New Study

Is anyone familiar with a recent completed study that said that if a patient goes one year without any out of rhythm episodes then there is no difference in negative events whether you are on a blood thinner or not.

My local cardiologist told me this today and suggested it may be possible to get off the Xarelto I am taking. I am a little apprehensive about this possibility.

I went 6 months after going off Flecainide before going out of rhythm. I tried a few large doses of Flecainide but it did not work. I then went on 100mg of Flecainide twice a day and stayed in NSR for the next seven months. I then decided to go off again telling myself I would get another ablation (Natale said I would probably need another when he did the 1st one). It has now been over a year off Flecainide/Metoprolol and as far as I know I have been in NSR the whole time. However, since I have no symptoms I am not 100% sure (I do check with my Kardia mobile, I’ve had a couple of heart monitor sessions).

The cardiologist suggested either an Apple Watch or an inserted Loop reader. If no incidents after a period of time he suggest getting off Xarelto and on aspirin(I also have a high CAC score of 520 so he still would like thinner blood with less bleeding potential.

Appreciate feedback

Could be true but that's news to me. I'll have to go looking for it.

And it seems like strange reasoning considering that aspirin has a higher bleed risk than the DOACs like Xarelto and Eliquis.

This is closely related, a pill-in-the-pocket approach to anticoagulants.
Here is a youtube video Yoork Cardiology and here is the study reactaf.com. Here is the original paper PIP Study.

The basic idea is if you are in AFIB for more than one hour, go on a fast-acting blood thinner for only 30 days. I think the problem in the past was that some people don't know they are in AFIB. But with today's wearable that should not be a problem.

I am hoping the study shows good results. I am 70 with a CHADS score of 1 and am not on blood thinners per cardiologist's recommendation. I rarely go into AFIB and when I do it is usually less than an hour. When I turn 75 I get my second CHADS point, so I am hoping for the PIP approach. BTW I am very symptomatic.

This used to be the reasoning behind a prophylaxis like apixaban or rivaroxaban if one does not have a Watchman, and does not have a way to determine if they are in an arrythmia with chaotic or ultra-rapid atrial pace. One could even make the argument that sedentary people, those who sit a lot (gaming, flying, surfing until the wee hours on their PC) might be better off with a DOAC to stave off deep vein thrombosis. But a year with no detectable arrhythmia, while probably a good sign, is not a guarantee that there IS NO arrhythmia.

I have two personal opinions on this:

a. even a few minutes of continuous AF is raising the risk of a clot forming in an open LAA. If that clot gets dislodged after a couple of NSR beats where the increased and proper flow of blood commences anew.....; and

b. unless a person with a formal diagnosis of AF at any of the four commonly-accepted stages can be sure they are NOT in AF, there is always going to be a risk of AF going unnoticed (happens all the time!). If those short paroxysmal runs get along into an hour, four, 12, and then lurch back into NSR, that's a long time with poor blood circulation in the LAA. I think a full year is a reasonable length of time after which one could stop taking a DOAC, but not if there is no Watchman in place with demonstrably no leakage, and not if the person has no practical means of monitoring 24/7 for almost all of those 12 months. From that kind of reasoning, it becomes a personal choice to continue or to discontinue, with the associated risks borne by the individual. Personally, and as an older male, I do sit a lot at my computer soaking up everything I find interesting. Just that practice, alone, puts me at a risk of DVT. Additionally, while I used to know immediately I was in AF, I'm not sure I do now. I don't sense that I ever have it, and my watch doesn't indicate that I do, but can I be sure? Even when asleep? Plus, no Watchman. That puts me in very iffy territory, so I just take the damned pill.

Thank you for all your input. I thought I would just take the pill for life until my Cardiologist put in my head the higher risk of bleeding as you get older.

BTW, is it common or uncommon to get a watchman put in at the same time as one’s first ablation? A friend of mine’s EP is suggesting it.

It has been uncommon but it's becoming increasingly common. However, if the ablation is going to touch the LAA, it's generally avoided because the mouth of the LAA where the Watchman fits can be swollen, so choosing the correct size would be hit or miss. When the swelling goes down, you could end up with a leaky Watchman.

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Carey
It has been uncommon but it's becoming increasingly common. However, if the ablation is going to touch the LAA, it's generally avoided because the mouth of the LAA where the Watchman fits can be swollen, so choosing the correct size would be hit or miss. When the swelling goes down, you could end up with a leaky Watchman.

I think this is still Natale‘s policy as I know someone who just had an extensive ablation and their Watchman was scheduled for several months later. It was also true for me a few years ago – he isolated my LAA and asked me to come back three months later for the Watchmen.

Had my LAA closed off 19 years ago during a Mini Maze. This has been checked many times for leaks or other issues via CT scans and during a touch up ablation. For years I was advised to consider a NOAC even though closed LAA. More recently my EP and Cardiologist feels that it is not necessary. I am not eligible for a watchman because of that surgical closure years ago. I do take a baby aspirin twice a week for other reasons. I am 76. If you look at my CHAD Vasc score, you would think I should be on a blood thinner. It would appear that having a closure influences that score. Check out Dr. Wolf's web site for his take on LAA closure.