounding better all the time. I'm glad I asked the question, and I

hope

others are benefitting from the very thoughtful analyses being posted by this

board's members. I really liked to hear from the higher-risk folks about what

Natale told them. Thanks, all. Kathleen

[Guest guest]

TO Kat in OH,

Just one clarification. Chronic is a LOT different from persistent, they're not

the

same at all. In chronic, there is no in and out, no surprises, you're just in

AF all

the time, and as long as the overall rate is kept low with beta-blockers or

Calcium channel blockers, you go about your life almost normally, save for

some energy drop. You don't " feel " AF at all. I have always felt lucky to be

chronic rather than in and out, have lived well with chronic for 15 months now.

All the best. Kathleen

[Guest guest]

> TO Kat in OH,

>

> Just one clarification. Chronic is a LOT different from

persistent, they're not the

> same at all. In chronic, there is no in and out, no surprises,

you're just in AF all

> the time, and as long as the overall rate is kept low with beta-

blockers or

> Calcium channel blockers, you go about your life almost normally,

save for

> some energy drop. You don't " feel " AF at all. I have always felt

lucky to be

> chronic rather than in and out, have lived well with chronic for

15 months now.

> All the best. Kathleen

Now I'm confused...! I thought afib that does not respond to

treatment of any kind and lasts unabated for a period of time, is

chronic *or* persistent and Afib that comes and goes, in and out,

over any period of time is intermittent or occasional.

From m-w.com:

chronic: marked by long duration or frequent recurrence

persistent: existing for a long or longer than usual time or

continuously

intermittent: coming and going at intervals

Either way, I've had 'em all...

[Guest guest]

> TO Kat in OH,

>

> Just one clarification. Chronic is a LOT different from persistent,

they're not the

> same at all. In chronic, there is no in and out, no surprises,

you're just in AF all

> the time, and as long as the overall rate is kept low with

beta-blockers or

> Calcium channel blockers, you go about your life almost normally,

save for

> some energy drop. You don't " feel " AF at all.

Some folks are lucky that way. Others are miserable in chronic.

[Guest guest]

Kathleen wrote:

> Chronic is a LOT different from persistent, they're not the

> same at all. In chronic, there is no in and out, no surprises, you're

> just in AF all

> the time, and as long as the overall rate is kept low with

> beta-blockers or

> Calcium channel blockers, you go about your life almost normally, save

> for

> some energy drop. You don't " feel " AF at all.

Rob wrote:

> Now I'm confused...! I thought afib that does not respond to

> treatment of any kind and lasts unabated for a period of time, is

> chronic *or* persistent and Afib that comes and goes, in and out,

> over any period of time is intermittent or occasional.

>

> From m-w.com:

> chronic: marked by long duration or frequent recurrence

> persistent: existing for a long or longer than usual time or

> continuously

> intermittent: coming and going at intervals

>

> Either way, I've had 'em all...

>

>

>

Hi Rob/Kathhleen,

see

http://www.affacts.org/Questions/classified.html

for the definition of the " 3 P's " .(persistent AF can be converted)

Whilst I think it's true that there is a trend toward lessening of

symptoms when going chronic(permanent) this is not a hard and fast

rule. There are some people with chronic(permanent) AF who have a real

bad time and there are folks with paroxysmal AF who are asymptomatic.

--

D

[Guest guest]

> Hi Rob/Kathhleen,

> see

> http://www.affacts.org/Questions/classified.html

> for the definition of the " 3 P's " .(persistent AF can be converted)

> Whilst I think it's true that there is a trend toward lessening of

> symptoms when going chronic(permanent) this is not a hard and fast

> rule. There are some people with chronic(permanent) AF who have a

real

> bad time and there are folks with paroxysmal AF who are

asymptomatic.

>

> --

> D

Thank you . That certainly clarifies it.

[Guest guest]

TO :

Yeah, the terminology is a pain. Help out, those of you who are in AF 24/7,

always in AF, no episodes, just permanent AF, never in nsr, never. What is

THE word(ing) that will make it clear to others what we are talking about? I've

been using chronic, permanent. I think the problem word may be " persistent, "

because that can mean either frequent or permanent.

All you 24/7ers, what do we call ourselves so that we don't confuse others?

Kathleen

[Guest guest]

To Kat:

The only time I am aware of AF is when I climb too many stairs at once, or

otherwise exercise too much. My heart then does what I call palpitations, by

which I mean noticeable and " quirky " thumps. These stop as soon as I stop the

exercise, though, within just 15 or 20 seconds. I suspect all that means is

because of the exercise each beat is a little harder, and of course because the

beats are irregular (all the time), at such moments of unusual exercise I

become aware of them. Except for that I have zero awareness of the irregular

rhythm (but it sure shows up on my periodic ECG's).

Others in 24/7 seem to have much the same situation as mine, unawareness of

AF as we go about our daily lives.

(Of course I never forget the AF because of the coumadin, the beta-blockers

and the digoxin - who could forget?)

All the best. Kathleen

[Guest guest]

TO - thanks, excellent clarifications. I communicate (directly) mostly

with those in 24/7 who are not symptomatic, and tend to forget that some in 24/

7 do have problems, even under good rate control. It's so hard to get good

stats - I wonder what percentage of those in 24/7, with otherwise healthy hearts

and under successful rate control, do continue to have regular problems with

their AF (other than the energy loss, which is at least partially attributable

to the

meds and which most of us are aware of). So many questions. Thanks again.

Kathleen

[Guest guest]

I've been 24/7 for at least a couple of months now, Kathleen-- I've

been using the term Persistent because it hasn't self-terminated (and

because Permanent just sounds too, well, permanent...). If my DC

cardioversion Tuesday doesn't work and I go back to 24/7 very soon, I

guess I'll have moved from Persistent to Permanent; if it works and I

then revert in a week or two, I guess I'll still be Persistent.

TR

In AFIBsupport , " kageygreenbay " <KageyD@a...> wrote:

> TO :

>

> Yeah, the terminology is a pain. Help out, those of you who are in

AF 24/7,

> always in AF, no episodes, just permanent AF, never in nsr, never.

What is

> THE word(ing) that will make it clear to others what we are talking

about? I've

> been using chronic, permanent. I think the problem word may be

" persistent, "

> because that can mean either frequent or permanent.

>

> All you 24/7ers, what do we call ourselves so that we don't confuse

others?

>

> Kathleen