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Re: Mechanism of AFIB - when a maze is not a maze procedure podcast tomorrow 5 CT 3/3 - 2 days ago

Incidentally, there's a video of a WP procedure on youtube. I watched it years ago when I was considering a Maze. 3Gives you a good idea what the procedure actually entails.

by Carey - AFIBBERS FORUM

Re: Eliquis or Not? - 5 days ago

Oh, I'm not disagreeing with that at all. Surgical closure is almost always superior to transcatheter devices. But people who are undergoing cardiac surgery for other reasons and can elect to have their LAAs closed during the procedure are a pretty small percentage of the people who would benefit from having their LAA closed one way or another. I can't imagine undergoing surgery just to

by Carey - AFIBBERS FORUM

Re: Eliquis or Not? - 5 days ago

Quotemjamesone devices like Watchman, which typically require low-dose aspirin for life. Actually, that depends on whose opinion you prefer. The FDA's recommendation is aspirin for life, but there's no good evidence to support that recommendation. It's based more on a sense that they had to do something rather than any empiric data. You won't find much agreement with that re

by Carey - AFIBBERS FORUM

Re: 7 Day Heart Monitor—Dr. Natale - 9 days ago

Considering how many people have skin issues with medical adhesives, it baffles me why none of the monitor manufacturers offer a chest strap option. Chest straps have been standard fare for sports heart rate monitors for years and they work just fine. They're not affected by sweating or getting them wet, they cause no skin irritation, they're not uncomfortable, and they're cheap.

by Carey - AFIBBERS FORUM

Re: Eliquis or Not? - 12 days ago

I've not seen any convincing evidence that things like viscosity and aggregate testing are worthwhile. Want more viscous blood? Simple, drink more water. If I were in your shoes, I would agree to half-dose Eliquis, but not full dose. That's what I take now and I even have a Watchman device that protects me from 90% of clot risks, but I view it as insurance against the other 10%.

by Carey - AFIBBERS FORUM

Re: Eliquis or Not? - 13 days ago

QuoteJackC My question is: Would it be indicated that ANY 80-year old man be put on a DOAC (Eliquis) to lower the risk of stroke? Yes, absolutely. Plenty of people 80+ are on anticoagulants. That said, I think putting someone who's a CHADS 2 and hasn't experienced an afib episode for 9 years is overly aggressive. That doesn't seem to me to be a good risk/benefit balance. You

by Carey - AFIBBERS FORUM

Re: Facetime for dummies? - 15 days ago

Try this link https://support.apple.com/en-us/109364

by Carey - AFIBBERS FORUM

Re: Factor XI Inhibitor Abelacimab Cuts Bleeding Risk Across Age Groups in Atrial Fibrillation - 15 days ago

Quotemjamesone As to injectables "will never fly with afib patients", I don't see that as a barrier. Millions of people, including myself, are already self-injecting PCSK9 inhibitors such as Repatha and Praluent, not to mention millions more who are self-injecting GLP-1 antagonists for weight loss. Really not a big deal, especially with the autoinjector pens. Oh, I disagree. Har

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Re: Factor XI Inhibitor Abelacimab Cuts Bleeding Risk Across Age Groups in Atrial Fibrillation - 15 days ago

This article is a good summary of what abelacimab is and its current status (emphasis is mine): QuoteAbelacimab is an injectable, experimental, anti-clotting medication that is categorized as a factor XI inhibitor. It has the potential to prevent the clots responsible for strokes and heart attacks while preserving the body's natural ability to repair blood vessels after an injury. How

by Carey - AFIBBERS FORUM

Re: Frailty in Patients Undergoing Percutaneous Left Atrial Appendage Closure - 19 days ago

Quotegloaming Whatever IS true about any one frail and elderly patient with respect to GA, I wonder what else is involved that makes such procedures as LAAC potentially catastrophic. Well, it's catheterization of the heart, so every risk that goes with ablation would also apply to LAAC procedures with the exception of injuries caused by the actual burning. So the list is long but everythin

by Carey - AFIBBERS FORUM

Re: Update on Stopping Blood Thinner - 19 days ago

I'm sure a Watchman would be far less painful than an ablation without general anesthesia. With a Watchman there's only the catheter insertion, septal puncture, and extraction that would cause pain. Total time is typically 20-30 minutes while an ablation is typically 2-4 hours. From various people I've heard from who've done ablations with conscious sedation, I've hear

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Re: Update on Stopping Blood Thinner - 19 days ago

QuoteCrosswise This is of interest to me. My husband was getting follow-up ablation work done and a watchman at the same time, by Dr. Natale. I know it's gunna be hard for some to believe, but afterward we were told that it didn't fit and it wasn't put it, but it had been attempted. I asked did they not have the right one on hand? I was told they had them there. Very weird. They c

by Carey - AFIBBERS FORUM

Re: Update on Stopping Blood Thinner - 19 days ago

Quotemjamesone CHADS 1-9 was represented in OCEAN, but yes, the mean was 2.2, so one reasonable conclusion is that the results are "primarily applicable to low-to-moderate risk patients". However, another way of looking at it is that the trial answers a fundamental question, which is whether 12 months of being AF free resets the system to that of someone who does not have AF. If the lat

by Carey - AFIBBERS FORUM

Re: Cox Maze - 22 days ago

So you did the full Cox Maze, not the mini-Maze?

by Carey - AFIBBERS FORUM

Re: Update on Stopping Blood Thinner - 24 days ago

When the Watchman device is in the catheter that delivers it to the LAA, it's folded up. Those sharp pointy spikes are safely stowed away and can't touch anything. It's not even in the heart yet if he damaged veins, so he never even got it there. If that EP "tore up" veins trying to insert an LAA then he either wasn't trained properly or he just shouldn't be nea

by Carey - AFIBBERS FORUM

Re: Inconsistent blood pressure - 25 days ago

QuoteKen Interesting, my question would be: Is there a difference between blood pressure in and out of afib? There can be for some people. I've known people who get light headed and even faint due to low BP during afib.

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Re: Update on Stopping Blood Thinner - 25 days ago

I would be fine with any EP doing a Watchman as long as they had ample experience with them. It's not the fine mix of art and science that ablations are.

by Carey - AFIBBERS FORUM

Re: Patience is overrated - 30 days ago

With almost all doctors and hospitals using electronic health records these days, you don't need to have your cardiologist send records. Usually, all you have to do is sign a release form and Natale's staff will then download it directly. Your cardiologist doesn't need to do anything, and that's probably why they didn't.

by Carey - AFIBBERS FORUM

Re: Noninvasive Heart Mapping System Speeds Arrhythmia Diagnosis - 4 weeks ago

I'm sorry for your loss, but I'm glad your father was able to leave on his own terms and surrounded by the people who mattered to him.

by Carey - AFIBBERS FORUM

Re: Radiation-Induced Cardiac Toxicity - 5 weeks ago

Interesting article about the shoe fitting machines. Never heard of them before. I would think the shoe salesmen of the time were the ones who probably suffered. They were exposed daily for hours at a time. A few visits to a shoe store per year by a customer would be a tiny fraction of their doses, and with radiation it's all about dosage.

by Carey - AFIBBERS FORUM

Re: Anti-arrythmic meds - 6 weeks ago

Pradaxa is known for stomach issues. I was on it a few years ago and although I didn't have any stomach issues, I would definitely recommend you ask to be switched to Eliquis. It's a safer drug with fewer side effects.

by Carey - AFIBBERS FORUM

Re: Does a List of the Top EP's for Ablations Exist? If Not, Why Not? - 6 weeks ago

QuoteEricY I suppose I should try calling the facility in Texas. I just want to know if they would provide an estimate or maybe they can't since ablation can require more time in some cases. I don't think Texas will be able to help you with this. Call Thousand Oaks again (and again) until you get someone who can help. As for cost, if Kaiser covers it then that will be your deductible

by Carey - AFIBBERS FORUM

Re: Anti-arrythmic meds - 6 weeks ago

Eric, this is why I stress so much how important it is to choose the best EP you possibly can. And in the case of ablations, the best means the EP who's done thousands of ablations, the EP who lives, eats and breathes them, attends the important conferences, and stays fully up-to-date with the best practices. You're young and you've got time, so take the meds if you have to, get th

by Carey - AFIBBERS FORUM

Re: Anti-arrythmic meds - 6 weeks ago

QuoteGeorgeN My understanding is that many EP fellowship programs do not include training such as is required for LAA work. That's true, but that's rapidly changing. There's enough benefit to the procedure that EPs have taken notice and are seeking out the training. There's even an annual conference devoted to it (ISLAA) where EPs can sit in on an actual ablation where the L

by Carey - AFIBBERS FORUM

Re: Anti-arrythmic meds - 6 weeks ago

Quotemjamesone But with an 80-90% success rate for an initial PVI, why take on additional up-front risks? Mapping doesn't add additional risk, and nobody's going to be ablating an LAA that doesn't need ablating. But if the LAA is a culprit, wouldn't you rather find that out and deal with it on ablation #1 rather than go through 9 months of waiting to do a second one? I since

by Carey - AFIBBERS FORUM

Re: Anti-arrythmic meds - 6 weeks ago

If an EP prefers you to be in normal rhythm during the procedure, and especially if they have you continue an antiarrhythmic drug, then that's an EP who doesn't map the actual sources of afib. They mostly just do a PVI and posterior wall and call it a day. Pretty much the same as a cryo ablation. Natale spends a lot of time up front identifying sources of afib, so if you're not in

by Carey - AFIBBERS FORUM

Re: Anti-arrythmic meds - 6 weeks ago

If he goes with Natale, Natale will definitely not want him on amiodarone. He likes his patients to be free of antiarrhythmics when they go into the lab, and amio's insane half-life makes that problematic. I've also never heard of him prescribing it for anyone. Pretty sure he doesn't like amio.

by Carey - AFIBBERS FORUM

Re: Anti-arrythmic meds - 6 weeks ago

Sotalol is a beta blocker just like metoprolol. So don't be surprised if it lowers your heart rate as much as metoprolol did. But there's really no reason to be concerned about your heart rate dipping into the 40s. It won't harm you.

by Carey - AFIBBERS FORUM

Re: Should I get an angiogram? - 7 weeks ago

Probably yes. It's possible they might have incidentally seen the clot on the fluoroscope while they were doing the angio, but I doubt it. They would be focused on ventricular blood vessels, not what's going on in the atria.

by Carey - AFIBBERS FORUM

Re: Blood clots on my watchman - 7 weeks ago

As I said, heparin doesn't dissolve clots so you wouldn't be treating anything. You'd just be increasing your bleed risk, especially if you combined Eliquis, ibuprofen, and heparin. That's a combination I wouldn't take without an absolutely compelling reason and a real expert advising it.

by Carey - AFIBBERS FORUM