My EP took me off eliquis. But I’m petrified. I’ll have a stroke now.

@sandw40 As we age and sit more/move less, and if we want to live well for another few years, I think anti-coagulation makes abundant sense. It's just that there are perhaps better options, at least at first, in the early days of aging, say from 60-80 for many of us with 'long genes'. One better option would be to clean up the diet. Another might be to haul our coats out and move our carcasses just a bit more often....and more than just once around the block and nip back indoors to the digital devices and their siren calls.

Most doctors are very eager to prescribe blood thinners so if your
doctor says you are outside of the recommendation range I think you can believe him.

Do you take any nutritional supplements? A very common combination, fish oil for the omega-3 DHA and EPA and curcumin as a general anti-inflammatory, are good for healthy people too and may have much the same effect as blood thinners when it comes to avoiding clotting issues. Others take the route of a baby aspirin per day, but that's rather less popular now than some years ago.

Other nutritionals offer additional and alternate approaches, too, you can have a new hobby good for years just researching them. What I've never seen, however, is a comparison to prescription approaches!

@gloaming Far as I know they don't give out pacemakers or ICD defibrillators just for the purpose of controlling or eliminating A-fib or any other arrthymias, with the exception, as I understand it, when a person is in permanent A-fib and is symptomatic to the point where the A-fib affects the quality of life, and/or is associated with a rapid ventricular response which drives the heart rate up to unsustainable rates. At this point a kind of "last resort option" is to ablate the A-V node so it can no longer function and the electrical signals from the atrium can no longer be transmitted via the A-V node to the ventricles. A pacemaker is implanted to send the electrical signals in a controlled fashion to the ventricles. As I understand it, the person still has the A-fib but may not feel it as badly.

A defibrillator is generally implanted when a person has had episodes, or is at risk for ventricular tachycardias which may be life-threatening, or is at risk or has had cardiac pauses, arrests. A defibrillator is implanted to shock the person's heart in the event of ventricular tachycardias or sudden cardiac arrests, to restore the heart to a normal sinus rhythm. As I understand it, most cardiac defibrillators currently come with pacemaker functions as well, whether or not the pacemaker function is activated depends on the patient's needs.

Far as I know, having A-fib alone does not meet the American Heart Association, European Cardiac Society, or the Heart Rhythm Society guidelines for the placement of a pacemaker or ICD. These guidelines address symptomatic bradycardia as primary reasons for pacemakers. Although one of their criteria does include the necessity of taking medication that causes bradycardia to control a condition in which there is no substitute for this medication. That's actually an A1 classification, meaning that all experts agree that pacemaker placement would be expedient and helpful for such a patient.

And that said, I've learned that pacemakers, once implanted in a patient, can be used to suppress A-fib episodes by using "overdrive" pacing. The pacemaker would be programmed to raise the pacing rate to a higher rate, ( I think mine is set at 75) when an A-fib episode is detected, this is intended to stop the A-fib and it seems to work pretty well, at least I've found. This is most helpful for paroxysmal A-fib, but pacemaker placement would not be indicated for this reason in a person who just has A-fib.

Pacemaker monitor readings/reports have to do with the status and functions of the pacemaker and cardiac functions and responses to the pacing over the period of time covered by the report. The reports include the remaining voltage in the battery and time estimated to the end of service, voltage applied for each paced beat, information about the leads, average percentage of atrial/ventricular pacing, total number, times and length of time that arrhythmias such as A-Fib ( these are classified as "Atrial High Rate Episodes" ) have occurred. The cardiac activity is also graphed ( called EGMs) so an EP/cardiologist/pacer tech can see the type of arrhythmia may be occurring, can see if it's A-fib or a non-afib atrial event, which they refer to as SVT. The reports will also show the number of times, dates and times and other details when the pacemaker made adjustments in its pacing to accomodate particular issues such as arrhythmias, lead issues ( some of those are referred to as "mode switching") and much other data that I can't even begin to understand or explain!

The CHAD2S2-VASc score has nothing to do with pacemaker readings. Looking at the link in your post, you can see the points listed there are for the risk factors in an individual's medical history, including history of hypertension, diabetes, strokes, TIAs, thromboembolism, cardiovascular disease, age and gender.

I hope this helps!

I had one episode of A-flutter years ago that lasted about 4-5 hours and then stopped on its own (once I got to the hospital, of course!) . I went to the ER, was admitted and referred to a cardiologist, who took me on as a patient. Though he adjusted some of my medication, he didn't prescribe a blood thinner. He ordered a 3 week monitor to completed before my followup visit to him. At that visit he informed me that the monitor report showed no A-fib/flutter, essentially was normal. He instructed me to keep an eye out for further arrhythmias, if they occurred to go to the ER or their office for an EKG for documentation, in the event of A-fib/flutter he would start me on an anticoagulant. As the years went by I had shorter episodes of arrhythmias but more monitoring showed these were not A-fib, but SVT. Those aren't associated with stroke risks so no blood thinner needed. I think at that time my CHAD2S2-VASc score was 2- I have a history of hypertension.
As time went on I had symptomatic bradycardia as well as the tachycardia and eventually had a pacemaker put in. This cardiologist got my pacemaker monitoring reports, and over time they started seeing short episodes of A-fib on those reports. At first these were sporadic, only a few seconds long and less than 1% of the workload, so to speak, and the cardiologist said there was no need of a blood thinner at this point.
Some time after that, they began seeing more frequent A-fib episodes, including some that were several hours long, and that's when they notified me that it was time for the blood thinner. They asked me to come into the office where the cardiologist broke the news and sent the prescription into the pharmacy for Eliquis.
I figured he had been conservative about prescribing the bloodthinner at times when many other doctors would have prescribed one mostly on a CYA basis I figure, so if he said it was time when he did prescribe it I had to believe him.

In your case, with the CHAD2S2 score of 1, you're at a very low risk of stroke associated with A-fib, and especially if it hasn't recurred. I'd be happy at the thought of not having to take a blood thinner. Keeping an eye on things sounds like a good idea, though.

@marybird Thanks, that helps a lot. As I said, I have no experience with them, but found it hard to believe that they would approximate a CHA2DS2-VASc score for a patient; that's for a cardiologist, family physician, or an EP to do. So, I continued the dialog hoping to learn more, and you have fleshed it out nicely.

One common problem with AF is RVR....rapid ventricular response (some sources state it as rapid ventricular rate). It could be that some pacemakers or ICDs can help to squelch AF, even with the hyper-stimulation rate, on both accounts, atrium and ventricle. Or if RVR is strictly dependent on the atrial mis-firing, then merely correcting the atrial rate might automatically slow the ventricular rate.

Thanks, again.

I just heard something that they are saying that if you are over 80 or under 135 pounds or have kidney disease that the normal dose of blood thinners could be to high ! I can’t say this is true I just got it on line

@gloaming Oh sure but that's a pretty select group your defining. Think most folks in that age group walking into the cardio shop walk out with a script for DOAC in their pocket and even if they were to discuss those topics with Dr. Cardio he/she would still be recommending the pill. Healthcare doesn't really make much money on patients who truly want to stay healthy and healthcare is a huge financial engine in the US with it's main purpose to make money and somewhere further down the list to make people last longer to try the next "super drug" they can't live without. Not arguing with anyone just personal belief.

@rice It's true.

@jc76 That % you see on your pacemaker reports, referring to A-fib or any other arrhythmia, would be the % of total time you spend in that arrhythmia. If, for instance, the report says your A-fib burden is 3%, that means during the time frame of that report ( often 3 months), 3% of your total heart rate activity was spent in A-fib, if your % was reported as 100% that would mean you're in A-fib all the time.

I'm in that same boat, I believe, as I have randomly occurring short-lived A-fib episodes, many of these last only a few seconds. My A-fib burden is reported on many of my pacemaker reports as less than 1%. My cardiologist or his PA, whoever it is I see during doctors' visits, has always made a point of mentioning that I either had x numbers of A-fib ( and sometimes SVT) episodes for the last report, or that I didn't have any. I have had longer episodes of A-fib that occur randomly and I don't always feel them, so the cardiologist has always put the kabosh on any suggestion I've made that maybe I don't really need the Eliquis- he mentions my other risk factors for stroke besides those listed in the CHADS2S2-Vasc score ( mine is 4 at this point).

@marybird
Thanks, really helps. When I get my ICD/Pacemaker reports sent to me they are quite medical sounding and hard to understand if problem or not. Your history with your ICD/pacemaker sounds like mine.

So I wait for Pace Clinic to call me or portal message me about an issue. I just had them call me as had 8 seconds of VTAC that my ICD/Pacemaker paced me out of thus no shock. They asked me what I felt and quite frankly I don't think I felt the VTAC just the pacemaker speeding me up.

My AFIB as just you posted is short lived and random. Great information. How long have you had a pacemaker? I have had one since 2006 and on my 3rd. Battery is at 2.5 years so coming up for another soon. The % you mentioned made the number I see understandable, thanks again.