Afib as a reason for poor leg circulation?

Met up with a 66 year lold cousin in another state this weekend. Found out he has afib and had an ablation years ago which has failed. He's asymptomatic and it was picked up by the anesthesiologist for a procedure for another issue. He was referred to a cardio. He also has poor leg circulation and the cardio said to do another ablation to help fix the poor leg circulation. He showed me a recent echo report and his EF is 60-65% (normal). His afib pulse was 95 (I took his radial pulse and it wasn't fast, and was in afib). They have currently have him on no meds (rate control or OAC). I was curious that with a normal EF, would putting him in NSR really help the poor circulation??? I'm going to suggest if he agrees to an ablation to go to Natale as I'm guessing he's in longstanding persistent afib and unlikely to be helped by anyone but one of the top EP's.

He needs to see a vascular surgeon. No way afib is responsible for his peripheral vascular disease. He needs to be on an OAC stat, get a PVD consult ASAP, and then maybe think about an ablation... or not. If he wants to go for one I agree a top-tier doc like Natale is the go-to doc, but I think it should be his last priority after he deals with his PVD.

Thanks Carey! I texted him my post and your reply.

The cardio may have a point per the paper below although it may be comorbid, so seeing a vascular surgeon also makes sense.

[www.escardio.org]).

Oh, could definitely be a comorbidity. Pretty much everything cardiovascular is a comorbidity for everything else cardiovascular.

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mjamesone
The cardio may have a point per the paper below although it may be comorbid, so seeing a vascular surgeon also makes sense.

[www.escardio.org]).

"Patients with AF often have coexisting vascular diseases, and the combination of the 2 diseases substantially increases the risk of future cardiovascular events. Therefore, we suggest that atherothrombosis is the mechanism underlying the significant association between AF and PAD. In addition, the results of the present study imply that overlapping of the thrombogenesis pathway involving endothelial damage, inflammation activation, and hypercoagulability connects AF and PAD. Furthermore, the fulfillment of Virchow's triad possibly explains the increasing risk of stroke and cardiovascular disease development in patients with AF and might also contribute to the pathophysiology of PAD. 6,8 The ACC/AHA/ESC 2006 guidelines emphasized the endothelial dysfunction, stasis, and elevated levels of P-selectin and von Willebrand factor in patients with AF. Levels of fibrin, D-dimer, and C-reactive protein, which may lead to a hypercoagulable state and the aforementioned multiple comorbidities, are also higher in patients with AF. 18,19"

However I still doubt that an ablation would solve the PAD! Need to solve root cause issues of both.

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Carey
He needs to be on an OAC stat.

Found out the reason he's not on OAC. He's got bladder cancer with a low white blood cell count. Some explanation here.

He did agree to find and see a vascular surgeon.

Hi all,
I've noticed that my afib episodes begin after a time of hr repetitively speeding up and slowing down before going irregular. Could this point to sick sinus?
Also, as i have no way of getting a top level ablation, after reading Carey's post it sounds as though i would be foolish to go down the local ablation route.
I can't tolerate sotolol or flec, so just use metoprolol if hr is high during an episode, and take elquis.
I read a study showing quinidine had a greater success rate than sotolol in conversion, and a safer profile. Anyone who has used it?
Regards, and thanks in advance for your insights,
John



Edited 1 time(s). Last edit at 10/12/2023 12:05PM by JohnBM.

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JohnBM
Also, as i have no way of getting a top level ablation

Curious about why? Many have changed their insurance in order to see a top EP and traveled when necessary.

Living in Ireland with no private health insurance and limited options to travel.
Apologies for mistakenly posting in George's thread, i have opened a new one

I agree with John. I realized after moving abroad that socialized medicine has challenges that one living in the states don’t expect. Most times one pays cash and sees a top notch doctor than waiting months to get referrals and payment commitments.

The UK has wonderful free insurance for tourists btw. I had angina once after walking up two flights in a London shop an hour after dragging two heavy suitcases (one lost a wheel) up endless flights from the tube. I sat for 3 hours dreading calling for an ambulance because I was unsure of the cost. It turned out the ambulance and ER was completely free for tourists..as long as I slept in the ER and wasn’t admitted all tests images and doctors saw me in the ER.

I would fly to France and get an ablation there since it’s not many hours of flying. EasyJet has fares for 20.99 pounds each way.

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GeorgeN
Found out the reason he's not on OAC. He's got bladder cancer with a low white blood cell count. Some explanation here.

He did agree to find and see a vascular surgeon.

Oh, geez. Yeah, that complicates everything. `

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susan.d
I would fly to France and get an ablation there since it’s not many hours of flying. EasyJet has fares for 20.99 pounds each way.

Thanks Susan, i shall look further into the cost of an ablation in Bordeaux

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JohnBM
Thanks Susan, i shall look further into the cost of an ablation in Bordeaux

There are several people on this forum who've had ablations there, but they may not be reading this thread. You might want to start a new topic with a title something like "Cost of an ablation in Bordeaux?"

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Carey
There are several people on this forum who've had ablations there, but they may not be reading this thread. You might want to start a new topic with a title something like "Cost of an ablation in Bordeaux?"

John, I've PM'd you with the name and PM info of one of these people that you can PM about this.