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If it resolves within an hour or two I wouldn't do anything at all. You'll probably be back in NSR before you can get to the hospital and an ER or cardiologist can even get you prepped for a cardioversion.by Carey - AFIBBERS FORUM
QuoteSueChef UPDATE: It's now about 15 minutes after I first started typing the new post above. I did nothing and yet, my pulse rate is now in the mid 80s for beats per minute. Yes, hooray! .... but what the heck?! My question remains, how long do I wait in the hopes of a resolution? ...& there's still the Flec question, & the biggest puzzle of all, why/whaaaat? You wait asby Carey - AFIBBERS FORUM
To add to what George said, assuming you've had a successful ablation, you're beyond the blanking period, and your LAA has not been isolated, then whether you need anticoagulants or not will depend on your CHADS-Vasc score. So if you're a 0 then yes, you can stop them. If you're a 1, it's a judgement call. If you're a 2, you should probably continue them. And if you&by Carey - AFIBBERS FORUM
QuoteChuck Connors Any information on the new Watchman that is due out and timing on its release? Thank you. I don't know an exact date but my understanding is it's fairly imminent, as in late 2020 or early 2021.by Carey - AFIBBERS FORUM
I'd want to see hundreds, at least. The one thing the studies have shown quite clearly with LAA occlusion devices is that operator experience is everything. That's obvious when you look at older studies conducted when the Watchman was new and no one had extensive experience and newer studies now that it's been in use for 5+ years. The complication rates dropped dramatically as expeby Carey - AFIBBERS FORUM
As I mentioned before, you should definitely get all needed surgeries and procedures done BEFORE doing an ablation that might leave your LAA isolated.by Carey - AFIBBERS FORUM
Sure, emergencies are a different thing. Nothing you can do there other than make the doctors aware of your risk factors and hope for the best.by Carey - AFIBBERS FORUM
With an isolated LAA and low flow velocity, I wouldn't consider stopping Eliquis for even a single day. If the procedure was truly necessary and the doctor refused to follow the bridging protocol, I'd find another, more reasonable doctor. If I had to drive 100 miles, so be it. We both flew to Austin to obtain the best, so a two-hour drive is nothing.by Carey - AFIBBERS FORUM
The trouble is, even having that protocol doesn't mean a doctor will be willing to follow it. I've heard from a couple of patients who had surgeons refuse to do procedures despite having the protocol sent to them directly by Austin.by Carey - AFIBBERS FORUM
Quotesmackman I listen to my EP’s in Austin but I do wonder why there is such a big divide on what to do. Because LAA isolation is actually a relatively new approach that most surgeons, PCPs, and even most EPs have never heard of. They heard nothing about it in med school or even during their residency and fellowship, so unless they're an EP who keeps up-to-date with the leading edge ablatby Carey - AFIBBERS FORUM
Quotesusan.d Carey does flutter count as “lone AF? What about one time history of dvt? Flutter (AFL) is generally equated with AF and treated the same. But what makes it "lone" is the absence of other forms of heart disease; eg, heart failure, valve disease, CAD, etc. So if you have AFL and no other heart disease, that would be considered "lone" AF. DVTs can be caused by a nby Carey - AFIBBERS FORUM
Quotesusan.d I notice there is no score if you are over 65. I thought that counted as one point. I thought I scored 3 points- age, gender and high blood pressure. According to this link I score 2 not 3. Clicking age >= 75 gives you 2 points, but clicking age 65-74 gives you 1 point. Note that the two are mutually exclusive. You can't be 65-74 and also be >= 75. So if you click one ofby Carey - AFIBBERS FORUM
CHADS-Vasc has been shown to be a better predictor of stroke risk, particularly with those who score 1 on the CHADS2 test. There's really no reason to even use CHADS2 anymore.by Carey - AFIBBERS FORUM
Nice graphic. Could've saved myself some typing. ;-)by Carey - AFIBBERS FORUM
Quotesusan.d I don’t understand. If you have been in nsr for 4 years, how can a stroke occur? Is it because the act of surgery causes blood clots, which is independent of AF? No, the procedure doesn't cause the clots. If your LAA has to be electrically isolated to stop your AF, one of the consequences of that may be that your LAA no longer pumps as effectively as it once did. It'sby Carey - AFIBBERS FORUM
Multaq does not require a hospital stay. If you really think flecainide is the culprit (I'm skeptical) then giving Multaq a try is easy (other than the deductible). It's generally the mildest of the antiarrhythmics and has few, if any, side effects for most people.by Carey - AFIBBERS FORUM
Yeah, I get the reasons for having a local EP, but my point was that having one giving you bad advice is worse than not having one at all.by Carey - AFIBBERS FORUM
Quotesmackman I will not jeopardize my health but to just say FIRE HIM is out of the loop. I will just get it taken care of. Someday maybe someone can explain to me why a missing A Wave is a Catastrophic Heart Issue. I'm sorry that comment bothers you so much, but honestly, what else can you do with a doctor who gives you totally wrong, dangerous advice? I don't understand what possibby Carey - AFIBBERS FORUM
Smackman, I spent a big chunk of my life living in rural America, so I'm familiar with the realities. But you seem to be saying there's no solution other than just going along with the guy and taking a monumental risk with your life. There is hard evidence that what he wants you to do is extremely dangerous. You might try printing out the research and showing it to him.by Carey - AFIBBERS FORUM
Quotesmackman Really FIRE HIM? Like he is going to give a rats butt when there is not many Cardiologist around much less a EP. Closest EP is in Shreveport 100 miles west. If he won't consult with Natale, won't follow his protocol, and won't educate himself as to why following that protocol is absolutely essential, then yes. Fire him. Driving 100 miles beats being dead or permanenby Carey - AFIBBERS FORUM
Yes, bridge for any procedure that requires you to stop Eliquis. You could make this easier by calling Natale's office and asking for a copy of the protocol so you can just hand it to local doctors and tell them you refuse to do the procedure unless they follow it.by Carey - AFIBBERS FORUM
Quotesmackman Individuals on this thread think that getting all Doctors onboard with the bridging protocol should not be a issue. They are wrong because they do not feel the way when there in house EP Says it’s okay. I've heard from others who've encountered the same problem so I know it can be an issue. Ask the EP to consult with Natale or his staff, and if he won't or he stillby Carey - AFIBBERS FORUM
Quotesmackman Yes, My LAA has been isolated but my ejection fracture is 55-60%. I do not have low flow. Yes you do. Ejection fraction (EF) is a completely different measure than the missing A wave you describe. The A wave measures blood flow in and out of your atrium, not your heart in general, which is what EF measures, so the two aren't really related. Since you have an isolated LAA andby Carey - AFIBBERS FORUM
Medicare and most insurance companies will only cover LAA occlusion (LAAO) devices if you're unable to tolerate anticoagulants or anticoagulants are inadequate. For example, having bleeding problems or experiencing a stroke or TIA while taking them would be an example of when they will cover it. I think this will change in the near future because there's early data showing that LAAOby Carey - AFIBBERS FORUM
What rocket and George said. A missing A wave suggests your LAA was isolated. Is that the case? If so, you should follow Austin's advice religiously. LAA isolation is a subject not well understood by most cardiologists because it's a fairly new aspect of ablations, so take your cardiologist's advice with a big grain of salt. The fact that the hospital and the doctor are reputablby Carey - AFIBBERS FORUM
There's no conclusive evidence that one device is superior to the other, but it's probably a moot point for you since it's extremely unlikely your insurance would cover either one. You would have to pay for it out-of-pocket and I would expect that to be well over $20K.by Carey - AFIBBERS FORUM
Quotesmackman Chads score played no role in decision for me to be on Eliquis for life. A missing A wave was my issue. Everything else was above par. Well, sure, there can be exceptions. Anyone with an isolated LAA that doesn't pump blood effectively would be a good example (that would be me prior to the Watchman). But I knew that didn't describe Pokey.by Carey - AFIBBERS FORUM
That's going to depend mainly on your CHADS-Vasc score. A score of 0 means yes, 1 means maybe, 2 means probably not, and >2 means definitely not.by Carey - AFIBBERS FORUM
Quotestranger So my question really is - if I started on Eliquis say 3 months before the op would that keep any new clots from developing and allow any already there to be absorbed by the body? Yes, that's more than enough time. Unless there's some other reason for a TEE you shouldn't need one. And if there is some other reason, I can't imagine an EP lab that doesn't haby Carey - AFIBBERS FORUM