PFA procedure with stroke risks

My brother in law was bleeding from an ulcer or one (or more) cancer lesions this past Friday. He was a long time user of Eliquis for leg blood clots. He received the Eliquis reversal agent in Ames, Iowa. Ames is neither a large city or a small town
But, they had the reversal drug for the Eliquis he had taken the evening before.

Please do an internet search on the probability of a stroke with a PFA, which is a type of catheter ablation, and the possibility of a stroke with AFib. I think you'll find your answer. Good luck!

That's good to hear. It was 2-3 years back when I was inquiring about reversal and availability with my cardiologist. At that time according to him it was supposedly only available at Level 1 trauma hospitals and would be available to others via request. But I believe what hasn't changed is the time for reversal to take effect which depending on the situation can potentially affect the outcome. But glad it was available for him.

I had a PFA performed 19 days ago and during the procedure they used heparin which is an anticoagulant. At the end of the procedure, they used protamine to neutralize the heparin induced anticoagulation. I am still on Eliquis and Metoprolol and should be off both meds in the near future.

The risk of stroke due to AF has nothing to do with the technique used to ablate the affected area where the extra signal is entering the left atrium. The risk of stroke is mainly due to the poor circulation during AF in the LAA...the left atrial appendage. So, if the PFA or RF ablation, or even cryo-ablation, is being implemented, the LAA still retains its shape, and the blood still circulates poorly in it. Stale blood tends to clot, and that's why AF is so dangerous...clotting risk in the LAA. Stop AF = reduce risk of stroke due to AF by about 90%. PFA, but also any successful method of ablation, obviates the requirement to use a DOAC (direct-acting oral anti-coagulant) if all other risks/comorbidities are low. In fact, it is the patient's assigned CHA2DS2-VASc score (you can google that, and even calculate your own) that determines the total risk of stroke for all potential causes/risks.

I had an RFA 5 days ago. The after action notes indicate that Heparin was used. If anything, the ablation should reduce the stroke risk. So far so good as far as my heart rhythm is concerned. I hope to get off Amioderone soon and maybe the Eliquis eventually.

Coming off Eliquis should/could happen if your CHAD Score that gloaming refers to below is in the lowest ranges. Coming off Metoprolol would depend on your blood pressure range. Both would be determined after the supposed 3-month blanking period. Good luck and glad your ablation went well 🙂

If you don't mind, please advise he name of the drug he received for Eliquis reversal. Thank you. Regards

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.

You would normally get a Holter monitor to wear for about a day at the 10-12 week mark to assess your heart's function. You would not want to be on any heart medication, not rate control (metoprolol, bisoprolol, Sotalol, Diltiazem) nor anti-arrhythmic (flecainide, Multaq, propafenone, amiodarone, Tikosyn..) for about two weeks prior to the Holter because of their potentially lingering effects on your heart's speed and rhythm. IOW, they would mask your heart's real state and the Holter would show that your heart is no longer prone to AF...when it actually IS! So, I hope you get an instruction to taper off amiodarone within the next three weeks. If not, please inquire.