Death rates?

1st post... just wondering... considering ablation, not considering cardioversion... have either of The procedures been associated with death either during the process or shortly afterwards? ... I am 70 years young and my current afib started on last December 14th and has been continuous since that time. Before was finding some success w/ chiropractic adjustments of t3 and t4 vert. And also neck... thanks for your patience, But have terminated chiropractic care

All medical procedures have death rates associated with them. Sometimes due to the procedure itself, and sometimes due to comorbidities, but it's not always easy to be sure which was which. I should add that even dental procedures have death rates associated with them. So do chiropractic manipulations, especially those of the neck.

That said, the mortality rates for AF ablations are well below 1%. I'm trying to find the definitive study I know exists but haven't located it yet, but from memory it's somewhere in the neighborhood of 0.3% or thereabouts, and that includes ALL ablations. Those done by experienced EPs and those done by total greenhorns who shouldn't be doing them. That same study found there was a huge difference between the highly experienced EPs and lesser experienced. Something like 85% of all ablations in the US are performed by EPs who do 25 or fewer ablations per year, and most of the deaths happen with those low-volume EPs, so that heavily skews the mortality rate stats. If you look only at the high-volume centers and EPs, the numbers are much lower. This is why we stress here that when it comes to ablations, the three things that matter are experience, experience, and experience. I'll find that study and give you the actual numbers as soon as I can.

As for cardioversions, the mortality rate is near zero. It's virtually unheard of for someone to die of a cardioversion, and when it happens it's usually because it was done emergently and a TEE wasn't done beforehand. The cardioversion didn't kill them. What happened was returning them to normal rhythm dislodged a clot lurking in their left atrium that a TEE would have seen had they done one.

Carey - this is the first time this has happened to me but I missed taking my pills Thursday AM - one of those is 5mg Eliquis. I normally take very close to 9 AM and 9 PM. I have an ECV scheduled about 10 days from now. Would I need a tee from missing this one pill? Thanks.

Missing a single dose 10 days beforehand shouldn't be a problem, but you could mention it to the doc just to be sure.

Thanks.

Hi NotLyingAboutMyAFIB, as Carey noted above you with be alright with a single missed dose that is easily early enough not to impact your important contribution to your ablation by making sure you take your regular twice a day full dosing during the week leading up to 'ABL-Day' . Assuming you don't miss any more doses leading up to your procedure with Dr Natale, the one most critical dose for you to take 'on time' without fail is the last dose of Eliquis on the morning of your ablation! Your assigned 'Nurse Navigator' at St. Davids will give you the precise time for that last OAC dose depending on the time set for your procedure that day. Typically if your ablation is set for either of the first two slots tie the day, they will ask you to take that last dose right at 5am on the morning of the procedure. Outside of arriving on-time for both your consult the day before your ablation, and obviously arriving on-time the morning of your procedure, the only other job that you are asked to perform as your contribution to your own procedure, is to take that last dose of OAC right on time as you will be assigned the day before your ablation.

The rest of the procedure is totally effortless on your part and you are just along for the ride, so you can then just kick back, take it easy and go with the flow from then on!

Dr Natale uses the time-honored 'Uninterrupted Anticoagulation Protocol' which is the gold standard for peri-procedural safety and efficacy of anticoagulation leading-up to, during and for 30 days following one's ablation. Indeed, Dr Natale was the pioneering main driver of the EP-field largely adopting this significant improvement in ablation safety with the first randomized trial that established uninterrupted anti-coagulation as the way to go to significantly reduce embolic risk just before, during or after an AFIB ablation.

And this was a big step forward compared to the original 'Interrupted Anticoagulation Protocol that had been ubiquitous prior the the new protocol, with the uninterrupted protocol proving itself as hands-down superior.

The original interrupted anti-coag protocol, was mostly built around warfarin (or one of it's analogues) that was then stopped 5 days prior to the ablation and the patient was then put on gradually increasing doses of Lovenox injections (i.e. Low Molecular Weight Heparin) the last 5 days before ablation day.

But as noted above, you've got nothing to worry about. Eliquis is very fast-acting and you will essentially be fully protected by end of the first day of dosing, so you've got plenty of time to be fine after missing only one dose at least 10 days prior to D-Day.

Cheers!
Shannon

Much more relieved now. That's the only dose I've missed in 10.5 months. This is just another ECV but headed to Austin if this one doesn't stick. I'll follow Dr. N's notes to the letter. Thanks Shannon.