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What is the age cutoff and other exclusion criteria for ablations?
Hi friends,
I haven’t posted in 3 years but follow and benefit from your these discussions frequently. I am 78 yo man, active, diagnosed paroxysmal AF 4 years ago, “palpitations” all my life . One 2-hr AF event and one 40-min event that resolved on their own in last year, but several seconds-long, short-running variety of arrhythmias day in and day out. Take 75 mg Flecainide twice daily and 25 mg metoprolol succinate once daily. Just completed 14-day heart monitor and then a long video consult with cardiologist mainly because I have felt like I have the flu since I began the AF meds and explored with him any alternative to taking Flecainide and metoprolol. My health provider here in California has 70 as age cut off for ablations, but cardiologist says because of my activity level, trim weight, healthful diet, and no other health problems, he will refer me to electrophysiologist for ablation consideration, despite my age. But first, have an echocardiogram. So yesterday I had my third echocardiogram with these comments just now automatically emailed to me:
“Left Ventricle: Left ventricle size is normal. Mild concentric hypertrophy present. Normal systolic function with an estimated EF of 60 - 65%. • Right Ventricle: Right ventricle size is normal. Normal systolic function. • Left Atrium: Left atrium is moderately dilated.”
The CONCENTRIC HYPERTROPHY and LEFT ATRIUM MODERATELY DILATED are new since last echocardiogram in 2023. It is Saturday morning and won’t likely get comments and advice from cardiology for another week. So does anybody know if these changes are something of major concern? And do you think their presence will remove me as a possible candidate for ablation?
Thank you very much for any comments you might have!
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My guess is the age limit is done for the doctor. He can say he has greater success with his ablations by limiting older folks who had higher failure rates. That persons would be an automatic no go for me. I have had 2 Afib ablations 1 at 72 and the 2nd at 76,5, The university based center I go to will do them on people in their 90's if they are candidates for the ablation.
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4 ReactionsI have no idea of their reasoning, but my cardiologist first told me that Kaiser Permanente has a standard age cut-off of 70 for ablations but that I nevertheless would be an acceptable candidate at age 79 because of my active lifestyle, trim BMI, and otherwise good health.
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1 ReactionI am 85 and yesterday I had a telehealth appointment with an electrophysiologist from the University of Colorado and he said that I am a perfect candidate for Pulse Field Ablation. Right now, just waiting to set up a date for the procedure. I am active, but only through the daily routine of dealing with the chores associated with caring for my small ranch and large animals.
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4 ReactionsThanks, Suerte. That is very reassuring! I just got an appointment for an appointment in a couple of weeks to see an electrophysiologist at Kaiser here in Sacramento, so the 70 age limit is clearly not a firm one…
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2 ReactionsIt surely is more of a personal/insurance/I'm too busy/I'm-not-sufficiently-experienced-or -skilled-to-tackle-this-one limitation. Just like with bridge players and track athletes, some are better than others. It's the same with EPs, and the best ones know their limits and act accordingly...and ethically and responsibly. So, if one says he/she feels your case has Limit X, then find another who doesn't feel that it's a limitation for them...and for you. My dad had a hip replacement when he was 87. He had the second done when he was 91. He's very diminished these days, probably within a year of his death (sad to see the decline, but...) he was convincing in his energy, his piercing gaze, his cognitive abilities as an engineer/problem-solving mining consultant, and the fact that he was still doing his own on-line investing and went for two 30 minute walks each day....pain and all. If you're the least bit convincing that you won't be wasting an operatory and other resources, you should get the nod. Maybe not next week, but perhaps next month, or the next.
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4 Reactions@riverpark, It sounds like you got a bit more confidence from the experiences of @suerte, @harveywj, @kudzu, @dandl48, @lhesse and the scientific resources from @gloaming.
You may notice I updated the title of the discussion to focus on the topic of whether there are exclusion criteria for older adults regarding ablation.
@riverpark, if you are a deemed a candidate for an ablation by your electrophysiologist at your upcoming appointment, would you have any concerns about moving forward with that procedure?
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1 Reactionamu45sin here
Am 79 m, with Kaiser in Denver, and am getting an Ablation in one week.
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2 ReactionsAre you with Kaiser because of insurance? I am using University of Colorado because of referral.
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1 ReactionYes. I pay very little with Kaiser per month, per doctor visit, and per procedure.
Can I as what you pay and what you get? Thanks.
I am on Medicare with a supplemental insurance from Blue Cross Blue Shield. My costs are minimal with a very low onetime deductible. My only costs after that are for a procedure that is required that is not covered by Medicare. I have only had a few of these and the costs were very low. My costs for a Pulse Field Ablation at UC Health will be zero or very, very little. Prescriptions are a different matter, and the only expensive prescription is Eliquis.
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