Second TEE to determine LAA function

Dear Forum,
A year ago October 2016 I had my second ablation by Dr. Natale in Texas after 10 years of being afib free. In May of 2017 I had a TEE done in Michigan . Dr. Natale said the LAA did not always pump and I needed to stay on Eloquis. Nurse Curry said I could have another TEE done later to check the function. Has anyone had a second TEE done where it showed full pumping function? I am seeing my cardiologist in December and hoping to ask for another TEE before January when my deductible starts again. I'm 58 years old am getting nervous about long term use of Eloquis. Do you think in the near future the watchman will be available for everyone? Has anyone ever had a second TEE done a second time to measure LAA function?
Best,
Pamela

I had a second TEE 2 years after my ablations. LAA function was unchanged. I was on Eliquis since the ablation. Then had side effects I couldn’t tolerate.
I am on Pradaxa now. Also hoping the Watchman pans out. I am 53..

I had 2 follow up TEEs over 8 months after inadvertent LAA isolation. The function had improved from atonic to " mild to moderate dysfunction" but not enough to go off Xarelto which I continue to take. I hope to get a Watchman placed in January as I do not expect further improvement in the LAA function. I will be getting a final TEE prior to the procedure however

I was planning on having a Watchman installed last month. But insurance wouldn’t cover.

Reading about all of those people that have had ablations and now have problems with the pumping of the LAA and having to stay on blood thinners for life unless they have another proceedure done is scary . Why go through all of that?

Liz

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Elizabeth
Reading about all of those people ... Why go through all of that?

Liz

I'm one of those people. My LAA was isolated by Dr. Natale because it had to be in order to restore my heart to NSR. I will soon have my 1st post-ablation TEE to assess my LAA etc.

What it comes down to for me is knowing that I have been arrhythmia free for 5 months and 1 day (but who's counting?) and off of AR drugs for 3 months and 1 day. Yes, I am still on Eliquis, and very well may need to stay on it until I have a closure device, should that be the path I take. The Watchman procedure can be done by Dr. Natale, and it takes about 30 minutes. NOAC is then continued for 45 days is my understanding.

The end game for me has been NSR and freedom from AR drugs and NOAC's. Being off Eliquis will happen I believe. In the meantime, a life free of afib, AR drugs and the anxiety as a result of afib has been worth it. I feel better than I have in years. If I have to have a 30 minute procedure performed by the leading EP in the world in order to stop Eliquis, then sign me up.

I'm another one of those people. In exchange for an isolated LAA, I got rid of afib and intractable flutter at rates of 230-250 that multiple EPs had been unable to stop. Best trade I've made in my entire life, bar none.

People with afib who undergo no ablations at all usually remain on anticoagulants for life too, plus they're usually on beta blockers and often antiarrhythmics too, all of which have very serious potential side effects and often stop working after some period of time. Compare that to my situation now: I take one drug (Eliquis) and I'm 100% free of afib and flutter. Like I said, best trade I've ever made.

Like AB, I'll probably go for a closure device sometime in the next year or two, and then I'll be off anticoagulants for life, have a drastically reduced stroke risk, and be free of afib and flutter too. Sounds like a pretty big win to me.

It would depend on a person's age, if you are younger than 75 than an ablation and any succeeding ablations, watchman any blood thinners meds would be different. If one is in their late 70s and beyond then I say again "why go through one or more ablations, maybe a watchman and blood thinners.

Liz

From my limited experience, it seems that if the first TEE shows low blood flow, so does the second one. Is there anyone who got off Eliquis after a second TEE? I will have my first TEE in a few months after my first ablation, so am hoping that the TEE shows a good result.

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Elizabeth
It would depend on a person's age, if you are younger than 75 than an ablation and any succeeding ablations, watchman any blood thinners meds would be different. If one is in their late 70s and beyond then I say again "why go through one or more ablations, maybe a watchman and blood thinners.

Sure, age matters, and so do other factors, but when considering ablation I think the most important factors are afib burden and symptoms. Some people can easily live with afib because it doesn't happen that often and/or the symptoms aren't severe while others can be outright disabled by it.

I concur with Carey. When I didn't realize that my increased consumption of calcium (from stress eating wheels of brie during my divorce) was the culprit in severely diminishing my afib control, I was seriously contemplating a Natale ablation. Fortunately I figured out the root cause and that was not necessary.

oleanmike - My second ablation procedure(2014), 11 years after the first, isolated the LAA.

The followup TEE showed normal clearance velocity, 53cm/sec. Then, about 6 months later, I began having breakthrough flutter so had "touch up" ablation #3 and the subsequent followup TEE. That clearance velocity was 40cm/sec. So because of my age... (79), Dr. Natale said I should continue with the half-dose of Eliquis as 'best practice.'

As for age and going for ablations, it certainly has to do with overall health status and activity levels. I recall Shannon talking about various afibbers having Natale ablations in their 80's and getting back to tennis and other activities. When I had the recurrence 11 years after the first Natale ablation, it was a-flutter and if you haven't experienced that, then let me just say, go experience a couple days of high-rate flutter repeatedly and multiple ECVs and then say that someone in their late 70's should not consider ablation. Of course, my decision was easy considering Dr. Natale did the first ablation in 2003 and I knew I'd be fine with the second and I was. I felt a bit tired for a couple days as a result of the anesthesia but otherwise, NSR was such a relief, it was more than worth the trip to Austin. Plus, I was able to hang out with my son who lives in the area.

The only downside I notice now (at age 81) is the side effects of Eliquis - even at half-dose daily - as I have MCS and don't typically tolerate medications. But, this is a small sacrifice for the freedom from a-flutter HR around 220 and multiple electrocardioversions. The ECV's (to me) seem more of an assault on the body than the ablation procedure.

I am otherwise healthy, take no meds others than the Eliquis, am treating for no other health issues except ARMD which has actually improved with time thanks to the recommended vitamins. I am active and expect to live many more years in blessed NSR.... thanks to my hero, Dr. Natale, and my healthy aging protocols!

Whether or not I will go for the Watchman remains to be seen. I'd love to be off the Eliquis. I'm waiting for news about insurance approvals and such.

Jackie

Jackie:

I am a year older than you, I have had AF since the late 90s, about 18 years, at first the episodes were only about a couple/year. They increased over the years but after finding this site and taking Magnesium they lessened to every few months, sometimes a little more or less. Now when I get an episode of AF I take mag. and an aspirin, and chew a tab. of Propfenone (aka george) and it lessens my episodes greatly---I used to get them for around 20-24 hours, now they go from 3 hrs. to 11hrs.they are not debilitating. My only worries are that I cannot take blood thinners, but it sounds like getting an ablation doesn't guarantee that one would be free of blood thinners, in fact, it may be more necessary to take them.

It appears that a lot of times the LAA pumping ability is compromised and it is then necessary to take blood thinners maybe for life, I coudn't do that, then it would be necessary for a watchman device.

This is a site for affibers, I respect your way but it isn't my way, I believe there should be discussions whatever one decides is the best for themselves. I have read this site for many years and many have had to get more than one ablation, no matter who they have do it, it is said that some have had less pumping ability in their LAA, so this all should be understood before undertaking any surgery. If as some have said they have very debilitating episodes, then of course they should do what they can to have a peaceful heart.

Liz

Liz - I totally agree with you and respect your decision not to consider ablation for the reasons you mentioned. I chose to proceed because I was helpless to function during the frequent and long episodes of a-flutter which to me were far worse than atrial fibrillation and the pattern was escalating and seemed to always require ECV which is no joy either.

I would just caution you to be very mindful of your blood viscosity at all times because with age, your heart's clearance efficiency does decline and the risk of stroke is serious. I can appreciate that you can't take blood thinners... I can barely tolerate them and definitely can't do aspirin. But I did very well for all that time on my regimen of natural aids that helped keep inflammatory markers low, removed the sticky fibrin and avoided clots during the extended events when I did have them.

I hope you can continue on safely and be well for a very long time with what you tolerate. This afib stuff is no picnic. So hang in there, Liz, and be well.

Jackie