We should know by December 2027 if the Watchman is a reasonable alternative to NOACs or a possible supplement to NOACs. CHAMPION-AF trialby JakeL - AFIBBERS FORUM
We should know by December 2027 if the Watchman is a reasonable alternative to NOACs. Prior Discussion Linkby JakeL - AFIBBERS FORUM
One of the USP certified brands he recommended was Nature Made Magnesium Citrate. I checked around and found it Walgreens. The bottle contains 120 softgels and a daily "serving" is 2 softgels, so a bottle lasts 60 days. Cost was high at $30 but until 8/26/23 you can purchase 2 bottles for the price of one ($30). You also get a $3 off with a coupon - net price for 2 bottles: $27.by JakeL - AFIBBERS FORUM
See my post about the CHAMPION-AF trial that will compare effectiveness of Watchman and DOACs There is a NIH study underway that will determine if the Watchman is a reasonable alternative to NOACs. It is scheduled to be completed in December 2027. CHAMPION-AF Clinical Trial - NIH US National Library of Medicine Study Description, Brief Summary: The primary objective of this study is tby JakeL - AFIBBERS FORUM
See my post for Medicare Advantage in NY paying for Natale ablation There are some Medicare Advantage plans that do cover out of state care. I have UnitedHealthcare Medicare Advantage Choice Plan 1 (Regional PPO), live in NY, and had it cover 2 Natale ablations in Austin and just paid a copay each time. From their description: This PPO plan gives you freedom to see any provider nationwideby JakeL - AFIBBERS FORUM
At this point I don't think we know if the Watchman or NOACs like Eliquis are most effective against strokes. Therefore I would think that afibbers that take a NOAC and have a Watchman, like Carey, reduce their risk of a stroke vs only taking a NOAC or having a Watchman alone. Patients hear from their EP that if they have a Watchman they may not need to take a NOAC. How do EPs know thisby JakeL - AFIBBERS FORUM
Quotejasams I don’t think you can suspend all anticoagulants permanently or the company would be pushing for approval of that instead of merely switching the initial 6 weeks from warfarin and aspirin to a dual antiplatelet. You could infer that Boston Scientific believes that "you can suspend all anticoagulants permanently" with the Watchman since the Champion AF Clinical Trial willby JakeL - AFIBBERS FORUM
There is a NIH study underway that will determine if the Watchman is a reasonable alternative to NOACs. It is scheduled to be completed in December 2027. CHAMPION-AF Clinical Trial - NIH US National Library of Medicine Study Description, Brief Summary: The primary objective of this study is to determine if left atrial appendage closure (LAAC) with the WATCHMAN FLX device is a reasonableby JakeL - AFIBBERS FORUM
It looks like seniors on Medicare, possibly including those with Afib, may get a reduction in their drug costs from this new legislation that may soon be signed into law: Winners and Losers in the Inflation Reduction Act The law will only let Medicare negotiate over a few drugs in the early years of its implementation. Medicare will only be able to haggle over 10 drugs in fiscal 2026. Onby JakeL - AFIBBERS FORUM
If I had a Watchman implanted now I would follow Carey's advice. Taking Eliquis together with a Watchman is likely to reduce the risk of a stroke. I would continue with Eliquis until the CHAMPION-AF clinical trial is completed to find out if/when the Watchman is better or the same than a blood thinner for reducing the risk of a stroke. Don't know when that will happen. Cardiacby JakeL - AFIBBERS FORUM
If the CHADS-Vasc score isn't really applicable following a Watchman implant then you think they would state that before you started the calculator; or there would be a question in the calculator asking if you had the Watchman implanted. I did some research to see if the Watchman was as good as Eliquis, or similar drugs, and could not find any answers. However, I did find that there is aby JakeL - AFIBBERS FORUM
You can go to the Boston Scientific Watchman FLX website where they offer a CHA2DS2-VASc calculator that will recommend if you should be on a blood thinner, or not. Watchman CHA2DS2-VASc Calculator If you are a male over the age of 75 and no other issues you get a score of 2 with the following recommendation - which I believe means a blood thinner: - For a CHA2DS2-VASc score of 2 and higby JakeL - AFIBBERS FORUM
Thanks to Carey and Susan for that explanation. I have had afib for many years, am over 75 years old, had 2 successful Natale ablations, and been in NSR for over 2 years. That means, according to CHA2DS2-VASc, that I will be on an anticoagulant for the rest of my life. Even though I am in NSR now, afib and a stroke could return at any time. But if I were to get a Watchman, I could go on a hby JakeL - AFIBBERS FORUM
We know the CHA2DS2-VASc score is used for people who have Afib. So anyone over 75 years old with Afib should be taking an anticoagulant. So what is the definition of someone who has Afib? If they have an irregular heart beat then they are in Afib. But what if they have had one or more ablations and are in NSR for a year or more (5?) do you still have Afib and have to worry about a strokeby JakeL - AFIBBERS FORUM
Related to this question: Does everyone in the world over 75 years old (male or female) with no other heart issues and no afib or diabetes be recommended to take an anticoagulant? The chart below would imply "yes". Or, if you did have afib, but have had one or more ablations and are in NSR for a year or more, do you still have a vascular disease? And if not, would an anticoagulaby JakeL - AFIBBERS FORUM
Carey, thanks for the detailed answers to my 7 questions. I will use this information when I discuss options with my doctor next month. I gather from your answers that it is most important to get a TEE after an ablation so that you can decide what to do next. If your TEE blood flow is high in the LAA then you to come off anticoagulants entirely if your CHADS score is less than or equalby JakeL - AFIBBERS FORUM
A couple of questions about LAA isolation and Watchman: 1. Is a LAA isolation the same as a LAA ablation? 2. Do you need to, or should you, have a Watchman implanted if your LAA has been isolated? 3. I read that you need a successful TEE before a Watchman is implanted. Is this correct? 4. So if you fail the TEE after the LAA is isolated, you cannot have a Watchman implanted. Is thisby JakeL - AFIBBERS FORUM
A starter list: Choosing the Right Doctor: 10 Questions You’ve Got to Ask (And What the Answers Mean) https://a-fib.com/questions-for-doctors-and-what-the-answers-mean/by JakeL - AFIBBERS FORUM
frankangelo , I had my first ablation with Dr Natale over 2 years ago and a touch-up ablation with him over a year ago. I have been in NSR since. In both cases I had the UnitedHealthcare Medicare Advantage Choice Plan 1 (Regional PPO) insurance. I reside in NY. The insurance costs $16/month and it paid for all my medical bills in Austin and I am keeping it until I am gone . See if United Heby JakeL - AFIBBERS FORUM
Actually DHANUNJAYA LAKKIREDDY MD, if this is the correct one, does pretty well, except for CODE: 93657-F: 0. Medicare payments in 2015 from the Wall Street Journal database, check my numbers to make sure: https://graphics.wsj.com/medicare-billing/#/1023067881 CODE: 93656-F: 64, Top 20% nationally CODE: 93655-F: 47, Top 20% nationally CODE: 93613-F: 84, Top 20% nationally CODE: 93657-F:by JakeL - AFIBBERS FORUM
There is an article (Finding the Right Doctor for You and Your A-Fib) on another website (https://a-fib.com/finding-right-doctor-for-you-and-your-afib-treatment-goals/) that can help get you started to find a doctor. Once you find a doctor you can compare him/her against what Dr Natale does to see how experience he/she is. It has been said by many here that the more experience the doctor hasby JakeL - AFIBBERS FORUM
There are some Medicare Advantage plans that do cover out of state care. I have UnitedHealthcare Medicare Advantage Choice Plan 1 (Regional PPO), live in NY, and had it cover 2 Natale ablations in Austin and just paid a copay each time. From their description: This PPO plan gives you freedom to see any provider nationwide that accepts Medicare plus access to network costs when you see doctorby JakeL - AFIBBERS FORUM
Here is a good starter list; click on the letter of your term or abbreviation: A-Fib Medical Terms and Abbreviationsby JakeL - AFIBBERS FORUM
I concur with Carey, St Davids food is the best. I would even go there just for the food . St Davids Patient Menu in 2019by JakeL - AFIBBERS FORUM
Thanks all for your responses and suggestions of what and when to eat. I never realized that eating food correctly with AFIB/Flutter requires so much measurement and could be so complicated. Doing things you suggest is very difficult when you have a spouse who does not appreciate eating alone or not eating her favorite foods. I will cut out the chocolate for a week (taking for insurance againsby JakeL - AFIBBERS FORUM
During these trying Covid times many people (me) are eating the same stuff every day. In this Forum we have had many discussions about AFIB triggers (things to avoid). What about the other side - what specific foods do people on this Forum eat that they feel is good for their AFIB. I would guess that some people are on diets (low carb, Mediterranean, low fat, Paleo, vegan, Atkins, etc.), but Iby JakeL - AFIBBERS FORUM
Thanks Carey. I found a study from 2016 that also shows that using Flecainide and Metoprolol together is more effective (at least for rhythm control) than using these two drugs separately. https://pubmed.ncbi.nlm.nih.gov/26893497/ This study is a monocentric, prospective, randomized, open-blinded trial on 173 patients with a recent episode of paroxysmal or persistent AF. Patients wereby JakeL - AFIBBERS FORUM
I have always heard on this board that Flec is an antiarrhythmic drug and that we would likely also need a beta or calcium channel blocker to reduce the heart rate. But when I look at the description of Flec from the the Mayo Clinic they also mention that it treats fast heartbeats like Flutter and Tachycardia. So if Ritva only has a fast and regular heartbeat (flutter) is Flec alone appropriateby JakeL - AFIBBERS FORUM
Thanks, Carey. What else will the doctors need to know to determine if I can stop Metoprolol and Eliquis?by JakeL - AFIBBERS FORUM
I had an ablation a year ago from Dr Natale and am very pleased with the result so far. I was in permanent Afib for around a year before the ablation. According to my report, Dr Natale isolated my LAA at the same time he did the ablation (he knows how to do two things at once). I have been Afib free most of the time. However, there have been 4 instances of SVT or Atrial Flutter (not sure wby JakeL - AFIBBERS FORUM