A curiosity....

In your opinion, if general cases, if ablations seem so (relatively) easy and effective, why do people battle for years trying to get strong medications correct, suffering thru side effects, messed up combinations, possibility of stroke, death or afib getting worse, burden on the liver, etc.... Why don't they just get an ablation and be done with it? I know you can't speak for everyone, but I'd like to hear your opinion.



Edited 2 time(s). Last edit at 02/01/2020 10:45AM by cirenepurzalot.

Most meds and methods are much older than ablations. Many cardiologists still don't trust this New technology and consider ablationists as barbarians.

Quote

In your opinion, if general cases, if ablations seem so (relatively) easy and effective, why do people battle for years trying to get strong medications correct, suffering thru side effects, messed up combinations, possibility of stroke, death or afib getting worse, burden on the liver, etc.... Why don't they just get an ablation and be done with it? I know you can't speak for everyone, but I'd like to hear your opinion.

I can share my experience as someone who has had Afib for 10 years, but has not had an ablation. First, the medications I am taking (Eliquis, low dose flecainide and low dose propranolol) have not caused noticeable side-effects or caused any changes in my labs. Flecainide has, so far, controlled Afib nearly completely and though it is likely to fail at some point. I also have other health issues that might make recovery from an ablation more difficult.

Thanks for sharing. That makes sense. Wishing you the best.

Fear is one big reason. I've seen many people on this and other forums express extreme fear of the procedure as a reason they won't get one. I think that fear is irrational in view of the actual risks, but fears often are irrational and that doesn't make them go away. And, like Daisy, if the drugs work for you and don't cause uncomfortable side effects, living with it is a perfectly reasonable choice.

Quote
Pompon
Most meds and methods are much older than ablations. Many cardiologists still don't trust this New technology and consider ablationists as barbarians.

Interesting. I hadn’t heard that perspective. I thought most cardiologists were pro drug and pro ablation, at least in the US.

Quote
Pompon
Many cardiologists still don't trust this New technology and consider ablationists as barbarians.

Cardiologists maybe but doubt many EPs feel that way.

Quote
cirenepurzalot
In your opinion, if general cases, if ablations seem so (relatively) easy and effective, why do people battle for years trying to get strong medications correct, suffering thru side effects, messed up combinations, possibility of stroke, death or afib getting worse, burden on the liver, etc.... Why don't they just get an ablation and be done with it? I know you can't speak for everyone, but I'd like to hear your opinion.

If you go to a top tier EP, then your statement about easy & effective may apply. If you can't/don't choose such an EP, than the risk benefit equation may change. Since I've had afib for over 15 1/2 years, I know many people personally who've gotten a local ablation. I know only one who has had durable success. I've referred a number of personal friends to Dr. Natale. All have had success, though some take two ablations with the second typically working on the left atrial appendage. I also referred my cousin to a Natale proteje' 12 years ago, again with a successful ablation as an outcome.

Two and a half years ago, a friend of a friend presented with what 3 local EP's though was vfib. They'd put him in a "shocker vest" such that it would shock him back into NSR if he went into vfib again. None of the local EPs thought they could help with an ablation and offered only some meds that "might" be effective. I got this guy lined up with Natale and, because of the vfib diagnosis, he was ablated by Natale in two weeks. Natale, by the way, thought the vfib diagnosis was incorrect. The ablation has been durable and my friend could not believe that Natale could do what 3 locals said was not possible (at least in their world).

I get asked fairly frequently why I don't just get an ablation and be done with it. In my case, I had a 2.5 month episode in the first 4 months of afib. My understanding is that this puts me likely in the "complex" category. Hence LAA work would likely be required. There are consequences to this. I created a plan, that was approved by my EP nearly 15 1/2 years ago, to try to stay in rhythm with electrolytes and moderation of exercise, with flecainide PIP when my plan fails. This has worked well enough that my afib burden is very low. In the last 21 months, it has been 0.013% (2-one hour episodes out of about 15,300 hours. My afib burden has not increased - in the first four months of afib, it was 57%. With a CHA₂DS₂-VASc score of 0, I'm on no meds chronically. Only a loading dose of flec very infrequently. In the risk/reward calculation I do for myself, I do not see a benefit to an ablation at this time. My situation could change, but this is how I view it today.



Edited 1 time(s). Last edit at 02/02/2020 08:43AM by GeorgeN.

Quote
cirenepurzalot
. . . if ablations seem so (relatively) easy and effective, why do people battle for years trying to get strong medications correct, suffering thru side effects, messed up combinations, possibility of stroke, death or afib getting worse, burden on the liver, etc.... Why don't they just get an ablation and be done with it? I know you can't speak for everyone, but I'd like to hear your opinion.

That was precisely my logic in getting my ablation back in 2009, and then about a year ago getting a Watchman FLX device implanted. I'm sensitive to medications, had lots of side effects, etc. The support of folks in this forum, I must say, was invaluable.

Of course, I had pretty good insurance--and the Watchman FLX was pretty much paid in full by a study . . . So in that respect I was very fortunate.



Edited 1 time(s). Last edit at 02/01/2020 10:37PM by ln108.

Quick reminder: ablations carry risks... from the relatively minor to the ultimate.

Just peruse carefully the pre-procedure release form requiring a sign-off.

/L

Hi Cirenepurzalot,

"Why don't they just get an ablation and be done with it?"

My guess is many cannot afford an ablation and many of the rest may well fear an ablation. I had no fear of ablation whatsoever and could not wait to have one asap possibly because I was having up to 48 hour long AFIB attacks with only 12 hours or so in between the attacks toward the end and before my first ablation in Escorts Hospital in New Delhi, India. On the phone Escorts said they could do the ablation at 1 weeks notice though I actually went two weeks later due to visa requirements etc.

Its all about the AF burden, my case was summed up in a quote I think I read on this Forum many years ago i.e. I am not frightened of dying of AFIB, I am frightened of living with it.

Cheers,
Barry G.

Quote
Barry G.
I am not frightened of dying of AFIB, I am frightened of living with it.

Wow, that's a great line.

Yes Carey its classic, wish I had made it up.

Cheers,
Barry G.

In108, Barry, George, Daisy, Casey, Larry and all of you: THANKS! You’re insights are invaluable.

Quote
Carey

I am not frightened of dying of AFIB, I am frightened of living with it.

Wow, that's a great line.

I couldn’t have had said it any better. I was very symptomatic with AF. Now with PVCs with high HR (last month zio patch showed 17.3% burden) I think it’s mostly all the time now with rare episodes of normal beats, I can say that AF is worst and more frightening and so far I am relieved My AF is not occurring. I just wished Natale did pvc Ablations in CA where he did my AF ablation instead of me having to travel alone to Austin with the 10 pound weight restriction and flights.

A have only had three Afib episodes In about 3 years ........but....the moment the AFib episodes start to increase.....the minute my EP say yes....I will have an Ablation.

I am probably in the minority, but I fear the medications used to treat AF more than I fear the Ablation.



Edited 1 time(s). Last edit at 02/02/2020 01:21PM by lds001.

I think I tend to agree.

Quote
lds001
I fear the medications used to treat AF more than I fear the Ablation.

My thoughts exactly!

--Lance

How is the burden percentage number determined?

Quote
JDfiB
How is the burden percentage number determined?

It's simply the time spent in afib divided by the total time.

So, for example, if you spent 12 hours in afib during one week, that's 12 hours out of 168 hours.

The math look like this:

12 / (7 * 24) =
12 / 168 =
.0714 =
7% afib burden

Hi Cirenepuralot.

I have had 5 ablations and if you wish to get a lay-mans take on having an ablation maybe use the Forums search facility - at your own risk ;-) - for 3 of my following posts 2007 to 2010 i.e.....Fill in the relevant boxes with the following info
1) Search Messages.....Back from India / Search Authors...Barry / Forums.....Search all Forums / All dates
2) Search Messages.....Bordeaux Diary / Search Authors...Barry / Forums....Search all Forums / All Dates
3) Search Messages.....Native English Speaker / Search Authors....Barry G. / Forums ....Search all Forums / All Dates

As post go they are long but hopefully also very informative and reader friendly from a personal perspective with a bit of tongue in cheek humour thrown in.

Just found and read them myself today. How did I ever get thru that nightmare and come out the other end in one piece..the trials and tribulations of an ablated AFIBBER:-(

P.S. I would have been totally lost without this Forum, and all its regular posters.

Cheers,
Barry G.

Thanks Barry. Sorry you had to go through all of that. How are you feeling now?

Hi Cirenpurzalot,

"How are you feeling now". I am 70 going on 25.

There were far many people worse off that me i.e. the people who cannot afford an ablation and others failing to find their triggers and eliminating them.
I got almost 10 years arrhythmia free after my last ablation 2010 however Atrial Flutter appeared about 7 months ago but a cardioversion stopped that at first attempt so now taking things easy i.e. hard exercising a thing of the past now.

Cheers,
Barry G.

Quote
Carey

How is the burden percentage number determined?

It's simply the time spent in afib divided by the total time.

So, for example, if you spent 12 hours in afib during one week, that's 12 hours out of 168 hours.

The math look like this:

12 / (7 * 24) =
12 / 168 =
.0714 =
7% afib burden

Thank you !

I was in Persistent AFIB from the first time I was diagnosed with AFIB. The ONLY way I could get back to NSR was the Paddles of joules. Nothing chemically would convert me and I spent many days in the Hospital.
I have had 2 Ablations. One in Jan. 2014 and a second in July 2016. My LAA was isolated on the second procedure so I take 2.5 mg Eliquis 2X a day due to no P wave. 😒 I have considered the Watchman but I do fear this for some reason. I want to see some more “runtime” on this first plus it is difficult to get Medicare to approve. I talked with Austin earlier about the Watchman and honestly the people I dealt with were not very helpful and made it out to be a beast to get approved. They are probably right but I do despise taking a blood thinner for life.

Had I been better informed and met Shannon earlier in my journey I wouldn't have the regret of the hell that are anti-arrtyhmics, and also following a good EP who bought into bad science and left me in worse condition than I was. In everyone's defense, afib is complicated and we don't realize the difference in quality between our local EP's and the top tier is so great.

The staff may not have been helpful but they were right. Getting a Watchman approved by Medicare or any private insurance company when you can tolerate anticoagulants and don't have bleeding problems is going to be almost impossible.

Incidentally, I have a Watchman and yet I still take a half dose of Eliquis by my own choice. I could have stopped the Eliquis entirely but I chose to continue with a half dose. I ran the question past two EPs and my PCP -- with one of the EPs being Natale -- and they all agreed the benefits of the Eliquis outweighed the risks. The LAA isn't the only source of clots, after all, and I do have a diminished P wave. I spent a long time thinking about this and doing research, and in the end I concluded that being on a low dose of Eliquis wasn't such a bad thing. If nothing else, it means I can take that 14-hour flight to New Zealand without risk of DVTs.

Carey, You got the watchman basically free right? If I would of had that opportunity I would have jumped on it like stink on a skunk. You also say your cost for eliquis is minimal. That’s not the case with me and many others.
What if I need surgery in the future? That is just one of my concerns that you really do not have to consider. You can get off Eliquis without having to worry about a stroke. You taking Eliquis for PM is smart but a personal choice. Eliquis puts me in the donut hole every year..
I cannot get nerve end therapy to my back anymore due to mandatory anticoagulant. All I get is medication for a chronic bad back. Now that stinks for me.

Austin was nice to me about the Watchman but it is obvious it’s hell to get approval for. As I get older, I worry more about the need to get off Eliquis for a short period such as I am due for a Colonoscopy this year and they will not do it with me on a blood. Thinner.

Quote
smackman
Carey, You got the watchman basically free right? If I would of had that opportunity I would have jumped on it like stink on a skunk. You also say your cost for eliquis is minimal. That’s not the case with me and many others.
What if I need surgery in the future? That is just one of my concerns that you really do not have to consider. You can get off Eliquis without having to worry about a stroke. You taking Eliquis for PM is smart but a personal choice. Eliquis puts me in the donut hole every year..
I cannot get nerve end therapy to my back anymore due to mandatory anticoagulant. All I get is medication for a chronic bad back. Now that stinks for me.

You're right on all counts. I got the Watchman for free as part of a clinical trial of the new Watchman FLX. And yes, my cost for the Eliquis is zero because my insurance considers it a preventative med and covers it at 100%. So my only cost so far has been two trips to Austin (about $2400 total). I'll be going on Medicare next year, so that rosy situation will come to an end. :-(

I readily admit that cost was a big factor in getting the Watchman and also in continuing the Eliquis. Will I continue it next year when it's going to cost me? I don't know. Haven't crossed that bridge yet.

What's so frustrating about this is there's already data available showing that a Watchman becomes cheaper than NOACs after about 5 years. Plus there are no compliance issues. You can't exactly forget to take your Watchman. So Medicare and the insurance companies should be jumping all over it because it will reduce their costs in the long run. Probably substantially when you factor in strokes among people who aren't compliant with their meds (upwards of 40% of afib patients eventually quit taking their anticoagulant). I think they will come around and start covering it, and that will happen in the next few years, so I think you'll be able to get one eventually.

Quote
Carey
What's so frustrating about this is there's already data available showing that a Watchman becomes cheaper than NOACs after about 5 years. Plus there are no compliance issues. You can't exactly forget to take your Watchman. So Medicare and the insurance companies should be jumping all over it because it will reduce their costs in the long run. Probably substantially when you factor in strokes among people who aren't compliant with their meds (upwards of 40% of afib patients eventually quit taking their anticoagulant). I think they will come around and start covering it, and that will happen in the next few years, so I think you'll be able to get one eventually.

Makes more economic sense for Medicare as people not on it (in the US) tend to change carriers at 5 years or before.

Quote
cirenepurzalot
In your opinion, if general cases, if ablations seem so (relatively) easy and effective, why do people battle for years trying to get strong medications correct, suffering thru side effects, messed up combinations, possibility of stroke, death or afib getting worse, burden on the liver, etc.... Why don't they just get an ablation and be done with it? I know you can't speak for everyone, but I'd like to hear your opinion.

Spent over twenty three days on afib, including eight in afib-rvr. Needless to say I begged and begged for an ablation!

Whats scary about the first ablation? The $5,000 insurance deductible!!! Whats scary about the second ablation? ANOTHER $5,000 deductible!

I know right?! But I’m glad we don’t have to pay the full amount. 😋

Are you glad you got it?