Post op AFIB & anti coagulation drug

Some of the best EPs in the country will agree to have you stop NOACs after your watchman has been enclosed and there is no danger of clotting and stroke. But that proof comes after a TEE at the six and 12 month marks in most cases. There's always variability between EPs and between any one EP and one individual patient with unique circumstances.
AF comes on after changes to the structure/morphology of the heart. Those changes are generally progressive in nature, and generally not reversible. Yes, heart valves can be fixed or replaced, but one doesn't shave off a smidge from a left atrium to help to get it back to size. So, if there's enlargement, AV node re-entrants in place, or developing, you are almost certain to have more persistent and frequent AF in time. For now, it's early, and I would rely on Pill in Pocket technology (you take a prescribed drug to reduce rate or to restore/maintain rhythm). At some point, you might find anxiety and symptoms associated with more frequent AF becoming a burden and you'll want to have educated yourself about the benefits of catheter ablation.

I have sporadic "paroxysmal" afib and declined anticoagulation. One cardiologist pressured me to take one and 5 years later, when, at that point, I was having it once/year, he admitted that "we overmedicate." Another cardiologist told me, while I was in the hospital with afib, that I could "go home and forget it happened." Guess which doc I now use?

That said, for the most part, my afib has been a year apart (now two with one short episode last year) and the longest episode was 7 hours, and they did an echo to make sure I had no clots at the time. Some of my episodes are only an hour or two. I am always in the ER or even ICU because my heart rate goes up to 180+ and bp down. They use diltiazem in a drip.

The CHADS scores provide a sort of recipe for docs and I believe that they feel afraid of liability if they don't follow it. Your frequency is more than mine but it may be slowing down. And I don't know how long it lasts.

I read a great study on sort term anti-coagulation for one month after any episode lasting more than 5 (?) hours (sorry I forget the duration). I ask for short term anticoagulation every time I go in the hospital. I hope someday it goes into practice because anticoagulation has risks too.

Hard decision. Maybe, if you go 6 months without any afib, you can find a doc who will let you go off, or of course, you can decline the meds, but I cannot say anything pro or con, only what I do. I also don't know if you have to wean off of them because stroke risk might go up when you stop, if afib is going on. I don't know that but it is a question to ask.

Cardiologists are generally full of crap. I've been dealing with them for 11 years and had I not taken the initiative to research the medications they were trying to give me I would be dead right now. This is a conclusion I've reached after taking medication prescribed by one cardiologist or another and ended up in the ER with congestive heart failure or was given medications that conflicted and caused heavy uncontrollable bleeding after a surgery. This of course is not true of all cardiologists but enough for me to take pause and research any medications they suggest using. I will not tell you you can stop taking a blood thinner but do some research. If you are not in AFIB then why take one?
Drugs. com is a good source for just the facts info about any drug. The Mayo clinic is also a very reliable source. And last but not least a good pharmacist knows everything or knows where to find the information about any legal drug out there.
Why is that heart chamber there if it needs no blood. A watchman seems like a device invented by somebody wanting to make some easy money.
I came off blood thinners several years ago as they caused excessive bleeding, (nose bleeds, hemorrhoids bleeding, cuts won't stop bleeding....) I found out the reason is I eat foods that are natural anticoagulants such as vinegar, garlic, etc. etc. (check online for a complete list). I don't remember where online but it's easy to find.
In there defense, Cardiologists are in an era where medications are the solution they are taught in medical school. Anyway I guess this turned into a rant, but I feel better. I would just encourage you to take the initiative and do some of your own research and find your own workable solution to your issue. Remember the number 3 cause of death in the U.S, is PREVENTABLE medical mistakes made by medical professionals. Number 2 and 1 is Heart Disease and Cancer.

I am 79. I had mitral valve repair, ablation, and LAA Closure using Atriclip over a year ago (maybe you can do a closure instead of Watchman) assuming you really need one or the other. No more AFIB. I got off of Eliquis after four months by wearing a heart monitor for 30 days to be sure AFIB was gone. I had to push my cardiologist to put me on the monitor. My vital stats while sitting average 116/66, heart rate 66. Everyone is different, but I hope this helps.

Amen--& I couldn't agree more! As a rule, I aim to avoid interaction & involvement with practitioners of American interventional cardiology & its shill, the American Heart Association.

To be fair, there is a small but vibrant group of American physicians organized under the rubric of "Medical Conservatism," led--ironically, by John Mandrola, who is an E.P. cardiologist. He is also a researcher & Medscape's chief editor for its cardiology forum & has his own Medscape column, entitled "Trials and Fibrillations with Dr. John Mandrola" (see: https://www.medscape.com/index/section_10325_0).

In one of his columns (2017), entitled "Seven Reasons New Data on Watchman Are Not Persuasive," he reviewed new (post-approval) surveillance (clinical) data on the safety & efficacy of the Watchman implantable device (see: https://www.medscape.com/viewarticle/888355). In keeping with his Medical Conservatism ethic, Dr. Mandrola noted--& I quote that..."if you infer noninferiority based on the risk-difference margin, you must also admit that Watchman is up to nearly fivefold worse than warfarin."

If I were ever left with no other alternative (a situation that, frankly, seems to me to be worse than death) & had the avail myself of American interventional cardiology, I would only accept diagnosis & treatment from Dr. Mandrola (even though I do not live anywhere near Louisville, KY, where Dr. Mandrola practices) or one of his colleagues in the Medical Conservatism movement (here's their manifesto: https://www.amjmed.com/article/S0002-9343(19)30167-6/fulltext).

Thank you for the information. There is a lot of medical bullshit from medical professionals out there. And my advice to my boys is "If you want to live a functional good life avoid doctors".
Please keep in touch.

Very happy to find you here @ezekio--& look forward to your continued presence 🙂

Here's Dr. Mandrola's takedown of the Pro-Ablationist evangelists (in the treatment of persistent atrial fibrillation), who are very loud in their Pro-Ablationist evangelism & very often succeed in drowning out and/or suppressing divergent & evidence-based views, including those advocating what now-deceased Dr. Stephen Sinatra termed "metabolic cardiology" & prevention in general (of which Dr. Mandola, who is also a triathlete, is a vocal advocate):

"CAPLA Challenges Expert Opinion on Ablation of Persistent AF and Should Change Practice" (https://www.medscape.com/viewarticle/979804).

A noteworthy quote from his pointed commentary on the CAPLA presentations/findings:

"But, as it so often is in the practice of medicine, less proved as good as more when tested in a rigorous trial. In 2015, Atul Verma, MD, and colleagues published the results of the STAR AF II trial, which randomized patients with persistent AF to PVI alone or to two other strategies of PVI plus more ablation. They observed no differences in the primary endpoint of freedom from AF.

Despite this strong evidence, the idea of additional ablation for persistent AF remained strong. One year after STAR AF II, a group of influential electrophysiologists published a nonrandomized study of 52 patients and concluded that isolation of the posterior wall of the left atrium "provides additional benefits" over standard PVI.

Two years later, many of these same authors wrote a review article on approaches to ablation of nonpulmonary vein triggers that included this line: "Therefore, empirical isolation of the left atrial posterior wall should be performed in all patients undergoing AF ablation." Their seven citations for this proclamation included observational studies and small randomized controlled trials.

These opinions plus the plausibility of posterior wall isolation led many electrophysiologists to accept the practice of adding it to standard PVI in patients with persistent AF. This became a therapeutic fashion."

Good Stuff!!
Totally Agree

👍👍

👌👌