Pericarditis?

I apparently got a case of Pericarditis after the EP Study. Any similar experiences?

Not me, but I've known a few who have, including a guy who had that and he was in serious pain for a couple of months.

I had peracarditis twice 2012 and 2021. Both hit me 12-15 hrs following ablation. My aug 2021 ablation with Dr Natale was perfect. He had me on colchcine for a week prior then lasix in iv the am after. Nothing. The previous 2 lasted 3-5 days. It’s inflammation so they had me used advil despite eliquis. I had no after effects Dr Natale noted i had had it twice so he was proactive. Over 2 yrs now and zero afib nor flutter

Post procedural pericarditis is quite common according to my ep nurse and some ep's actually use an anti-inflammatory like Colchicine prophylactically. I was given a short course of Colchicine after my ablation and told to take it easy. I did see a study somewhere saying that those treated with Colchicine had slightly better ablation outcomes. This may have been irrespective of having pericarditis or not, can't remember.

Jim

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mjamesone
Post procedural pericarditis is quite common according to my ep nurse and some ep's actually use an anti-inflammatory like Colchicine prophylactically. I was given a short course of Colchicine after my ablation and told to take it easy. I did see a study somewhere saying that those treated with Colchicine had slightly better ablation outcomes. This may have been irrespective of having pericarditis or not, can't remember.

Jim

Yes, I was given Colchicine for a week before and two weeks after my ablation with Natale. As I remember, he usually gives half the lowest dose (twice a day?). Seems to work well.

Yes, twice a day dosing. If I remember correctly, I also had to split the pill for the prescribed dose. Symptoms persisted after the first two week course so started a second course, but ended it early due to stomach pains, a known side effect. Fortunately, the pericarditis resolved. At my 3 month follow up, the ep downplayed the diagnosis, but given how many ablations he does in a day, my guess is that the ep nurse deals a lot more with the after shock of ablation, than he does Like Dr. Mandrola is fond of saying, "ablation is a big procedure". Nice that Natale recognizes it and uses colchicine prophylacally as do a number of ep's. Thinking of using him should I need a touch up from my last.

Since you've used him, what is the story with the LAA isolation? Is this something he routinely does for touch up ablations? I ask because my understanding is that it would then require an LAA closure device like Watchman, something not sure I want now.

Jim

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mjamesone
Since you've used him, what is the story with the LAA isolation? Is this something he routinely does for touch up ablations? I ask because my understanding is that it would then require an LAA closure device like Watchman, something not sure I want now.

No, he doesn't do it routinely, only when mapping shows the LAA as a source. He doesn't do much of anything blindly. If he's burning tissue, there's a reason.

Having your LAA isolated doesn't necessarily require a closure device. Six months after an ablation with LAA isolation, they do another TEE specifically to measure your LAA performance. If it has retained sufficient pumping ability to ensure that blood stagnation won't occur within the LAA, then no closure device is needed. And if your CHADS-Vasc is low enough, you can even stop anticoagulants. In my case, I didn't make the grade and was told I would have to remain on anticoagulants for life or get a Watchman. But that was 2017 when insurance companies and Medicare wouldn't pay for a Watchman unless you couldn't tolerate anticoagulants. But I lucked out in 2018 and got into a Watchman clinical trial at St, David's and got a Watchman entirely for free. After being verified that I was leak-free at 6 months, I was told I could stop the Eliquis if I wanted. But, just like doctors used to routinely prescribe low-dose aspirin for older adults, Natale recommended continuing with a half-dose Eliquis since the LAA isn't the only source of clots in the body. My PCP and my local EP both agreed with that recommendation so that's what I did. Unlike many people here, I fear strokes about 1000 times more than I fear anticoagulants, and that fear is founded by the data and by my own EMS experience. Never once in 15 years did I see anyone ever have a major bleeding problem with anticoagulants, but I sure saw a hell of a lot of strokes, some of which resulted in death and outcomes worse than death.

Thanks, very informative.

1. Do you have any idea how often mapping shows the LAA to be the source? Is it most of the time? 50-50? Infrequent?

2. Sort of the same question regarding the closure device? After isolation, about how often does the TEE suggest a closure device is needed?

3. In your case, where "you didn't make the grade" could you have just remained on full dose thinners versus getting the Watchman? I think you suggested you could have, but wanted to confirm.

Jim

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mjamesone
Since you've used him, what is the story with the LAA isolation? Is this something he routinely
does for touch up ablations? I ask because my understanding is that it would then require an LAA closure device like Watchman, something not sure I want now.

As Carey said, he doesn’t do it routinely at all. In my case, he isolated my LAA during my index ablation as I was a complex case and that was the only way he could get to the root of my arrhythmias. During the touchup he just spent a few minutes touching up a couple of places that he had noticed from my pacemaker reports as causing a bit of tachycardia. After the touchup, which included getting the watchmen, my resting heart rate returned to pre-ablation numbers.

For first ablations it would be uncommon for the source to be the LAA unless you were a complex case as I was. In fact most of the time the source will be the pulmonary veins and that will take care of it. As far as how often after LAA isolation you will require either full dose Eliquis – which cannot be stopped for even a day—or a Watchman, from what I have heard it’s about 3/4 of the time. In my case he did not do a TEE separately before the Watchman procedure as he had done one during my earlier ablation and my ChadsVasc indicated the need for a Watchman, mainly due to age. I am very glad to have a Watchman though because I can now stop Eliquis for several days if needed for a medical procedure.

Thanks. Just to clarify, are you saying that after LAA isolation, either continuous anticoagulation or a Watchman is required 3/4 of the time -- regardless of your CHADS score, afib frequency, etc -- and simply because your LAA performance has deteriorated because of the isolation?

Jim

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mjamesone
Thanks. Just to clarify, are you saying that after LAA isolation, either continuous anticoagulation or a Watchman is required 3/4 of the time -- regardless of your CHADS score, afib frequency, etc -- and simply because your LAA performance has deteriorated because of the isolation?

Jim

3/4 of the time is a rough estimate from what I hear from others, but yes, about 3/4 of the time the circulation in the LAA is reduced enough to put you at greater risk for stroke--hence the need for continuous anticoagulation or a Watchman. Natale told me after my ablation that I must not miss a single dose of Eliquis. Stroke risk is not tied 1:1 with Afib episodes. It is looking like there is a common causal factor behind both stroke and Afib (fibrosis as I remember) so even without having an episode you are at greater risk for stroke. Since we all need procedures like colonoscopies etc. occasionally, getting a Watchman seemed like a no brainer. Particularly when it could be combined with a needed touchup.

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mjamesone
Thanks. Just to clarify, are you saying that after LAA isolation, either continuous anticoagulation or a Watchman is required 3/4 of the time -- regardless of your CHADS score, afib frequency, etc -- and simply because your LAA performance has deteriorated because of the isolation?

Jim

Correct. See Shannon's post describing this in more detail here: [www.afibbers.org]

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mjamesone
1. Do you have any idea how often mapping shows the LAA to be the source? Is it most of the time? 50-50? Infrequent?

2. Sort of the same question regarding the closure device? After isolation, about how often does the TEE suggest a closure device is needed?

3. In your case, where "you didn't make the grade" could you have just remained on full dose thinners versus getting the Watchman? I think you suggested you could have, but wanted to confirm.

1. I don't know the answer to that, but I expect it would be less than 50-50 for paroxysmal afib and more than 50-50 for persistent. In my case, it wasn't afib at all. I had paroxysmal atrial flutter at rates of 250 bpm that was emanating entirely from the LAA and had been for 2 years straight that one ablation and no drugs were able to control. A few burns around the mouth of the LAA and poof! It was gone.

2. There really isn't a number for that because a closure device is never actually required. Continuous anticoagulation is always an option. See #3.

3. Yes, I could have simply remained on Eliquis for life instead. If you can tolerate any type of anticoagulant, there's never a circumstance where a closure device is required.

Sorry, I didn't phrase #2 correctly.

What I meant to ask was after LAA isolation, how often does the follow up TEE suggest some sort of extra clot protection will be needed moving forward, be it thinners, Watchman, etc. Assuming a low CHADS score.


Jim

I believe it's around 40% but that's just verbal information from Natale based on his experience. I've never seen any published studies on the question.

I asked Dr Natale before my flutter ablation: so will you do the LAA? Lol dumb question: he said if thats where your problem is
It was. Waited 6 months then he put a Watchman in. 6 wks later TEE here in Charlotte. Perfect. No leaks & a good seal already
They call the LAA the 5th pulm vein. I have 5 so my 6th
All i know is my heart is 55-60 BP 128/72 no pac pvc s no
Meds. Im 70
Yes after LAA you gotta do something: eliquis or watchman etc. i try and not take it for granted. My 2021 was no fun: a failed ablation a Natale ablation 2 CTs 2 cardioversions covid the Watchman the TEE. Yet here i am

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mjamesone
Sorry, I didn't phrase #2 correctly.

What I meant to ask was after LAA isolation, how often does the follow up TEE suggest some sort of extra clot protection will be needed moving forward, be it thinners, Watchman, etc. Assuming a low CHADS score.

Jim

In my experience, Natale's process on this has changed--at least it was different for me and another patient who received a Watchman about the same time. Right after my index ablation Natale came into my room telling me that he had had to isolate my LAA and that I would need a Watchman in the next 3 - 6 months and that I must not miss even a single dose of Elliquis. He didn't do another TEE. I asked my nurse navigator about this as I had heard that the process toward a Watchman required a TEE. She said that this was not what he had been doing in the last couple of years as he had used a catheter with ultrasound on it and was able to make the call without doing a separate TEE. (Note, I may not have understood this perfectly!) But what I do know is that he didn't feel it was necessary for me or the other patient evaluated about the same time. He was very clear that I needed a Watchman. Probably my age, 79, and my extensive ablation and history of Mitral Valve disease played into this, but that is not what my nurse navigator said and the other patient I was in touch with is younger, with a less complicated history. My CHADS score is 3, if you count one point for being female. When it came time for the Watchman, another TCAI doctor, an internist, also evaluated me and signed off on the Watchman. Still, when I first woke up the first thing I asked was whether they actually put in the Watchman!

Would anyone be willing to describe what the pain felt like? I am struggling a bit with my inability to function. The ER did a full workup so I know it isn't something terrible, but it is really terrible pain. I cannot sleep. I don't know what pericarditis normally feels like to know if my pain is relative to what would be expected. Would anyone want to share what it felt like,? Thanks.

Megan

On a new thread I posted a study