Healthcare Technology Featured Article

July 08, 2021

How Dr. Andrea Natale Has Transformed Surgical Treatment of Atrial Fibrillation


Atrial fibrillation, commonly known as AFib, is a type of heart arrhythmia that affects approximately 2.7 million Americans every year. According to the Centers for Disease Control (CDC), that number could be as high as 12 million by 2030. Dr. Andrea Natale is a world-renowned cardiologist who specializes in the field of Atrial Fibrillation and Electrophysiology.

Introduction to Atrial Fibrillation

AFib causes the heartbeat that normally occurs in the upper chambers of the heart to beat too slow, too fast, or in an irregular pattern. Because of the irregularity, blood does not flow from the chamber of the heart to its ventricles like it should.

AFib can lead to an increased risk of blood clots, heart failure, stroke, or other serious cardiac conditions. Stroke results when a blood clot forms, breaks off, enters the bloodstream, and travels through arteries to reach the brain. Patients with known AFib usually take a prescription blood thinner to prevent blood clots from forming in the first place.

The American Heart Association states that people with AFib have as much as a five-fold chance of premature death. Despite this, millions of people around the world are unaware of what AFib is or that it is a serious condition. Awareness begins with education about the symptoms and a commitment to regular preventive care.

About Dr. Andrea Natale

Dr. Andrea Natale, the Executive Medical Director at the Texas Cardiac Arrhythmia Center, created the world’s first circumferential ultrasound using vein ablation to correct abnormal heartbeats present in AFib. He also developed some of the more recent catheter-based treatments for AFib and was the first electrophysiologist based in the United States to perform a procedure to correct AFib known as percutaneous epicardial radiofrequency ablation.

Dr. Natale is board certified in cardiac electrophysiology, cardiovascular disease, and internal medicine. He studied medicine in Italy, receiving his medical degree from the School of Medicine and Surgery at the Universita' degli Studi di Firenze. Upon receiving his degree, Dr. Andrea Natale completed separate fellowships in cardiac electrophysiology and cardiology at the University of Western Ontario, under the guidance of EP pioneer, Dr. George Klein, and at the University of Wisconsin, with EP trailblazer, Dr. Masood Akthar.

Between 2005 and 2020, Dr. Natale authored the following medical research papers:

  • “Contemporary Concepts in Atrial Fibrillation Ablation.”
  • “Evolving Treatment Strategies for the Ablation of Chronic Atrial Fibrillation.”
  • “Long-term Outcome of Pulmonary Vein Isolation Versus Amiodarone Therapy in Patients with Coexistent Persistent AF and Congestive Heart Failure.”
  • “Esophageal Injury During AF Ablation: Techniques for Prevention.”
  • “Outcomes in Women Undergoing Electrophysiological Procedures.”
  • “Percutaneous Treatment of Non-paroxysmal Atrial Fibrillation: A Paradigm Shift from Pulmonary Vein to Non-pulmonary Vein Trigger Ablation?”

Dr. Andrea Natale has held the Executive Medical Director position at the Texas Arrhythmia Center since 2008. He has also held other leadership positions at other institutions like Los Robles Regional Medical Center in Thousand Oaks, California, where he completed the first implant of a WATCHMAN FLX on August 5, 2020.

Dr. Natale began his career as part of the faculty at Duke University as Director of the EP Laboratories. Later on, he joined the Cleveland Clinic in the Department of Cardiac Pacing and Electrophysiology as Medical Director for the Center of Atrial Fibrillation and Section Head.

He is a Fellow of the American College of Cardiology, European Society of Cardiology, the College of Cardiology the Heart Rhythm Society.

Dr. Andrea Natale has received many honors over the course of his career, including serving on the FDA Task Force for Atrial Fibrillation. He has received Top Doctor awards in Cleveland, Northern Ohio, Austin, and throughout the United States. Dr. Natale receives frequent invitations to speak at medical symposiums across the world. He is highly regarded and considered a true mentor by colleagues who often seek his guidance to treat their most complex AFib patients. He appreciates the trust that they place in him and the ability to help so many people heal from this serious heart condition.

What Are the Symptoms of Atrial Fibrillation?

One thing that makes AFib especially dangerous is that some people experience no symptoms at all. They only receive a diagnosis after a doctor detects the condition during a physical exam for something else. Other people experience symptoms but do not always attribute them to AFib. The most typical symptoms associated with this heartbeat irregularity are:

  • Chest pain.
  • Dizziness.
  • Exercise intolerance.
  • Fatigue.
  • Heart palpitations that feel like an uncomfortable or racing sensation in the chest.
  • Lightheadedness.
  • Shortness of breath.
  • Weakness.

Doctors classify AFib as occasional, persistent, long-standing persistent, or permanent based on a patient’s symptoms. With occasional (also called paroxysmal) AFib, symptoms come and go over a period of several minutes or hours. Most people do not yet need treatment at this point. Persistent AFib means that the heartbeat does not return to normal on its own. Patients require medications or an electric shock for the heart to beat normally again.

A patient has long-standing persistent AFib if the symptoms appear consistently for at least 12 consecutive months. When the condition becomes permanent, patients need to remain on blood thinner medication for the rest of their lives to prevent the formation of blood clots.

What Causes Atrial Fibrillation?

AFib develops when the heart receives inconsistent and chaotic signals from its two upper chambers. The normal number of heartbeats per minute for people without AFib is 60 to 100. When AFib is present, the number of heartbeats per minute can reach as high as 175. Some patients also experience fewer than 60 heartbeats per minute. Although doctors cannot always pinpoint the exact cause of AFib, the most common causes are:

  • Abnormal heart valves.
  • Congenital heart defects present at birth.
  • Coronary artery disease.
  • Excess use of stimulants such as alcohol, caffeine, certain medications, or tobacco.
  • High blood pressure.
  • Lung disease.
  • Overactive thyroid gland or other type of metabolic imbalance.
  • Previous heart attack.
  • Previous heart surgery.
  • Sick sinus syndrome, which means that the natural pacemaker of the heart does not function properly.
  • Sleep apnea.
  • Stress.
  • Viral infection.

When people with AFib have no heart damage or defects, doctors refer to their condition as lone atrial fibrillation. These patients rarely sustain serious or permanent damage to their hearts. People can also have atrial flutter, a condition similar to but not as serious as AFib. Receiving prompt treatment for atrial flutter can sometimes prevent it from progressing.

What Are the Risk Factors of Atrial Fibrillation?

AFib is more common in patients who present with the following risk factors:

  • Advanced age, since the condition is more common in older people than younger people.
  • Alcohol consumption, especially binge drinking.
  • Certain health conditions, especially diabetes, chronic kidney disease, lung disease, metabolic syndrome, sleep apnea, or thyroid problems.
  • Family history.
  • Heart disease, including congestive heart failure, coronary artery disease, congenital heart disease, previous heart attack, previous heart surgery, or heart valve problems.
  • High blood pressure, particularly when not controlled with medication.

Except for age and family history, people have a lot of control over their risk factors for developing AFib. The best way to prevent this condition is to consume a healthy and balanced diet, get plenty of exercise, and lose weight if necessary. People who smoke, drink alcohol, or use a lot of caffeine should quit or at least cut down. Reducing stress can also be extremely helpful in preventing AFib.

Anyone who suspects that they may have AFib should see a doctor right away for proper diagnosis and treatment. Surgical treatment may be necessary once the condition has advanced. Several new procedures are now available due to the hard work of Dr. Andrea Natale, one of the leading experts in the world on the prevention, diagnosis, and treatment of irregular heartbeat.

Dr. Andrea Natale Develops Breakthrough AFib Treatment in August 2020

Dr. Natale helped develop a device called the WATCHMAN FLX Left Atrial Appendage Closure that helps reduce and prevent blood clots, a leading cause of stroke. The device is the first implantation device approved by the Food and Drug Administration (FDA) for the purpose of stroke prevention in patients diagnosed with non-ventricular atrial fibrillation.

After implantation by a surgeon, the WATCHMAN FLX cuts off blood flow to an area of the heart known as the left atrial appendage or LAA. The purpose of the surgery is to prevent blood clots from developing in the LAA that may later cause a stroke. Some patients who have this surgery may even be able to stop taking blood thinners for stroke prevention.

Dr. Andrea Natale purposely made the device small and round to allow it to fit easily into the LAA. He states that the new WATCHMAN FLX is available in a variety of sizes, which enables surgeons to implant the device in more patients. Surgeons implant the device during a procedure that lasts about one hour. Most patients only need to spend one night in the hospital.









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