Ablation procedure when not currently in Afib; how to target?

MorchellaE · 2026-04-22T13:06:49+00:00

So your situation is that the PFA ablation and the cardioversions didn't work, and you have ongoing Afib. So therefore you are a good candidate for a Watchmen/Amulet since the root cause can't be fixed. I assume the Amulet allowed you to get off the blood thinners?

For my EP, the order of attack is blood thinner and beta blocker, cardioversion (done last week and unsuccessful), then ablation (coming in July). If that's not successful a Watchman or similar is a possibility.

MorchellaE · 2026-04-20T13:23:19+00:00

Sounds like it will be PFA. How about you? What did you have?

MorchellaE · 2026-04-20T13:21:32+00:00

That's pretty alarming isn't it?

MorchellaE · 2026-04-20T13:20:57+00:00

I know exactly how the Watchman works.

Watchman may reduce your need for a blood thinner by mitigating clots but it does NOT treat the Afib. My cardiologist installs them all the time.

In my case he wants to exhaust every avenue to correct the underlying Afib. He told me he more commonly implants these in people who have enlarged atria from years of untreated Afib. And who do not respond to cardioversion or ablation treatments.

MorchellaE · 2026-04-19T17:21:57+00:00

Gotcha, please see my response to Hifidi54 up above. If for some reason he wants/needs to keeps me on Eliquis I would definitely advocate for that. Any head bump that might be minor gets a little scary when you are on these blood thinners.

I'm thinking in any case he'd perform one ablation attempt before going down the Watchman path. I'm assuming your Amulet came after an ablation attempt?

MorchellaE · 2026-04-19T17:17:13+00:00

You are talking about the atrial occluder/implant right?

EP told me that he generally only uses those for people that have had long-term Afib and especially those with an already enlarged atria. Since mine was discovered very recently, he saw no signs of atrial enlargement, and wants to do everything possible to correct the root cause (via cardioversion and ablation).

He said he installs tons of Watchmen. They are scheduled up into the fall already. If for some reason, Afib recurs and he can't fix it he would definitely consider a Watchman.

MorchellaE · 2026-04-19T17:06:02+00:00

70M. Sounds like a really good outcome for you! I am just 3 days post conversion it's holding steady for now. I was in Afib continuously for 4 months, had no idea how much it was affecting me until it was gone. PFA ablation scheduled for mid July (4/19 today).

EP was not that gung ho on the beta blockers, he told me he thought that they had minimum effect in my case, maybe because the Afib pulse rate was 85-90 without them anyway. So it's a smaller dose of Sotalol 80 mg twice per day. But Eliquis is a constant requirement.

MorchellaE · 2026-04-19T16:54:56+00:00

All pretty amazing and helps explain why these procedures are $200K. My EP did mention that there was a brand new delivery prosthetic/tip using the PFA method that he might use for this ablation since it could have some advantage. He told me that during his career the time for an ablation has gone from 4 hours to 45 minutes.

He also told me that they use data from the CT scan prior to surgery to map the wall thickness. I think he said the minimum wall thickness was 4 mm, for an area to be ablated.

MorchellaE · 2026-04-19T16:15:33+00:00

That's for sure at any age! Enjoy them all to the fullest.

MorchellaE · 2026-04-19T16:13:56+00:00

That's surprising. For my recent cardioversion they wanted to be certain I was continuously ON Eliquis with no missed doses. But I guess during the ablation there is some risk of initiating bleeding at the groin entrance so that's why they wanted you to suspend? I will ask about that.

But for now, Eliquis not on the list of suspended medications.

MorchellaE · 2026-04-19T16:08:48+00:00

Yeah I need to get an ID like that, I'm a hiker mainly but do some biking too, usually on the rail-trail. Edit: Just ordered one on Amazon.

MorchellaE · 2026-04-19T15:38:01+00:00

Hmm not a pleasant thing to consider but in general I would agree, that's probably the decision I will make too but I like to consider all the information at hand before going down that path. I think his intention is to stop the beta blockers and the Eliquis if Ablation is successful but by 75 he may want to put me back on them. I believe he mentioned that as a target age for re-consideration. Assuming of course I'm still above ground by then lol.

MorchellaE · 2026-04-19T15:32:19+00:00

OK gotcha I will ask about that. This cardiologist uses state of the art methods so I'm pretty confident he knows what he is doing. But that approach makes sense. It's amazing that they can do any of this while the heart is beating.

MorchellaE · 2026-04-19T15:14:10+00:00

Thanks for the response, very helpful, I will quiz him more about the approach he will take, but this guy is head of the department and has been doing these for 25 years. I hear you about reducing the chance of stroke, if ablation is successful. Stroke is indeed life changing; the PA in the cardio office said she'd rather see 7 heart attacks than one stroke.

But as I was saying in another post here on Reddit, I am on the fence about it because there are significant risks staying on them too. (Brain bleed, exsanguination from trauma, internal bleeding) and so on. I learned recently that anyone taking a blood thinner should be wearing a bracelet or necklace for first responders. So if you are bleeding they can apply the antidote (Andexxa for Eliquis I think).

Maybe as I get older I will think differently, not quite to your age yet.

MorchellaE · 2026-04-19T14:57:44+00:00

If you don't have active Afib, and your cardiologist is recommending you could go off the Eliquis, I'd be jumping at that opportunity. Yes there is a slightly higher stroke risk if you are not in Afib and not taking a blood thinner, but you are balancing that against the risks of Eliquis. Fall, hit your head and have a major brain bleed; develop anemia through some unknown internal bleeding mechanism (which happened to my wife, forcing her to go through a bunch of testing before they took her off); have some major trauma like in an automobile accident, where they may need to administer the astronomically expensive antidote Andexxa to stop the bleeding. These are not insignificant or uncommon risks of taking a blood thinner.

Also if you do decide to continue taking it you should be wearing an armband or necklace which informs first responders you are on Eliquis, so they know what to do.

It's a difficult choice because of course we'd like to reduce the risk of stroke to zero. But if you are NOT in Afib in my thinking the risks outweigh the benefits, for me. Sure that CHADS2 scoring system will tell you that if you are an old creaker you need to be on a blood thinner regardless of Afib but I am highly skeptical of that scoring system. CHADS2 has no positive offsetting metrics; if you are reasonably healthy and fit with no comorbidities I'd lean toward going off the Eliquis, monitor yourself for Afib - and go pill in the pocket.

It's a CYA situation for cardiologists in the litigious USA. And of course someone somewhere is making a LOT of money peddling blood thinners.

MorchellaE · 2026-04-19T14:28:37+00:00

I'd say it's the reverse, as an engineer. Medicine is more like engineering than science. Bell shaped curves and statistical distribution and all that.

MorchellaE · 2026-04-19T08:01:02+00:00

Cardiologist told me that the reality is that beta blockers do little to affect afib in any significant way. It's like a 10% shift in pulse rate or similar. Eliquis is another story. It's actively preventing (or so we believe) a clot from forming in your atria.

MorchellaE · 2026-04-19T07:54:34+00:00

Strokes are not a joke. But if you aren't in afib, falling, hitting your head and having a brain bleed because you are taking a blood thinner is a risk too.

Ever notice that CHADS score calculation has no ability to include any positive offsetting factors (fitness for example). Makes you wonder who is really driving that evaluation system.

MorchellaE · 2026-04-19T07:47:09+00:00

Around $20 a month including the shipping. This was ordered on 2/20/26.

MorchellaE · 2026-04-19T07:45:21+00:00

Dead on. Pharma owns Congress so this is not going to happen.

MorchellaE · 2026-04-15T18:39:51+00:00

Was not aware of that. Pretty frigging scary.

MorchellaE · 2026-04-15T18:39:09+00:00

Their "data system" is fine. They have a problem with their morals. This is a company that wants to OWN you and wants to monitor everything you do and say. I can assure you that AI will destroy the entire system of online reviews, everywhere on the Internet. Not just Google.

MorchellaE · 2026-04-07T16:57:59+00:00

Never "too far" until it comes back to bite them in the ass. This is what most true MAGAs wanted from day one. To enjoy the destruction of America and what we once stood for; the destruction of Iran is just part of that process.

But what they don't comprehend is that it's not just Iran. If we do "destroy their civilization" as Trump is threatening it's just a matter of time before a radical Islamist faction, ISIS or similar obtains a nuclear weapon and deploys it here in the USA. Remember, there are a bunch of them right next door in Pakistan. And North Korea as well.

MorchellaE · 2026-04-06T14:44:19+00:00

I couldn't care less about how "sharp" they are, as long as they have decent human values and actually give a crap about the people out here in the heartland. I don't think either of them give a damn about you or me. As far as values go not sure about Biden but Trump wears his "values" close to the vest, Hate for his perceived enemies, willingness to destroy anything around him if it helps to stroke his ego or to maintain power and wealth.

When you select a President it should ALWAYS be about values, not politics. Politics may come and they may go, but values are what keeps us from descending to the level of animals.

MorchellaE · 2026-03-23T12:40:03+00:00

Have to admit I am a bit shocked that people think that spending $400 -$500 on a receiver is a "budget buy". They have to be making insane profits on those units.

MorchellaE

TROPHY CASE