Ha! Carey, That’s a good suggestion for budding EPs ... Obviously, though, I suspect there will not be many EPs taking you up on that advice! One of the other still often overlooked issues that could very well be relevant in this equation, is the increased risk of early onset dementia (meaning onset dementia/Alzheimers before age 70) from poorly addressed long-term AFIB. While we areby Shannon - AFIBBERS FORUM
There is a caveat to staying in so-called ‘asymptomatic’ persistent AFIB and that is an increased risk for silent cerebral ischemia and possible increased risk of early onset dementia as noted by a growing body of research worldwide on the topic over the last 10 + years. Please refer to issues #131 and #135 for more insights about the origins and potential outcome of Silent Cerebral Ischemia (SCIby Shannon - AFIBBERS FORUM
Hi AnnaC, Yes indeed, early onset (Prior to 70yrs old) cognitive dysfunction, dementia and Alzheimers are a significant risk for poorly addressed Afibbers. There have been a wave of good studies on the topic over the last 8 to 10 years with some excellent work done by Dr. Jared Bunch and the group at Intermountain Medical Center in Utah. You can also find at least two articles I summarizedby Shannon - AFIBBERS FORUM
SAFIB almost by definition CHF patients are not asymptomatic so you’ll likely have to wait for the full CABANA to see if they discriminate to that level of patients ... keeping in mind two factors to factor into that equation being: 1. Up until recent years most so-called ‘asymptomatic’ patients were not offered ablations by the average run of the mill PVI-only majority of ablation EPs and: 2: tby Shannon - AFIBBERS FORUM
Good point Carey, These silent brain lesions from catheter ablations can be dramatically reduced through state of the art ablation procedural steps such as using uninterrupted anticoagulation protocol religiously where the activated clotting time of ones blood is raised by a large IV Heparin bolus injection BEFORE transeptal puncture access of the lasso mapping catheter and ablation catheter intoby Shannon - AFIBBERS FORUM
Hi Larry. Short answer there are currently no recommended follow up tests for NOACs other than the standard kidney and/or liver panels (depending on which NOAC) to test periodically but only for those with known kidney or liver dysfunction. The usual remedy in the case of such a kidney impairment is a halving of the dose of said NOAC. If either the kidney or liver dysfunction is too severe theby Shannon - AFIBBERS FORUM
Another point brought up by Morpheus, It's possible the bisoprolol may not have a direct causal relationship to your 86 year old relatives temper tantrums, if she is taking the drug regularly every day, then its possible she might be suffering from some age-related .. and possibly AFIB influenced ... dementia as well and the the beta blocker at such a low dose, may at best be a kind of inby Shannon - AFIBBERS FORUM
Welcome Joyce, Overall its nice to have youth on your side for any medical procedure, for a host of reasons regarding overall body functions etc. That being said .... HA, I think I've heard everything now! Rest assured Joyce that it is total HOGWASH that this EP considers afibbers above 52 to be near the end of the line for doing an ablation! What is true is that some EPs should notby Shannon - AFIBBERS FORUM
Eric, The recognized beginning window of not just when a clot can start to form, but the earliest time frame accepted now for beginning of actual stroke/TIA risk is 5 hours after onset of AFIB. The 24-48 previous window was a rough average time frame as obviously not everyone is going to have a stroke after 5 hours of unprotected AFIB... Thank goodness. But the 5 hour time frame is imporby Shannon - AFIBBERS FORUM
Hi researcher, Natale's group primarily uses RF because they are highly skilled in it. The good news about cryo is it's easier and faster for the PVI portion of an ablation, especially for EPs not highly experienced in RF (highly experienced meaning at least 4 to 5 years of hands on RF training in a high volume center,) and still get roughly equivalent PVI only results. There are Aby Shannon - AFIBBERS FORUM
Hi Anti AFIB , It's good you mentioned it, the mini maze is a viable approach for sure, and for some folks can be the way to go, usually the very morbidly obese with LSPAF and with very large LA. It's hard to visualize well with endocatheters through a lot of fat. But it is a good deal more invasive with a lot rougher recovery than an expert endo catheter Ablation. Plus it is jusby Shannon - AFIBBERS FORUM
These exterior techniques also carry more overall morbidity Anti-AFIB. Also in large number of cases mini-maze AFIB ablation also require at least one endocardial ablation to address post maze flutter/AT. This SCI creation can truly be minimized with proper protocol. And we have no indication at all so far that there is any cognitive impact from the very limited numbers and transient natureby Shannon - AFIBBERS FORUM
Yes Moerk, I realize this was Dr Mandrola's article and lead in you quoted above and I corrected one word in my reply above to clarify that. What Dr Mandrola fails to even point out in his review that implies that avoiding an ablation (when all other methods have failed to deliver a durable lasting unbroken life of NSR), might still be his preference, is that he does not state or even seby Shannon - AFIBBERS FORUM
Yes Moerk, the creation of SCI (silent cerebral ischemia) is indeed a very important issue. But is is not at all 'Big news' as noted in the title above, and has been one of the biggest focus of current AFIB research increasingly so over the last 5 to 6 years. I've written 4 articles in the AFIB Report myself over the last 2.5 years on this SCI issue sharing multiple large studies aby Shannon - AFIBBERS FORUM
I've been taking NT Factor and its prior version for almost 10 years. Its a very good product and the theory behind the combined nutrients in NT Factor make sense for having a potential neurological benefit that has kept me taking it ever since. But I am not taking it based on any claims of' confirmed sure 'cures', just to be clear on this point. And I have not seen any clby Shannon - GENERAL HEALTH FORUM
I'll start with that last question first which answers all the rest. YES, the results of achieving durable NSR are more than worth the possibility of having to deal with anti-coagulation which, if you do need full LAA isolation because that is the prime remaining source driving your arrhythmia ( which is the only reason you would get full LAA isolation in the first place) then you actuallyby Shannon - AFIBBERS FORUM
Hi researcher and Jackie, Yes this retrospective population study out of Rotterdam simply adds more confirmation to this key issue of the ever stronger association between AFIB and Dementia/Alzheimer's as a key driver and inspiration for NOT just settling for 'living with the beast'. We have reported now multiple times over the last few years in the AFIB report on this now frontby Shannon - AFIBBERS FORUM
Very interesting George and an important topic indeed. More research is currently underway looking at ApoE4 gene association in relation to AFIB as well, and not only via the dementia connection, but a probable connection to fibrosis tendency as well. ... I agree, this will likely become a key marker to know about as the unfolding genome starts to make real inroads in our understanding of chroniby Shannon - AFIBBERS FORUM
One in three AFIBBERS having a real stroke (and not when including TIAs or SCIs ( silent cerebral ischemia) in that number is a big over-exaggeration ,, However, include the other two, especially SCIs and the numbers might easily hit that mark if not more ..... just saying. In a number of studies SCI have been seen in from 46 up to 80% of some AFIB cohorts studied. The consequences of SCI asby Shannon - AFIBBERS FORUM
Hi Researcher, Good summary of Natale's long standing persistent and regular persistent approach as he narrated in the video. Many EPs less sure and experienced ... And yes he has at least 8,000 right and left atrial ablations since he began helping to pioneer focal AFIB approaches and worked in concert with the Bordeaux team as they developed and published the blueprint for PVI ablatby Shannon - AFIBBERS FORUM
Last question first, the stroke risk for former AFIBBers who have had a successful ablation process that restored full time unbroken NSR, has been shown in a number of studies (most recently in large study at Intermountain Utah) to fall to that of those of the same age/sex matched population control group who have never had AFIB. Next question, LAA morphology applies, of course, as this just cby Shannon - AFIBBERS FORUM
Nice find researcher, Dr. Pete Weiss is a very smart EP and really one of the bright lights in the up and coming world of EPs in their mid-40s. He does both AFIB ablations and has a particular emphasis on PVC and VT ablations and is an expert on Stereotaxis magnetic navigation which is particularly valuable in VT ablations. He is also an avid researcher and probably the leading technical reseby Shannon - AFIBBERS FORUM
Apache, Please do Not make the mistake of forgoing an ablation based on Rons rougher than usual recovery, occasionallu that happens but every indication is that he will make a full recovery in short order and his odds of ongoing success are very good! His experience, while not unique is the exception rather than the rule and in discussing his details with him, its quite possible him very acby Shannon - AFIBBERS FORUM
Ive been on a mini vacation the last 5 or 6 days since finishing the latest issue of The AFIB Report but I ear-marked this thread to come back too today. It's true Anti-AFIB that asymptomatic AFIB ablation is not yet indicated as an officially guidelines sanctioned process, and no where does ablation, nor drugs nor nutrients rank as a 'cure' for AFIB by the Cardios much stricterby Shannon - AFIBBERS FORUM
Keep in mind Safib this study is NOT talking about a complete expert ablation PROCESS .. asymptomatic patients are nearly ALL persistent AFIB who by definition often require a second and occasionally a third true touch up only, for the last one or two max follow up procedures after a top tier full index ablation, in order to achieve the approx. 85 % freedom from AFIB levels long term that is veryby Shannon - AFIBBERS FORUM
Yes Liz, I have published a few study reviews over the last year and a half showing very strong correlation with early stage Alzheimers and AFIB patients from large registries of AFibbers, that fact that the younger groups of AFibbers under 70 had the most significant impact from dementia and Alzheimers strongly implied that these were not just two co-existing morbities that share similar etiologby Shannon - AFIBBERS FORUM
The big ongoing risk we are finding now with unaddressed AFIB whether symptomatic or aysmptomic is the now large wave of research in the last 3 to 5 years that has confirm Silent Cerebral Ischemia indeed is THE number one issue after anticoagulation issue is addresed.. but the ongoing presence of AFIB even complicates the OAC issue too long term as now long view evidence shows that a fair amountby Shannon - AFIBBERS FORUM
Don, I'm sure you'll find Dr Rubenson a Natale-like quality in his realm of excellence of TEE. He will have you lay flat on your back instead of on your side in most cases, and I had no issues at all with the tube or with any post TEE soreness and I have had that in the past with other Cardios. It's 13 TEEs Ive had so far ... not 12 ... but whose counting? :-). Longer termby Shannon - AFIBBERS FORUM
Hi Don, While its only natural to feel a bit disappointed to learn you have to address the anti-coagulation issue long term, lets take a look here at just what you might have actually 'lost' out on .. or not ... on this gamble? Keep in mind Don that for any one who has active triggering from the LAA, the odds of them having to deal with this very same OAC issue for life in any eveby Shannon - AFIBBERS FORUM
Hi All, Certainly persistent AFIB that is low speed and largely asymptomatic now, is much easier to live with than rocking and rolling paroxysmal AFIB with all the fits and starts and highly symptomatic extremes, and never knowing when it will come or go and interrupt one's life in such a predictably unpredictable manner. But it's a bit of wishful thinking to assume one can justby Shannon - AFIBBERS FORUM