Can I Do Anything To Improve LAA Velocity???

Ok perhaps another odd question from North Carolina. Since my LAA isolated 8/6 is there anything that would improve my odds of the 60% LAA velocity when i do the TEE in January all assuming no more atrial flutter which ive had none since July 10 prior to the Natale 8/6 isolation. I am just always scheming and thinking. I realize this question could be ridiculous
Tom

No, not really. I suppose general cardiovascular fitness could only help but I don't know of anything you can do to specifically target the LAA.

👍

Hi Tom,

My buddy had two Natale ablations, including LAA isolation, 6 or 7 years ago. Initially he was in the "red" zone for getting off OAC, but not too far away. After a couple of years ago he improved into the "green" zone and is off all meds. I don't know that he did anything specifically to improve, just luck, I guess. Other than afib, he's very healthy. He was another person who followed the chronic exercise path to afib. Now 69, he was captain of the Judo team at West Point in college. He's maintained good health throughout life, and now, with my influence, maintains fitness, but moderately.

Best to you!

George

Thanks George. Ill assume he never got a Watchman? Which will be my hope should i fall in the 40% velocity group
I just going foward want off Eliquis due to being 68 now. Still very active and yes i was the ocd work out guy. Now its scaled back alot of course to lighter weights and walking

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Poppino
Ill assume he never got a Watchman?

Correct, he did not get a Watchman.

As I recall, his index ablation was very extensive. Shannon said my friend's time in the procedure was 2nd only to his own. My buddy was long standing persistent starting this journey.

My friend lives in Houston. He was like, why are you telling me to go to Austin, we've got great docs here? I was very insistent. Now he and his wife thank me every time we are together. I tell him if he wasn't my best friend from childhood, I wouldn't have been so persistent.

Yes great advice. So far ive had no flutter and im 8 wks 2 days. But the light at the end of my tunnel is not a glimmer yet. I wear a monitor for a week. That determines next move. So if no flutter ill assume TEE test. If 60 im done. Maybe. If 40 a watchman. Maybe. Its like my EP here told me: once the LAA is isolated youve taken a new path. But if it stops the flutter ill take that path. Its longer and bumpier but in a year i could be pretty much done

Hi Tom,

I believe you've got the numbers backward on the likelihood of one's LAA emptying velocity at the 6th month mark after LAA Isolation being more likely to not need life-long anticoagulation or not needing a Watchman or other LAA occlusion/ligation device installed ... thus the correct answer is that the ~60% odds number reflects those who did NOT pass the 3-step testing process: (test 1. = not passing an LAA emptying velocity if was less than 40cm per second on the 6th-month TEE after having had LAA Isolation, (test 2. = not passing the Doppler A-Wave test into the mitral valve inflow, (test 3. = not passing the green light on the TEE scan such that there is too much 'smoke' or 'spontaneous echo contrast' still seen within either the Left atria chamber itself or within the LAA itself.

Not passing any one of those 3 metrics will disqualify one from potentially being able to stop life-long anticoagulation going foreward. Though you can achieve almost the same thing after successful install of a Watchman or other LAA occlusion/ligation device.

On the other hand, one's odds are roughly a 40% chance of not needing anticoagulation after the 6th month TEE mark, but only if you pass all three tests with flying colors ... and again ... the odds of requiring either life-long anticoagulation or a Watchman (or other) occlusion or ligation device, are roughly 60%.

I imagine this isn't quite the news you were hoping for based on your comments above, right?

Nevertheless, it is still decent odds when you factor in a roughly 40% chance of not needing anticoagulation going forward after you pass the 3 step 6th month TEE scan after one's LAA isolation ... keep in mind that these less robust odds are still better than a poke in the eye :-).

Cheers!
Shannon

Hi Shannon yes I understand i just worded it incorrectly. I get the 40% chance ! If it happens great. Im going with the assumption i wont so if i do its an exciting surprise
Im 10 weeks post ablation today and have an 11-22-21 (jfk assassination 11-22-63)teleconference with Dr Natale scheduled so ill find out then my future schedule , hoping that nothing stands in the way of a Watchman cause thats the route i think ill want but ill follow Dr Natale s rec

I failed Test 2. (test 2. = not passing the Doppler A-Wave test into the mitral valve inflow. Hence I have been on Eliquis since LAA was isolated in mid 2016. I passed all the other test.
I am on 2.5 mg 2X a day of Eliquis. The cost is the same. Individuals on Part D Medicare prescription drug coverage will really get the shaft starting in 2022. I suggest anyone on Medicare prescription drug plan look at the major price difference for Eliquis or any of the brand NOAC Meds.

The stranglehold big pharmacy has on prescription drug pricing is beyond ridiculous. I see many individuals not being able to afford this change and Coumadin will be used. The labs are paid for on most plans required with Coumadin. The big pharmaceutical companies have a strong grip of keeping generics from being made. I do not know how I will handle this situation. My drug cost will go up over $1000 dollars in 2022 because of Eliquis.

The Government is not doing crap to help the Senior Citizens.

Smack. Why didnt u get The Watchman? Then maybe no eliquis??

I tried on 2019 and I was told Medicare would not approve the Watchman. I spent many days of my personal time trying to get information to justify the Watchman procedure but Austin finally said it was a NO. I am not 65. I am disabled on Medicare. I will be 64 in February.
It was Hell at that time to get anyone onboard in Austin whom seemed interested in my situation. I love TCA center and what they have done for me. Maybe things have relaxed. I do know some on this forum have the Watchman and still take Eliquis 2.5 2x a day.
I will try again when I turn 65.
I have Medigap with a Part N supplement that currently cost me $310 a month. I keep this type of policy because of my Heart and Texas is out of state. Basically the all in one plans will not cover out of state surgeries which is no good for me because I will go to Austin if anything happens again.
Part N supplement is less than $100 a month when I turn 65.



Edited 1 time(s). Last edit at 10/20/2021 10:32AM by smackman.

Ok i see. Well im sorry but maybe at 65 things change. Ive seen charts showing costs savings in 4-5 yrs with Watchman over eliquis
As far as still taking eliquis after a Watchman i dont quite get unless its not sealed 100% ? Or some choose it over daily aspirin use
Or a person might have another risk factor

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Poppino
As far as still taking eliquis after a Watchman i dont quite get unless its not sealed 100% ? Or some choose it over daily aspirin use
Or a person might have another risk factor

If you receive a Watchman, you'll find out that the FDA-approved protocol is daily aspirin for life, regardless of how well your device is sealed. Not all EPs agree that's necessary or even helpful, and think it's more of a knee-jerk protocol implemented out of a sense of "we've got to do something" rather than a proven benefit. In the end, the decision will be yours if you receive a Watchman.

My decision was to follow Dr. Natale's recommendation, which was half-dose Eliquis for life. Why? Because I'm 65 and like most westerners my age, I have evidence of mild aortic plaque. I also have hypertension, which is another CHADS point, and aortic plaque can cause clots to form all on its own, and that's not something a Watchman can protect you against. My PCP and my local EP both agreed with his recommendation, so with 3 concurring opinions among 3 doctors I respect, 1/2 dose Eliquis it was. And in view of the recent studies on aspirin, it appears his advice was spot on. So I don't take the Eliquis because of concerns about atrial clots. I take it as prophylaxis against all the other kinds of clots. I like it. It gives me piece of mind, and if I need a colonoscopy or something, I don't need to do anything or consult anybody. I just stop the Eliquis for as long as needed. The Watchman gives me that freedom.

On the money side, fortunately for me when I had my final ablation that isolated my LAA, my employer's insurance coverage considered Eliquis a preventative medication, so paid for it at 100%. When I took early retirement in 2019, I kept that insurance via COBRA for 18 months, and then went to Medicare when I turned 65 earlier this year. I shopped part D plans carefully, and now pay $40/month for Eliquis (price is the same for 5 mg and 2.5 mg). The two other drugs I take are dirt cheap ($4/month), so less than $50 per month is very tolerable.

Carey:

Is that 40.00 monthly for 12 months, does your plan reach a period called the donut hole and then your price for your drug increase for about 3 months. I am checking plans now so that my price remains the same for the whole year. These supplemental plans usually don't want to talk when they know a person has AF, that may not apply to you as you are no longer in AF.

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Elizabeth
Is that 40.00 monthly for 12 months, does your plan reach a period called the donut hole and then your price for your drug increase for about 3 months. I am checking plans now so that my price remains the same for the whole year. These supplemental plans usually don't want to talk when they know a person has AF, that may not apply to you as you are no longer in AF.

I pay the same $40 per month all year. No donut hole. Whether I'm now in active AF or not, from their point of view I'm someone with a long history of AF, so they don't treat me any differently than they would anyone else here.

I don't ever talk to anyone if I can help it. I use medicare.gov and so far that's been all I need. I was just there a few minutes ago looking at my 2022 options, and I see I can switch drug plans and reduce my monthly premium from $46 to $41, but that will increase my cost for Eliquis from $40 to $48. Kind of a wash so I'll have to look at the two plans more carefully and see if there's some reason to prefer one over the other.

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Carey

Is that 40.00 monthly for 12 months, does your plan reach a period called the donut hole and then your price for your drug increase for about 3 months. I am checking plans now so that my price remains the same for the whole year. These supplemental plans usually don't want to talk when they know a person has AF, that may not apply to you as you are no longer in AF.

I pay the same $40 per month all year. No donut hole. Whether I'm now in active AF or not, from their point of view I'm someone with a long history of AF, so they don't treat me any differently than they would anyone else here.

I don't ever talk to anyone if I can help it. I use medicare.gov and so far that's been all I need. I was just there a few minutes ago looking at my 2022 options, and I see I can switch drug plans and reduce my monthly premium from $46 to $41, but that will increase my cost for Eliquis from $40 to $48. Kind of a wash so I'll have to look at the two plans more carefully and see if there's some reason to prefer one over the other.

Can I ask what Part D plan you are looking at for 2022? Aetna formerly Silverscripts increased their deductible to $480 and only pay 17% of the cost of Eliquis. If you buy Eliquis 4 times a year, you will hit the donut hole. There is not a Part D plan available in Louisiana that does not have a $480 deductible for Tier 3 drugs and above like Eliquis.
Please, If you know of such a great Part D plan where you will only be paying $40ish dollars a month for Eliquis including the deductible, let the secret out. Donut hole for 2022 is $4430. Eliquis is approximately $1500 for 3 months or $6000 a year.
Splitting 5 mg pills? 🤐😀

Whiskey thins the blood. Joke but true. In moderation of course.



Edited 2 time(s). Last edit at 10/19/2021 03:41PM by smackman.

Smackman;

Silverscript (Aetna) has a plan called Smart RX, 6.90/ins., 46.month for Xeralto, donut hole is 445.00 adds up to around 1079/year. Not real good but it is a little cheaper than what I am paying now. If Carey can show up something better that would be great.

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smackman


Is that 40.00 monthly for 12 months, does your plan reach a period called the donut hole and then your price for your drug increase for about 3 months. I am checking plans now so that my price remains the same for the whole year. These supplemental plans usually don't want to talk when they know a person has AF, that may not apply to you as you are no longer in AF.

I pay the same $40 per month all year. No donut hole. Whether I'm now in active AF or not, from their point of view I'm someone with a long history of AF, so they don't treat me any differently than they would anyone else here.

I don't ever talk to anyone if I can help it. I use medicare.gov and so far that's been all I need. I was just there a few minutes ago looking at my 2022 options v8, and I see I can switch drug plans and reduce my monthly premium from $46 to $41, but that will increase my cost for Eliquis from $40 to $48. Kind of a wash so I'll have to look at the two plans more carefully and see if there's some reason to prefer one over the other.

Can I ask what Part D plan you are looking at for 2022? Aetna formerly Silverscripts increased their deductible to $480 and only pay 17% of the cost of Eliquis. If you buy Eliquis 4 times a year, you will hit the donut hole. There is not a Part D plan available in Louisiana that does not have a $480 deductible for Tier 3 drugs and above like Eliquis.
Please, If you know of such a great Part D plan where you will only be paying $40ish dollars a month for Eliquis including the deductible, let the secret out. Donut hole for 2022 is $4430. Eliquis is approximately $1500 for 3 months or $6000 a year.
Splitting 5 mg pills? 🤐😀

Whiskey thins the blood. Joke but true. In moderation of course.

Why don’t you just pay cash (credit card) at my overseas pharmacy during the donut hole period and then resume using your insurance in 2022? My sister in law and I have bought from them for years. Fresh great exp. dates, blister packs quick delivery and you get $50 off your first order. It’s cheap than what you will end up paying.

Here is the thread again. Their prices are the same regardless of strength so you can split if you take 2.5mg a day. I get brand name Tenormin from them and split the pill. If you take Xarelto, it’s really cheap. Even cheaper if you use the $50 code I provided.
[www.afibbers.org]

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Elizabeth
Smackman;

Silverscript (Aetna) has a plan called Smart RX, 6.90/ins., 46.month for Xeralto, donut hole is 445.00 adds up to around 1079/year. Not real good but it is a little cheaper than what I am paying now. If Carey can show up something better that would be great.

Aetna does not offer that plan in Louisiana. Also donut hole is met by the ACTUAL cost of the drug not what you pay. For instance, Eliquis cost approximately $1500 for a 3 month supply. $1500 x 4 refills is $6000. Way above the donut hole for 2021 and 2022. 3 refills puts you above the donut hole.
The deductible for Aetna went up above $400 for 2022.

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smackman
Can I ask what Part D plan you are looking at for 2022? Aetna formerly Silverscripts increased their deductible to $480 and only pay 17% of the cost of Eliquis. If you buy Eliquis 4 times a year, you will hit the donut hole. There is not a Part D plan available in Louisiana that does not have a $480 deductible for Tier 3 drugs and above like Eliquis.

The difference between what's available in CT and what's available in AL is substantial, but you should probably ignore my posts quoting prices. It slipped my mind when answering that I had received a discount when I signed up for Medicare earlier this year due to a quirk in my 2020 income, so those prices probably aren't available to most people. Sorry about that.