One Year Post 2nd Ablation - LAA

Greetings! It has been awhile since I posted and I wanted to give a followup to my second Dr. Natale ablation.
After being in persistent AFIB I traveled to Austin TX and had my first ablation with Dr. Natale in July 2014. It was an extensive ablation and I remained in NSR for a year before have a re-occurrence of flutter. I had my second ablation with Dr. Natale in October 2015 and I've been in NSR since. (Easy recovery from 2nd ablation.) However, due to the substantial ablating around the LAA the follow up TEE showed minimal functioning of the LAA, thus I remain on Xarelto indefinitely (I don't take any other Rx meds- just supplements).
At this point, Dr. Natale and another EP with Vanderbilt both say that insurance will likely not pay for LAA closure with the Watchman or AtriClip procedure. This is something I did not anticipate when I had the second ablation. I knew the risk of limited LAA functioning, but I thought I had a "plan B" and a future LAA closure. I am age 61 and don't really want to be on Xarelto the rest of my life. Evidently, since I am in good health, low CHADS score, and I am tolerating Xarelto then insurance won't pay for closure at this point. I currently have Anthem, but will move to Medicare in a few years.

As I mentioned, I am tolerating Xarelto fine at this point and NSR is great! But when things in life come up - like a recommended colonoscopy, it compounds decision making and I'd love not to be on a blood thinner the rest of my life- or have to wait until something major happens to consider a closure option.

I have a follow up with my EP at Vanderbilt next summer and I'll discuss options further. (I probably won't travel back to Austin Tx for a LAA closure since Dr. Natale wouldn't be doing it any way.).

If anyone else has had experience with LAA closure and insurance issues- or long term Xarelto use, feel free to comment.
Thanks!

Hello Ken,

My situation is the same. I am 52. No meds other than Eliquis for a slow LAA.
Insurance wont pay for a closure device. They may have good reasons.
The research does bare out that closing the LAA is better than anti coagulation.
That is just the way it is.
On a positive note Eliquis was shown to be comparable to asprin for bleeding risk. You may want to switch
My own experience has been I clot just fine. I had a nose bleed yesterday and it seemed the same as before Eliquis.

Don

Thanks Don! Let me know if you find out anything else on this topic.
Ken

I had posted the following to the other post on LAA closure but it didn't stick... so reposting it here and again at the other thread just as information and consideration...


Learning curve - closure of LAA.
Saturday, November 05, 2016 12:49 PM

Hi Chuck - you are wise to become conversant with the various options for LAA occlusion or closure. Shannon is the expert in this area having had a leak from the Lariat ligation and then going for the Amplatzer cardiac plug. If you use the search feature here for the the words Lariat and Amplatzer, I believe he posted details.

While I haven't tried to find studies or comments by EPs stating the historical results of those methods as well as the Watchman device indicate... such as after 5 years in place, no complications.... my paranoia on having anything implanted in my body stems from what happens, long term, such as 10 or 20 years later. Obviously, that's not available. I also worry about bio-compatibility with materials used in implantable devices and the risk of reactions or hypersensitivities.... as as found in hip replacement materials... although certainly there is more material exposure in hip than heart. I'd want to know the material used in any device... again - my paranoia.

I believe I recall that Shannon said the Amplatzer plug becomes engulfed with tissue so it's embedded permanently which was more reassuring to me regarding the risk of potential migration that has been my concern.

I'm not sure about details on whether insurance or Medicare would cover any of these as I am not actively pursuing the potential but if for some reason I become intolerant to the anticoagulants and if it could be done safely at my age, I'd consider it eventually. Here's a link published by Blue Cross that describes the various options for occluding the LAA... there are probably others as well. [www.bcidaho.com]

I'm sure there are many cardiology reports that go into more detail with current findings.

Looking forward to your posts on what you learn.

Best to you,
Jackie

Ken,
You might want to read this Medscape article.
[www.medscape.com]



Edited 1 time(s). Last edit at 11/10/2016 11:51PM by gmperf.

Thank you so much for sharing! I definitely found out info I had not heard before.
Ken



Edited 1 time(s). Last edit at 11/11/2016 05:16AM by KenKY.