February 19, 2018

Ask Dr. Andrea Natale Your Questions About Atrial Fibrillation

You can take advantage of a rare opportunity to ask famed electrophysiologist and “catheter ablation maestro” Dr. Andrea Natale your questions about atrial fibrillation.

Learn more …

UPDATED 8-17-2008: “Ask Dr. Natale” is now closed, but you may now ask questions of Salwa Beheiry, who works very closely with Dr. Natale. Click on the link above to learn more and to go to the site where you can ask Salwa your questions.


  1. HELP!!! I hace an urgent question for Dr. Natale about AV Nod ablation and depending 100% on pacemaker!!! Who can help me?! Is anyone in this group gone through this?! Please help!!!

  2. Melanie, I had my ablation about 6 weeks ago. I’ve started having a few episodes of afib; however, over the weekend, I had several episodes that were actually worse than before the ablation. They lasted up to 4 or 5 hours. Is this common?

  3. Mellanie, I’m set for an ablation this month. I’m 55 and in very good health (an endurance athlete). I’m hoping I won’t have to continue taking warfarin for the rest of my life???

    • Rick,

      Are you currently taking a blood thinner? If so, you may need to continue after your ablation as the risk of silent afib is greater after an ablation. And if the left atrial appendage are is ablated, there is a definite need to continue with blood thinners.

      We are presuming you are having a catheter ablation, not a surgical ablation (maze or mini maze). After surgical ablation, since the left atrial appendage is often removed, blood thinners are usually discontinued. That can also apply when the left atrial appendage is tied off of occluded with a catheter procedure, but that is usually done at the same time as catheter ablation.

      Good luck with your ablation! We hope it goes well. You may also be interested in this article:
      Catheter Ablation May be Better Atrial Fibrillation Treatment than Drugs for Serious and Professional Athletes

      Melissa @StopAfib

      • Thank you so much Melissa. My ablation went very well. Feeling great; however, I’m still having a raspiness that isn’t going away. I asked the question about it, and was told it was due to the anesthesia; however, I still have it. It occasionally almost goes away, but is there most of the time.??

  4. In the May 17, 2012 issue of the New England Journal of Medicine, the results of a multi-year study comparing aspirin and warfarin in heart failure and sinus rhythm were published.  Apparently, it was determined that aspirin is just as effective as warfarin.  In April 2010, Dr. Natale performed a PVA on my brother who will soon be 68 years old.  He took warfarin until Pradaxa was approved by FDA.  At our request, Dr. Natale prescribed Pradaxa and he has taken Pradaxa ever since.  We are wondering if aspirin would be as effective as Pradaxa without the risks that are currently being associated with Pradaxa.
    Thank you.

    • Ruth,
      Aspirin has been proven to NOT BE EFFECTIVE for stroke prevention in atrial fibrillation, and many of the guidelines are in the process of being changed to reflect that. We have a wonderful video interview on this subject with Dr. Albert Waldo, a world expert; we are in the process of editing and transcribing it and we’ll post it in the next week. After catheter ablation, patients are continued on warfarin or one of the new drugs to prevent afib strokes based on their risk factors. Aspirin is not considered effective for preventing afib strokes, regardless of how effective it might be for other uses.

  5. Dave Peterson says:

    I have had two ablations and now am in atypical fibrillation. My Dr. (David Burkhardt) is giving me the option of drugs or another ablation to “isolate the appendage”. Can you give me a description of how that works( risks -rewards) . Dr. Burkhardt has described the procedure but I’d like some more. Thank You — Dave P.

  6. Anne Corris says:

    I am 56 and have suffered from paroxismal AF for over 10 years. and I take Aspirin and Flecainide. I had an oblation procedure 3 years ago, however since then the AF has got worse. Sometimes it ia so bad I am unable to stand and is so violent that you can see my chest vibrating with the force of it. I tend to want to go to sleep and it has usually gone when I wake up 6-10 hours later. I also feel the need to drink small quantities of ice-cold water. If I go to hospital, it takes upwards of 12 hours to correct with drugs, but the last time this happened, my sinus node did not kick back in and I had a 7 second pause, so they fitted a pacemaker. Do you think that I should have another oblation treatment? What type of medication would you recommend? I have always felt that the medication I have been on does not keep the AF at bay when it decides to kick in. I was put on a beta blocker, but apart from making me extremely tired, if anything I had more episodes of AF.

  7. John Brewer says:

    I fasted for 2 days before my colonoscopy. I took a prescribed laxative 2 days before and drank golytely 1 day before to prepare. They did an ekg immediately prior to the procedure and found that I had suddenly developed atrial fibrillation. They consulted with one another, and did the colonoscopy. Doctor, I have had a perfect heart (blood pressure and rate – – at 58) all my life. Is it possible that my system is just “freaking out” due to the preparations for the procedure? I know that the process was terribly tramatic for me at the time. I have an echocardio exam later this week. But is it POSSIBLE that this condition may self-correct over time??

  8. I have had 3 PVI ablations. The last two by Dr. Natale. My last procedure was April 2, 2009. Based upon available data, what are my chances to remain A-Fib free? If I have renewed episodes, is a 4th procedure an option. I am 59 years old and in good health.

  9. Dennis Jackson says:

    Ms. Hills,

    You state in one of your replies to a patient’s request: “About one third of afib patients will have a stroke at some time.” Does that “one third” include those who have received treatment from physicians, as well as those who take no medications or who have not undergone the kind of procedure that you did?
    If, indeed, one third of afib patients are destined to “have a stroke at some time,” how do you avoid constant anxiety about your future?

    Thank you (by the way, I learned a LOT from your four-part video. I am newly diagnosed with AFib, and rather intimidated by the whole thing).

    Dennis Jackson

    • Dennis,

      That fact, that about one third will have a stroke, is for those receiving treatment as well as those who are not. Part of it relates to the complexity of managing warfarin/Coumadin. Because INR is often only tested once a month, you could be out of “therapeutic range” (2.0-3.0) between tests and not know it. Thus you could be at risk for a stroke. So trying to be stable on warfarin is one thing to focus on. Another option is to take one of the new anticoagulants (Pradaxa is approved, Xarelto probably will be soon) that doesn’t require monitoring and was found to be as effective or more so, than warfarin.


  10. I am a 24 yr old male in great physical condition with no family history of any heart problems. I had my first episode of A-Fib in July of 10, 2nd November 2010, 3rd December and 4th January. In 3 of the 4 episodes making myself vomit returned my heart to normal sinus. The other time it converted back on its own after taking Verapamil 8 hours later. I am scheduled for an ablation by Dr. Natale the end of March, What can I do to keep the episodes at bay before then? One Dr. suggested Tikosyn

  11. Dr Andrea Natale,
    Cordial saludo,
    Soy medico Pediatra de Colombia tengo 55 años con una cardiomiopatia dilatada desde hace 5 años, porto un cardiodesfibrilador hace 2 años ,a raiz de una muerte subita con ACV . hace 6 meses me someti a una ablacion con carto de venas pulmonares por una F.A.en la Fundacion CardioInfantil de Bogota , tengo alblacion del nodo av , actualmente mejore la F E al 35 % estoy anticuagulado con warfarina IRN 2.3 , tomo dia; enalapril 10,amiodarona 200,betaloc Zoc (Metroprolol succinato)75, espirinolactona, bromazepam1.5,
    Socilito una cita con Ud , En texas o en Boston pues mi condicion de salud no ha mejorado Posiblemente con una arritmia Ventricular no sostenida y hace 15 dias mientras dormia tuve un sincope tras dolor pecordial opresivo
    Por la atencion a mi solicitud quedo de Ud muy agradecido.
    Dr Ricardo Martinez Niño.

  12. greenturfco@meadowcrk.com says:

    How big is the normal size atrium? Is dr.andrea Natile hard to get for help? and what about the cost?

  13. Harriet,

    If you continue to have atrial fibrillation, you’ll probably want to stay on Coumadin, if you can. And you’ll probably also stay on blockers, unless they stop working for you.

    Are you in continuous afib, or does it come and go?

    Continuous afib can overwork the heart, which can lead to heart failure. That’s why many people in continous afib consider having a procedure that can stop the afib.

    As far as stroke risks…no, most patients don’t have a stroke within 5 years. About one third of afib patients will have a stroke at some time, and women are more at risk. Here are some important statistics to know regarding stroke and afib: http://www.stopafib.org/stroke.cfm

    Good luck to you.


  14. I was just treated in the hospital for af and wanted to know if coumadin is a drug to take for life? Does this af shorten my life and will most patients have a stroke within the next 5 years? Will I always be on blockers for my heart as well.

    Please advise

  15. Marcia and Terry,

    I’ve requested that your questions be added to the list of questions for Dr. Natale over at the Journal of Atrial Fibrillation.

    Dr. Natale’s answers will be posted August 26. This link will tell you more about the current status and how to view the answers: http://www.stopafib.org/newsitem.cfm/NEWSID/82


  16. Mary,

    That’s a very interesting question. Most patients don’t have a defibrillator (AED, Automated External Defibrillator) to carry around with them, so I’ve never heard that question asked.

    I’ve asked the folks at the Journal of Atrial Fibrillation, where Dr. Natale was answering questions through yesterday, to please add in your question. But since you already have a relationship with Dr. Natale’s office, you may want to contact his office right away rather than waiting until August 26 for his answer.


  17. mary peterka says:

    After having Dr Andrea Natale’s ablation procedure for Afib, is carrying a defibrillator with you recommended? If so, how long?

  18. Terry,

    I have heard that surgery is sometimes an option after an AV node ablation, but that would be on a case-by-case basis.

    You might find a surgeon to discuss this with. Feel free to check our Afib Services Locator at http://www.StopAfib.org, or let me know where you are and I’ll let you know if I know of any in your area.


  19. Terry Loveless says:

    I have had ablation,uv nod ablation,pacemaker installed,I take Tikosyn, warafin but still have bouts of afib that sometimes last two weeks.Is there any hope for a cure?

  20. Marcia,

    You might ask your doctor about the new Watchman device that catches clots.

    There is also a new anticoagulant (rivaroxaban) that has just been filed for US approval, but could take a year to get approved and on the market.


  21. What can I do to lessen my chances of a stroke with a-fib. the only advice I get from my heart specialist(s) is to take coumidin. I will not take rat poison for anything. Any thing else besides aspirin which I hear is not that much help.