Thanks JohnM, Your experience is exactly why there isn’t a lot of interest in mini-mase procedures on our site ... It can certainly help reduce AFIB burden significantly in the right patient group when performed by a true expert, and can often do so with less repeat PVIs than is still all too common WITH LESS EXPERIENCED EP CA OPERATORS (underscore less experienced as those not in the upper 10by Shannon - AFIBBERS FORUM
Hi George, As you noted, afibbers who require LAA isolation to achieve long term durable freedom from all atrial arrhythmia are a class of patients that often very specifically benefit from LAA Closure. The proper perspective for decision making in such LAA-Iso patients definitely supercedes much of the rather limited short term cherry-picked data analysis Dr John and his two compatriots fromby Shannon - AFIBBERS FORUM
Yes George is right Chuck, A ZIO-Patch report does not measure or detect in any way one's LAA emptying velocity ... nor any other echocardiographic parameter. LAA emptying velocity is accurately measured via a TEE (trans-esophageal-echocardiogram) done at least 6 months after an LAA Isolation ablation. If your cardio is suggesting he measured an LAA emptying velocity of 28cm/sec you muby Shannon - AFIBBERS FORUM
Libby NOAC is an acronym for 'Novel Oral Anti-Coagulant' and includes all the newer OAC drugs like Eliquis, Xeralto, Savaysa (Edoxaban), and Pradaxa (Dabigatran) ... in short, all the non-Vitamin-K antagonist with warfarin being the main Vitamin K Antagonist OAC drug. LAA velocity typically is only decreased at the 6 month TEE scan that is required for those whose ablation included aby Shannon - AFIBBERS FORUM
Hi Chuck, Well that's a head scratcher as the two devices aren't addressing the same issue really at all. Unless there is more to the story that might somehow explain why your Cardio or Doc of another specialty is even discussing the two devices in the same breath, especially for a patient who has been AFIB free for 2+ years now after what sounds like was a successful ablation procesby Shannon - AFIBBERS FORUM
Anneh, I want to underscore what Carey just said for added emphasis! Do NOT use Eliquis as a once a day dosing protocol, regardless of dose! That is not a safe way to 'cut down' your overall dosage. Plus, that should not be done, in any event, without the express agreement with your EP/Cardio. Going from a normal 5mg BID (twice a day) to 2.5mg BID is the only option for reducing thby Shannon - AFIBBERS FORUM
Hi Liz, After a successful LAA isolation, there is a 58% average risk of having to either stay on a OAC drug long term or go for LAA closure via an occlusion device like the Watchman or Amulet, or a ligation procedure like an Atriclip or LARIAT. If the person does not have a CHADsVASc of 2+ or higher then they can often stop all OAC after a successful LAA Closure so long as they are free fromby Shannon - AFIBBERS FORUM
That all sounds like a perfectly reasonable plan Don, especially vetting your particular case and working through the best options for you long term with Dr Natale who did such an first class job on your index ablation that required LAA isolation to begin with. And I agree, Dr Natale absolutely has no incentive to push a procedure on you, or on anyone, that he isn't entirely confident isby Shannon - AFIBBERS FORUM
Hi Don, Please consider setting up a consult with Dr Natale before even considering stopping Eliquis on your own, as someone after having LAA isolation which has shown a too low over all mechanical function to pass with flying colors. You can then discuss your thoughts about Watchman, Atriclip etc and let him tell you directly where we are in the real world progress made in this field as experby Shannon - AFIBBERS FORUM
Hey Don, Was nice talking with you week before last on the LAA Closure issue and I'm glad you found the link to the ISLAA conference I encouragedf you too attend at next years 2018 event in February I believe it is, and that will be in LA this time, right in your neck of the woods. Hope to see you there! The video links from the 2017 ISLAA, which I also attended and that was held in Aby Shannon - AFIBBERS FORUM
Shannon [ PM ] Dr Vivek Reddy: In Defense of LAA closure (Rebuttal of Dr Mandrola's comments and opinion on Watchman)-Medscape December 01, 2016 02:30AM Admin IP/Host: 47-215-236-94.sdoncmtk01.res.dyn.suddenlink.net Registered: 4 years ago Posts: 2,295 In Defense of Left Atrial Appendage Closure - Dr. Vivek Reddy (The above link, allows access to the article discussed below: In Deby Shannon - AFIBBERS FORUM
Hi Barb, As we have discussed several times on the phone this week, it is possible that you do have a degree of diastolic dysfunction and can rest assured that whatever degree of diastolic dysfunction you might now have is not related to your two prior AFIB ablations ... i.e. your index ablation with Dr Natale in September of 2013 and your follow-up more limited touch-up ablation with him in Jby Shannon - AFIBBERS FORUM
Don and redalfa1961, It is not that hard to get most insurance to pay for Watchmen at leading top volume centers when ChadsVASc is >/= 2.0 but of course at this time neither your nor redalfa1961 technically qualify for the Watchman based on the stroke risk score. Great effort is being made to push the recognition of LAA isolation as equal to 2 points on the ChadsVasc score but may be a whiby Shannon - AFIBBERS FORUM
Hi Anton, My guess is that this current break after the ECV is relatively temporary but as Jackie said it certainly wont hurt to wait until that proves to be true and you trigger again into Flutter. Besides, the vast majority of us will naturally have a hard time doing an ablation when we are in NSR as it is. Especially in a case like yours where you have been in such long term NSR of overby Shannon - AFIBBERS FORUM
Tony, Nice talking with you again today, Thanks for the EKGs too, though it is not a complete 12 lead. The PACs are a residual of the underlying flutter circuit that caused the recurrence of arrhythmia 13 years after your very successful index ABL with Dr. Natale. This pattern is a classic very late recurrence after 10 plus years of a stable heart after an early years a the successful Natale Pby Shannon - AFIBBERS FORUM
Jim, It is perfectly normal for you to have an elevated HR for some time after an proper and effective AFIB ablation. In fact some degree of elevation is a good sign that argues well for a better long term outcome than if you did not have any HR elevation. Its a sign that enough of those pacing cells making up the endothelial lining of the left and right atria were temporarily addressed byby Shannon - AFIBBERS FORUM
Hi Tony, sorry you have to reconnect with us all due to a revisit from the beast again ... Please send me your cell number and your time zone now by PM above, or via my editor@afibbers.org email address. I assume you are still in AZ, as I am, but please confirm and will call you as soon as I can in the nextby Shannon - AFIBBERS FORUM
Hi John, I'm so glad everything went super, as I was sure it would, with the Watchman procedures for both John and Mike from our forum last Friday in Austin at St David's. In fact, on that same Friday what must be a record 15 total successful LAA closure procedures were performed at St David's 4 state of the art EP Labs plus a 5th hybrid surgical/EP Lab, including 12 Watchman anby Shannon - AFIBBERS FORUM
Dear Oxik, I'm very sorry to hear of your very unfortunate stroke experienced by your husband and indeed your family! Did your husband have an embolic stroke which sounds more likely with the timing after the long 3.5 week AFIB episode, or was is a possible hemmorhagic stroke which I bring up only because you mention he was having bleeding and then one of his docs started him on Warfarin.by Shannon - AFIBBERS FORUM
QuoteMcHale Dr Natale told be stay on Xarelto and not switch to Eliquis after my 2nd touch-up ablation with him....well it was more extensive then touch-up! I now have low flow velocity from my LAA but afib free. Hi McHale, the last sentence too is the best bargain too! If you have LAA triggers and it is never addressed, you WILL have low flow velocity from your LAA the entire time you are inby Shannon - AFIBBERS FORUM
Hi PBqltbook, Please reread my reply just above your own and in particular the new last half that I added this morning to find answers to your question and a bit more insight into the special focus and value of this Danish study comparing low doses of all the major NOACs to each other and to Warfarin with either octogenarian's or even older folks and/or those with impaired renal function.by Shannon - AFIBBERS FORUM
Fortunately, I still remain in blissful NSR going on 9 years now of total freedom from all AFIB (not a single beat of AFIB has been felt by me, nor recorded on my inboard pacemaker, since the day of my extensive index ablation for a then 16 years progressive AFIB that had progressed to aggressive persistent AFIB for some time before finally making it to Dr Natale's ablation lab in Austin ...by Shannon - AFIBBERS FORUM
Hey Jay, Good to hear from you! What date will you be in Austin next month? You've done really well on this index go around, especially considering your long-term extensive AFIB prior to your index ablation. As we discussed before the ablation, I was pretty darn sure you would need a two part solution for long term freedom, and it seemed a near certainty when I saw your ablation reporby Shannon - AFIBBERS FORUM
Hi Jackie, This is a pretty good overall review of the LAA Closure issue. Dr Vivek Reddy's "In Defense of LAA Closure" editorial in Medscape a little over a month ago is also excellent! Regarding whether or not it is a good idea to perform, both a basic AFIB PVI ablation and install an LAA Closure system as part of the same procedure? While a couple of groups have done so asby Shannon - AFIBBERS FORUM
Hi Pam, Great to hear your heart is humming along again back in NSR after your very late recurrence over 10 yrs, following such great success from your index ablation with Dr Natale back when he was still director of AFIB at Cleveland Clinic. Dr Natale prefers folks who have had an LAA Isolation to return to either Austin or San Francisco for their first follow up appointment with him aftby Shannon - AFIBBERS FORUM
Quotegmperf Interesting - I received a letter today from Scripps La Jolla. Letter says Re: Consultation regarding WATCHMAN left atrial appendage closure. "per Dr Natale, you are currently maintained on a blood thinner for stroke prevention, since your ablation procedure." In summary the letter goes on to invite me to make an appointment for a consultation. It says when making an appby Shannon - AFIBBERS FORUM
The P-wave is part of the EKG and is typically absent on a single lead EKG in AFIB and after ablation. Though the P wave can be detected slightly in Afibbers post ablation in other leads on a 12 lead EKG. However, Smackman the P wave has nothing to do with your LAA mechanical function. As noted in our phone call today, the three criteria for being able to stop OAC after looking at results fromby Shannon - AFIBBERS FORUM
Smackman, LAA closure systems will almost certainly be covered by insurance as the comparative e vetting process continues to show its advantage for a fair number of AFIB patients going forward. The most recent results from the latest and cumulative Watchman studies, improved Lariat experience the last two years and Amplatzer Amulet prospective studies from Eurooe, Canada and Asia/Austrailia/Nby Shannon - AFIBBERS FORUM
researcher Wrote: ------------------------------------------------------- > I don't look at your situation as being messed up at all. Being in NSR and not AF is a big benefit in terms of progression to heart failure and other potential health related issues. If you were still in AF, then blood thinners would be required for life as it is for my father in law. If you can't take theby Shannon - AFIBBERS FORUM
Hi Isabelle and welcome to our forum, Are you saying that you have been in long standing persistent AFIb for most of your years with AFIB? Please share with us how long you have been persistent (in 24/7 AFiB though previously with a lower more comfortable heart rate). In terms of reducing your current HR, an EP is likely to help out more than most Cardios, even if you have to drive or go byby Shannon - AFIBBERS FORUM