EP evaluation of persistent AFIB

Posted by treeguy @treeguy, 2 days ago

I’m a 71-year-old physically fit male recently diagnosed with persistent atrial fibrillation (AFib) in June.

I had no idea anything was wrong until my exercise equipment showed an unusually high and erratic heart rate. I also noticed a drop in endurance while cycling.

Two weeks ago, I underwent a cardioversion. It restored normal sinus rhythm (NSR) for about 20 minutes before AFib returned.

Yesterday, I met with an electrophysiologist (EP) to discuss ablation. Because I rarely feel symptoms—unlike others who’ve shared their experiences here—and I walk five miles daily in hilly terrain at a steady 20-minute-per-mile pace, the EP suggested I might consider doing nothing and simply living with it. I’m currently taking 25mg of Metoprolol twice daily and Xarelto once daily.

The EP found my case puzzling and noted that a first-time ablation might only have a 50% success rate. Despite that, I requested to proceed with ablation, thinking that multiple procedures might ultimately be the best path forward.

I’d welcome hearing from others who’ve faced similar decisions or have insights to share.

Interested in more discussions like this? Go to the Heart Rhythm Conditions Support Group.

Profile picture for kellyb1960 @kellyb1960

@gloaming according to my cardiologist, the Watchman Procedure is frequently not covered by insurance/Medicare. I have an appointment with an EP in a couple weeks to discuss ablation & Watchman Procedure, & I am fully prepared to pay out of pocket if he recommends the Watchman Procedure. There are very specific qualifying criteria for insurance to cover the Watchman, and unfortunately not wanting to be on blood thinners is not one of the criteria! So ridiculous.

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@kellyb1960 I'm happy you are in that position. I do still feel that a cardiologist or EP should include the Watchman in discussions so that the patient, with whatever means and impediments they have, can make an informed decision, especially if they hope to reduce surgeries, travel time, accommodation costs if they can't be near home, etc. I may not be able to afford the installation of a Watchman, or my insurer won't compensate me partially for one, and that means warfarin, 81mg ASA, or if I can afford Eliquis or Xarelto, that as well. But if the Watchman can free me from other impositions, including the total lifetime cost of Eliquis, the 'business case' can be made for it, even when having to borrow or slap down the plastic. Either way, as a patient, I'd like to know what options I have. All of them.

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