ATRICLIP follow up

Hello Everyone,

I had my ATRICLIP surgery performed in Austin by Dr Hoenicke on July 20. On Tuesday (9/2) I returned to Dr Natale's office and had a six week follow up TEE and a short consultation with him.

Today I received a call from Norma, Dr N's assistant, who gave me the good news that I can stop taking anti-coagulants, so apparantly all is well with my clip.

My recovery from the surgery was very easy. I had no pain at any time. I did have some fluid retention that lasted about 10 days and was treated with diuretics and potassium. I was able to engage in moderate exercise soon after the surgery and did a 4 mile walk at the end of the first week. At six weeks my cardiovascular conditioning is where it was before the surgery and my resistance exercises are almost back to normal. So I am pretty happy at this point.

I will soon get a monitor to wear for a week to determine if there is any silent arrhythmia. If there is some arrhythmia the decision to stop Eliquis will be reconsidered. And, in three months I will have another TEE. In the meantime I will begin taking an 81 mg aspirin.

I cannot say enough good things about Dr Natale and the many professionals he has added to his arrhythmia team like Dr Hoenicke. They are on the cutting edge of practice and research and offer the best treatment for this awful condition. I am grateful to have the opportunity to benefit from their expertise.

Bill

This is great news, Bill. Congratulations.

On August 14th I had my second ablation with Dr. Natale. He isolated my LAA and ablated some in the coronary sinus. I am recovering well with no issues. I will be returning to Austin in 6 months for a 3D TEE to evaluate the LAA blood flow. With the new stats there is hope that the blood flow will be sufficient to stop anti-coagulation, or, I will be following you to the Atriclip and Dr Hoenicke.

Once again, I am so happy to hear of your continued strengthening and recovery.

John

That is great news Bill. Thanks for the update.
It looks like I will be following in your foot steps the beginning of next year.

I am a little confused by your statement:
"I will soon get a monitor to wear for a week to determine if there is any silent arrhythmia. If there is some arrhythmia the decision to stop Eliquis will be reconsidered."
I thought the ideas behind the AtriaClip was to get off ant-coagulation even if arrhythmia is present.
What am I missing?

Don

Great to hear Bill!

And Doug, they just want to confirm no silent activity. Technically not every stroke comes from the LAA obviously, and its possible for a very small percentage of AFIB related embolic events to occur outside the LAA, but we are talking mid to low single digit percentage, and almost invariably those kind of far more rare potentially AFIB related embolic events are associated with a number of other CVD co-morbidites co-existing with AFIB too.

But that is why the little potential caveat. No one expects him to have silent arrhythmia now either, its just being abundantly cautious as they plot out the natural history and course of these new breakthrough treatments.. and at first they will be very cautious and err on the extreme safe side for a while until the numbers of people who have had these procedures and the follow up is robust enough to relax it all even more. Then they may well see that the risk from taking an OAC is greater than any very small percentage of a non-LAA based stroke in the presence of a still ongoing silent arrhythmia as well.

But the bottomline is this is all good to know and verify for each person that walks down this path, but keep in mind that for the huge majority of us, a successful Atriclip/LARIAT and even Watchman will indeed result in being able to stop blood thinners once and for all in the vast majority of cases ... just not necessarily everyone and at least not this early while we are still gathering long term data to make even more honed down descisions.

It is really great though to hear how relatively easy the recovery has been Bill with the Atriclip surgery and how relatively little pain was involved all things considered! That, combined with the super high level of efficacy with an expert like Dr Hoenicke doing the honors, is hugely encouraging indeed!

If I had to do it all over again, I would chose the Atriclip minimal invasive process just like you went through Bill, hands down!

Shannon



Edited 1 time(s). Last edit at 09/05/2015 08:51PM by Shannon.

Don,

It is my understanding that 92-94% of emboli that cause strokes in AF patients originate in the LAA. That figure has been quoted to me by several doctors as coming out of the medical literature. On Tuesday I asked Dr Natale if I could have a reoccurrence of AF or another arrhythmia and he said it was unlikely but possible. I then asked, if I have a reoccurrence will I need to resume anti-coags, and he said "maybe." He explained that there were factors, such as the size of the left atrium, that would indicate the need for blood thinners in the event of a reoccurrence of arrhythmia. Only a small percent of cases fall into this exception. An 81 mg aspirin is all most would require after the LAA is occluded.

An ATRICLIP is not a "get out of jail free" card for all of us. If you are considering the surgery it would be prudent to speak with both Natale and Hoenicke about this to see if you might fall into the small number of patients where these other factors (the co-morbitiies that Shannon speaks of above) are present.

This is more evidence that we need to be diligent in our life-style behaviors and in attending to our supplement needs to mitigate or prevent the progression of the disease.

Bill

Thank you, Bill, for your information and Shannon, also for the elaboration. My evaluation will be in another month so this is very useful.

It's encouraging that you are doing so well.

Best to you,
Jackie

Thanks everyone for your comments.

After my LAA isolation with Dr. Natale a year and two days ago, my TEE shows I have to stay on Xeralto.
Being 51 with no other health problems, I think getting off blood thinners would be a prudent move.
The point that some of this is new and they are not sure about a few things long term makes me think maybe waiting another year might not be a bad idea. I am undecided. I plan to meet with Dr. Natale in Decemeber and see what he thinks.
I am involved in activities like Hang Gliding that make being on a blood thinner worrisome for me when I do the activities.

Don

The hang gliding and other such activities to me would make wanting to get off Blood thinners a slammed dunk Don!

Up to you, but especially until the new antidote for NOACs is approved and in ERs and ambulances everywhere, I would be very loath to do any extra risky activity

I sprained my left ankle badly last weekend when Magdalena and I were down in Scottsdale for two days of errands and meetings .. stepped off a sloping curb the wrong way and got an inversion sprain where my ankle suddenly buckled greater than 90 degrees horizontal and threw me to the ground instantly and curtailed our plans while I got worked up and fitted with an air cast moon boot to wear for 10 days (two more days to go now) .., just want I needed before flying to Kansas City this coming Thursday eh?

I was so glad I wasn't on Eliquis when I saw how much my ankle and foot blew up and how bruised as it was.. Had I been on a blood thinner even that relatively minor accident would have been a good deal more acute than it was, no doubt.

Anyway, just saying, hang gliding ...while a ton of fun I can imagine... plus blood thinners doesn't sound like a winning combo!

Best of luck anyway .. but at a young 51 yrs old a life time of blood thinners would not be my first choice.. the risks for stroke or bleeds are roughly linear over time, so even a low 1% to 3% annual risk of an embolic or bleeding event really starts to add up over the long term and at 20 years say, can range from a low of 20% to 60% + of cumulative risk depending on how those odds are calculated versus your own real world reality, and if you are shooting for making say 85 years on the planet then those ongoing risks keep adding up in a big way.

We can talk more about it all if you wish down the road.

Shannon



Edited 1 time(s). Last edit at 09/06/2015 09:19PM by Shannon.

Thanks Shannon,

I hope your sprained ankle heals quickly. Good thing you were not on on Eliquis. Sorry this will add to your travel "fun".

A few weeks ago I hit my shin on a cinder block. It cut it and it immediately swelled up. I quickly put ice on it. I thought I would have a huge bruise. Luckily the ice reduced the swelling to almost nothing. This was my first real injury since being on Xarelto.

When I Hang Glide, I bring a large cooler of ice and keep "stop bleeding" products with me. Even with these precautions, it still add a significant worry to the activity. Knowing a survivable injury would quite possibly become a fatal injury does take some of the fun out of the activity.
The last 6 months I have been flying Sailplanes instead of Hang Gliding (Sailplanes do not require a FAA medical).
I never renewed my FAA medical after afib was diagnosed five years ago. I keep hoping I can get stabilized and get my FAA medical back. Recently I had a job opportunity to get back into flying. Because I will probably be doing the LAA occlusion in the next year, I had to pass on the job to avoid the FAA medical issue. The FAA wants every shred of medical reports. Any time a doctor put a diagnosis on your medical records, it become something the FAA wants tests and follow ups on. For example, early on a doctor thought I might being having silent GERD that was causing inflammation. Therefore she code my medical records as a GERD diagnosis. I had tests that showed no GERD. However since I am know diagnosed as having GERD, the FAA would want all new test. I had a doctor group at Cedars Sinai mix up my medical records with a woman how had a pace maker implanted and billed my insurance for pace maker placement. Even after getting the billing corrected, the insurance company will not remove that I have a pace maker from my medical records. What a mess!

Everyone should be aware that any doctor who put a suspected diagnoses on your medical records make it a permanent part of your medical history. Even if they a wrong, it will be looked upon as you having that condition, unless you can prove otherwise. I now tell doctors please be careful what they put on my medical records. They will need to provide reasonable proof that the diagnosis is correct for the FAA when they evaluate my medical records.

I like the idea of the less invasive procedure of the Watchman. The research I have done seems to point to the AtriClip being the best option. I think Dr. Natale is still recommending the AtriaClip. However, when I had the latest TEE, Dr. Natale's nurse said the measured for the Watchman while doing the TEE.

I am not sure where I will go from here. Seems like there is so much gray information from which decisions need to made.

Don



Edited 1 time(s). Last edit at 09/07/2015 05:54PM by gmperf.

Thanks Don,

Taking a half hour break here from working on my little talk for Friday. Sorry to hear of the added scrutiny for the FAA issue.. those medical records can follow you a long time for sure,,, Luckily Ive been formally retired a good while... with my long roller coaster med history it would be a long shot for any grace being granted at all.

To me its not that grey on going with the Atriclip vs the other mechanical ligation/occlusion devices, should that be the decision to pursue, The Atriclip is very well vetted now with as of this past Feb when it was last reported at the ISLAA conference there had been 45,000 Atriclips installed with no one single significant complication being reported and getting a good seal is very robust in experienced hands.

They measure for the Watchman as that is the easiest still to get insurance coverage for now that it has full FDA approval, and that can work well too at least for getting you off blood thinners after 6 months post Watchman, but it does not re-insure that you will have no more LAA-based arrhythmia via full structural and electrical ligation of the LAA entirely with the Atriclip as with the LARIAT too.

But as long as your LAA isolation ablation is very solid for a good while you are likely good to go on that issue anyway and a Watchman could well get you off blood thinners too.

Just lets talk about all the caveats and plusses to each option before you go see Dr Natale next time so you are clear on just what those options really are.

Cheers!
Shannon