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PFA procedure with stroke risks
Heart Rhythm Conditions | Last Active: Jun 27 10:32am | Replies (31)Comment receiving replies
Thank you again for your message. Appointments here in Denver with an EP specialist are 15 minutes. I agreed to do the PFA, but at the last minute, EP added that he will also implant a Watchman device. I did not have any time then to discuss this with the EP or research it which makes me very uneasy, nervous and perplexed. Anyway, this would involve a multi device procedure. The Watchman's list of cons include Pericardial Effusion and Tamponade, device Embolization, Device Related Thrombosis, Stroke (even though Watchman is for avoiding stroke), but this can be due to formation of clots on new device mainly occurring days after device implantation! Since I cannot get another appointment with EP soon, I will talk to his NP. Hopefully she can detail how my body is suitable or not, as no analysis was done by EP regarding Watchmen. Anyway, I have tolerated Eliquis for 8 years now and can continue on it with doing just the PFA procedure (which 50% of patients say they had to do twice). As of now, I am leaning towards NO Watchman! I am surprised at myself for making this decision so difficult and causing so much stress! Thanks again for helping. Regards
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I'm not in agreement that approximately 50% of PFA patients need a touchup or a redo sometime soon after their first (known in the medical community as and 'index...') ablation. The PFA is safer, all things considered, with fewer potential complications, but it isn't more effective for either index or for subsequent ablations. RF and cryo have about the same success rate, and most of us who learn all we can about arrhythmia and ablations soon realize that the across-the-field success rate for any method relies more on the skill and experience of the EP than almost anything else!
So, across the field, the success rate for index ablations is about 75%, with subsequent attempts running near 85%. But there is a lot of variance, and that variance is not due to the method of delivery; it's due almost exclusively to the duo of patient's heart's state and the EP's skills. As an example of an index ablation failure, I can tell you that you'll be taken care of...both times, and that you should be optimistic in either case; the index or the possible redo...whatever happens. They are day surgery. You'll be home in your own bed that night, unless you've had to travel and must return home the next or following day.
The watchman, likewise, can only be successful with the right match of patient and practitioner implanting it. I do know that some of them leak, in which case it's a loss and you just have to take a DOAC for life if other comorbidities or continued arrhythmia warrant it.
BTW, we haven't talked about your CHA2DS2-VASc score. The medical establishment uses that derived score to assign a risk of thrombo-embolism. A score higher than 1.5 is cause for concern, but certainly a score of 2.0 and higher warrants a DOAC prescription. You can google that score, as I spelled it above, and find an online calculator. Be scrupulously honest with your answers and you'll see what your apparent (not expertly assigned since neither of us is an expert) score is. Again, 1.5 and above often warrants a DOAC or some other prophylaxis to minimize stroke risk.