Are the tides changing

[www.everydayhealth.com]

This is a good read about ablation as first line treatment. Also good comparison of the pros and cons of medication vs ablation.

Craig



Edited 1 time(s). Last edit at 11/02/2014 12:36AM by Craigh.

I agree that is a good article. Maybe I'm biased, having undergone an ablation after using a PIP approach for a while, but it seems the success rates quoted are updated compared to many articles I've seen that are based on historically older stats.

Neither antiarrhythmic drugs nor catheter ablation decrease the risk of stroke in afib — they are designed to control symptoms caused by the abnormal heart rhythm. Walid Saliba, MD, director of the atrial fibrillation center at the Cleveland Clinic, says, “The aim of any treatment for atrial fibrillation is to reduce the burden of the arrhythmia — the frequency, impact and symptoms — and improve quality of life.”

Shannon does this statement by Dr Saliba hold any water? No stroke reduction is he kidding me?


This study below talks about the risk of stroke after ablation regardless of Chads score after about one year is back to that of normal risk on par with someone without any history of afib

[www.cxvascular.com]

Also you had talked about that although you may have only a 3.2% risk of stroke say with a CHADS 2-3- that is a yearly number correct?....., multiplied over 10-20 years that % is exponentially higher so the chance of a stroke getting you is much greater higher % ? Hope I translated what I mean correctly here......

McHale

McHale Wrote:
-------------------------------------------------------
> Neither antiarrhythmic drugs nor catheter ablation
> decrease the risk of stroke in afib — they are
> designed to control symptoms caused by the
> abnormal heart rhythm. Walid Saliba, MD, director
> of the atrial fibrillation center at the Cleveland
> Clinic,
>
> Shannon does this statement by Dr Saliba hold any
> water? No stroke reduction is he kidding me?
> McHale


Hi McHale, you are correct in that the statement in this article that ablation does not reduce stroke risk is not true. In the latest The AFIB Report I share a recent large study out of the big Intermountain Heart Center in Utah showing that not only does a successful ablation process reduce stroke risk, particularly in people with a modest to higher CHADS2 score or non-lone AFIB. In fact, the study showed that such a successful ablation process reduced stroke risk in such previously higher risk patients to that of a large same age and sex matched control group who have never had AFIB at all!

The writer of this article must have quoted Dr Saliba out of context, or perhaps it was a quote from long ago before a number of studies have confirmed what everyone intuitively knew and suspected all along, but would not commit too in print until there was a solid body of evidence, as they very much is now, showing a substantial reduction in stroke risk particularly for those afibbers with some degree of underlying heart disease, hypertension, a CHADS2 above 1 etc.

Shannon



Edited 1 time(s). Last edit at 11/04/2014 12:44AM by Shannon.

The risk of a clot forming that would cause a stroke or MI is obviously of concern in a heart that is beating out of control and for long periods of time as is often the case with arrhythmia. Recall the old quote... churn cream and you get butter; churn blood and you get a clot.

However, beyond having an ablation, which prevents cause by arrhythmia, the same risk factors that allow for blood's tendency to clot more easily and quickly... (as frequently mentioned... Thick, sticky blood ... or hyperviscosity)... doesn't disappear automatically with an ablation procedure.

The patient still has to monitor blood hyperviscosity factors and make dietary and lifestyle changes so that blood flows smoothly and is not subject to silent inflammation, plaque buildups in sheer stress arterial areas and so forth.

I just learned of a 56 yo male (with no arrhythmia) having a stroke that left his one side mostly paralyzed; a second stroke, put him in a wheelchair. I have no other details but something was obviously not being screened prior to or monitored well, post stroke.

Jackie

Recent studies on cryptogenic strokes (those with no apparent cause in initial thorough exam when exhaustive follow up investigative screening has been carried out indicate that at least 10 - 15% of these unknown stroke sources, and likely a good deal higher percent are from undetected silent AFIB or short nocturnal runs.

Emphasizing the need to look very carefully when it seems there has been no AFIB history in a stroke patient. Though hypervuscosity of blood is a big deal everyone should get the Hemothix machine based whole blood viscosity test at least once from 50 years old and up to see where they trend on this important issue as Jackie mentioned.

Shannon

I more or less keyed in on a different statement made in this article. The author claims the March 2014 Guidelines now list ablation as a " first line" treatment. I'm confused. On another group this was discussed and it was pointed out as an inaccurate statement. Drugs are stilk first...at least in most circumstances. I looked at the guidlines and I didn't see where abkation had been moved in front of drug therapy. I would think that if it had been it would be a headline change? Has there been a change? I was fortunate in that Dr Natale was able to document my circumstance in such a way that I was insurance approved and offered ablation as first line treatment.

Thanks

Craig

Craigh,

Most all insurance will approve Ablation as a first line therapy, within certain diagnostic codes. If there is any bradycardia for example that can make drugs more risky etc and for complex cases in which drugs have shown a poor efficacy.

Ablation is considered a near full first line therapy at this point, with something like a 1a or 1b i tier indication rather than straight up top level '1' for example, though it slips my mind at the moment the actual nomenclature used to define the rankings.

Some insurance companies still want to see at least one AAR drug trial, but that is pretty easy for the EP to circumvent if its clear the person needs an ablation much more now rather than later and that the drugs are very unlikely to perform well long term in a given case. But there is some leeway in the regulations from insurance and in the AHA/ECS guidelines for going first line now.

Shannon

Hemothix.....is this the correct spelling?
I googled it and could only find Hemothorax

Colin - it's Hemathix

[www.hemathix.com]