Welcome to the Afibber’s Forum
Serving Afibbers worldwide since 1999
Moderated by Shannon and Carey
 |
 |
 |
 |
 |
 |
Home
>
AFIBBERS FORUM
>
Topic
TEE results
Posted by ron
|
TEE results August 06, 2016 09:37PM |
Registered: 11 years ago Posts: 97 |
I just had a TEE last week with 34 being my number. The Doctor wants me to wait 6 months and have another test hoping I can get to the magic number of 40.
couple of questions....
When looking at this test, does the 40 indicate a % that the left appendage is filling and emptying ?
Also, Just how easy is it to get from 34 to 40 after having the left appendage ablated ?
...ronH
couple of questions....
When looking at this test, does the 40 indicate a % that the left appendage is filling and emptying ?
Also, Just how easy is it to get from 34 to 40 after having the left appendage ablated ?
...ronH
|
Re: TEE results August 07, 2016 02:44AM |
Registered: 9 years ago Posts: 100 |
|
Re: TEE results August 07, 2016 05:21PM |
Admin Registered: 11 years ago Posts: 2,779 |
The target emptying velocity out of the LAA is 40cm/sec or 0.4meters/sec. This is true whether or not you have had an LAA isolation.
(Errata: thanks to Morpheus for alerting me about my 'fast math error' on the LAA emptying velocities listed below, the numerals are all correct, but in my haste in racing through the post I used millimeters and centimeters unit values in place of centimeters and meters respectively as it should have read below in the original posting ... All
unit values below have now been corrected for posterity and all those reading this post for the first time)
People with ongoing active Persistent AFIB often have emptying velocity well below 40cm/sec often in the 20s to teens indicating obvious need for long term OAC drugs so long as one is in AFIB if your LAA mechanical function is impaired by the AFIB as it often is, especially in persistent and long standing persistent AFIB or even very active advanced Paroxysmal AF with frequent long episodes of 20+ hours duration.
The reason for the strict guidelines for when a person with LAA isolation ( or Persistent/LSPAF) needing to stay on OAC or go for a mechanical LAA occlusion or ligation procedure, is due to the fact that if any one of the 3 parameters one must pass to get free of OAC are not good enough to pass the test, then they person will be at an elevated risk of an embolic event like a TIA to full blown stroke or PE even while in NSR.
1. LAA emptying velocity is only one metric that must be passed at the 6 month mark post LAA Isolation.
2. You also have to show a consistently robust positive inflection 'A-Wave on Doppler measure at the mitral valve inflow area.
3. Lastly, either Dr Natale or one of his very well trained and very experienced TEE expert cardiologists who are very familiar with checking these three not so common parameters on most standard TEE exams, must review the actual CD recording of the TEE and confirm the zero SEC (spontaneous echo contrast) or 'smoke' is seen in either the LA or LAA. Smoke or SEC indicated stagnating turgid blood pooling in the area which is highly prone to promote clot formation).
If all three parameters are passed it is safe to stop OAC and get on with your life.
Note too, that the commonly accepted limit of safety is 25cm/sec for LAA emptying velocity but the standard to add plenty of added margin of safety is to use 40cm/sec as the decision making point to account for variable velocities during real life living and yet insure you stay comfortable above 25cm/sec under most any circumstance and for the vast majority of the time.
Is you are 34cm/sec now and say you move up to 38cm/sec in another 6 month 2nd TEE and yet both a robust consistently of your LAA mechanical function as noted by a solid Doppler AWave into Mitral inflow, and with complete absence of smoke or SEC in both LA and LAA are confirmed, that may well be plenty solid enough to discontinue OAC too.
Hope this helps better understand the parameters needed. Keep in mind that IF you have LAA triggering as an active contributor to your arrhythmia, getting an LAA isolation ablation or a full LAA ligation are the only hope of ever getting off OAC. The LAA isolation ablation brings with it between 35% to 40% odds of still being able to stop OAC or at least lower Eliquus to a smaller half dose.
If you have LAA triggering AfIB/AFlutter/ATachy no cardio or ASAP will take you off OAC ever so long as you still have arrhythmia.
Shannon
Edited 2 time(s). Last edit at 08/08/2016 07:05PM by Shannon.
(Errata: thanks to Morpheus for alerting me about my 'fast math error' on the LAA emptying velocities listed below, the numerals are all correct, but in my haste in racing through the post I used millimeters and centimeters unit values in place of centimeters and meters respectively as it should have read below in the original posting ... All
unit values below have now been corrected for posterity and all those reading this post for the first time)
People with ongoing active Persistent AFIB often have emptying velocity well below 40cm/sec often in the 20s to teens indicating obvious need for long term OAC drugs so long as one is in AFIB if your LAA mechanical function is impaired by the AFIB as it often is, especially in persistent and long standing persistent AFIB or even very active advanced Paroxysmal AF with frequent long episodes of 20+ hours duration.
The reason for the strict guidelines for when a person with LAA isolation ( or Persistent/LSPAF) needing to stay on OAC or go for a mechanical LAA occlusion or ligation procedure, is due to the fact that if any one of the 3 parameters one must pass to get free of OAC are not good enough to pass the test, then they person will be at an elevated risk of an embolic event like a TIA to full blown stroke or PE even while in NSR.
1. LAA emptying velocity is only one metric that must be passed at the 6 month mark post LAA Isolation.
2. You also have to show a consistently robust positive inflection 'A-Wave on Doppler measure at the mitral valve inflow area.
3. Lastly, either Dr Natale or one of his very well trained and very experienced TEE expert cardiologists who are very familiar with checking these three not so common parameters on most standard TEE exams, must review the actual CD recording of the TEE and confirm the zero SEC (spontaneous echo contrast) or 'smoke' is seen in either the LA or LAA. Smoke or SEC indicated stagnating turgid blood pooling in the area which is highly prone to promote clot formation).
If all three parameters are passed it is safe to stop OAC and get on with your life.
Note too, that the commonly accepted limit of safety is 25cm/sec for LAA emptying velocity but the standard to add plenty of added margin of safety is to use 40cm/sec as the decision making point to account for variable velocities during real life living and yet insure you stay comfortable above 25cm/sec under most any circumstance and for the vast majority of the time.
Is you are 34cm/sec now and say you move up to 38cm/sec in another 6 month 2nd TEE and yet both a robust consistently of your LAA mechanical function as noted by a solid Doppler AWave into Mitral inflow, and with complete absence of smoke or SEC in both LA and LAA are confirmed, that may well be plenty solid enough to discontinue OAC too.
Hope this helps better understand the parameters needed. Keep in mind that IF you have LAA triggering as an active contributor to your arrhythmia, getting an LAA isolation ablation or a full LAA ligation are the only hope of ever getting off OAC. The LAA isolation ablation brings with it between 35% to 40% odds of still being able to stop OAC or at least lower Eliquus to a smaller half dose.
If you have LAA triggering AfIB/AFlutter/ATachy no cardio or ASAP will take you off OAC ever so long as you still have arrhythmia.
Shannon
Edited 2 time(s). Last edit at 08/08/2016 07:05PM by Shannon.
|
Re: TEE results August 08, 2016 08:57PM |
Registered: 11 years ago Posts: 4,238 |
Quote
Shannon
If you have LAA triggering AfIB/AFlutter/ATachy no cardio or ASAP will take you off OAC ever so long as you still have arrhythmia.
It this true even for a low/zero CHA2DS2-VASc or similar metric?
I say this as I'm guessing there is a high probability my afib is triggered (however infrequently) by my LAA, given my history of a 2.5 month episode 12 years ago, at the beginning of my afib journey.
I'm not horribly concerned. I've been on 4.8g/day fish oil and clotting isn't real fast, then Dr. Gundry added an 81 mg aspirin/day to activate anti-inflammation properties of the fish oil. This weekend I managed to rip a fair amount of skin off my left palm in a rock climbing incident. I noted that the time to clot was quite long...
Cheers,
George
Sorry, only registered users may post in this forum.