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PFA procedure with stroke risks

Heart Rhythm Conditions | Last Active: Jun 27 10:32am | Replies (31)

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Thank you for explaining so well. I checked my CHA2DS2-VASc score as you advised. My score is 3. I have been on Eliquis for 5 years and I have a pacer. Cardiologist presented 3 options: 1) Do nothing and live with AF using Eliquis and Sotalol, 2) change medication from Sotalol to Tikosyn as Sotalol is not working , 3) do PFA (which I am afraid of due to stroke risk even though you explained it so well). I am the only care giver for an 80 yr old). Am seeing cardiologist again next week re PFA as he himself says that 50% of his patients need a second PFA.

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Replies to "Thank you for explaining so well. I checked my CHA2DS2-VASc score as you advised. My score..."

I can see your concern for others dependent on you is stronger than your concern for yourself. It happens that you needn't fear an ablation. The surgical team and the nurses who prep you will follow protocols to ensure you do not have a stroke related to the operation, and your risk of a catastrophic bleed due to Eliquis is very small in the rest of your life outside of the cath lab. Eliquis would be bad to have in a very bad bleed, but you'd be in danger of such a bleed even without having apixaban in your system. Apixaban is not a clot preventative; it is a clotting retardant. Big difference. So, for your average kitchen knife cut, you compress it, bandage it, and leave the are undisturbed for a day or more. It should clot normally, just not quickly. Happened to me dozens of times, and I have been on apixaban for 7.5 years by now.
Once again, to put your mind at ease, you get cerebral strokes and lung embolisms from clots. If you are pumped full of aspirin, heparin, and Plavix, which is what was swilling around in my blood for my angiogram during workups for my ablation, you simply have all the clotting bases covered. The idea with the ablation is to dam the area where the extra electrical signal is entering your left atrium, usually at the mouths of the pulmonary veins. Those extra signals emanate from the ostia of the PV, and they spread in a wave along the endothelial lining of the atrium, which causes a rhythmic contraction that is also really a wave if you follow how the muscle tissue under the electrical impulse moves. So, all an ablation does is to put a 'hot' needle tip against tissue surrounding the pulmonary vein ostia, each one, and repeat until he/she has literally created a stockade, or a circle, of scarring where each dotted scar touches the next one on either side. The impulses cannot cross the scar tissue like it can the healthy endothelial tissue around it. If it's blocked.........................it stops! If it stops, it can't make the atrial muscle contract. All your atrial muscle has to do now is to respond to the normal signal coming from the SA node (sino-atrial) in the right atrium, next door. And that's what you want. None of this causes strokes. The stroke risk lies in the left extreme of the left atrium, where that weird 'grotto' called the left atrial appendage is.
By the way, next time you chat with your cardiologist/EP, ask about the Watchman device. It may be appropriate for you, it may not be. If it is, read up on it, and if it can seal off your LAA, you would not have to take apixaban for that purpose. You still might have to take it for other matters about your health, but again, it's worth the ask.