Atrial fibrilliation for obese male aged 63.5 years

[Anonymous282858]

hi All

  I love my dad a lot and we are in a third world country .. I am here in the USA trying make it thru for the past 8 yrs. he had an episode about 2.2 yrs ago where he fainted and then doctors attended to him to be diagnosed with Atrial Fibrilliation. We consulted at a few doctors in our country and some suggested trying surgery the ablation procedure  to correct the irregular rhythm where the electrical nodes are corrected. but another doctor suggested that is a risky procedure and instead recommended blood thinners. He takes it everyday.
  He has had some papitations and breathlessness and tiredness in this period of 2 yrs.
   An ECG every two - three months suggest sometimes AF is good and other times its mild.
   He is Obese (230 pounds) and aged 63.5 yrs and recently he feels restlessness and tired within a few feet of walking or climbing stairs.
the doctor there suggested that AF looks ok .. so you may want to do Angiogram to see blocks and that might even fix AF.
But I recently I saw that Stanford Medical center has some break thru mapping FIRM-guide ablation procedure which is very effeective .. If someone can assist me the options I have for my dad that I love very much to correct AF and also to detect other heart issues, blocks etc .. And also the typical charges I can expect for the ablation proccedure and other diagnosis and treatment if needed, whats the recovery time if AF ablation procedure is performed ..cause he may have return back soon. thx

[researcher09]

I think you will get some helpful comments if you post your budgetary question on the lone AF forum.  It is a tough one.

[researcher09]

If the AF symptoms including lack of circulation (ie oxygen) on exertion, by definition it would be defined as NYHA class I or II heart failure.  So a lot of the older folks that are 1. symptomatic and 2. get tired or fatigued during an AF episode fall under that definition.  It is perhaps too scary a description to use but I guess the medical profession has reasons to use the classifications it as a yellow flag to get the condition managed.  There have been a number of doctors with AF that post on the lone AF forum.  All of them ended up doing ablations, and they are very picky when it came to choosing centers and experts.

[Anonymous282858]

This is very helpful and lot of hope has filled me.

My dad will be a visitor to USA and I am not sure if I can get insurance for him for a pre-condition. Do  anyone know of any insurance that can help with this procedure

Does anyone now how much it would cost if I negotiatie at a high performance center.. My budget is $12000 .. I prolly can stretch $15k. Pls let me know ..

I will ask dad to wear the heart monitors to detect the abnormalities..

Thanks much again..  

[theforceiswithyou]

The cost of ablation varies from country to country and from institutions to institutions.  My ablation, altogether, was billed to the insurance at nearly $80,000.  I ended up having to pay about $2500 out of pocket, which was a big deal to me.  Ablations are not cheap, after you add in equipment fees, hospital fees, cardiologist fees, and anesthesiologist fees.  In many hospitals, it is considered an "out-patient" procedure.  Most patients will stay one night under observation and will be released the next day.  You will be able to go back to work immediately (depending on your work), but will have to minimize moving and heavy lifting as you will have two big puncture wounds around the groin area where the catheters were inserted.  Obviously, if you're a mover or a construction worker, you will need couple weeks for the wounds to heal completely.

With paroxysmal AFib, it is harder to diagnose as it will rarely show up on an EKG at the doctor's office.  Your dad will then have to wear a heart monitor over the course of a week (or more depending on the doctor's orders) which will detect when/if Afib occurred.  

Note that if your dad goes in and out of Afib within seconds, then the risk of having a stroke is much lower.  Indeed, many people have Afib episodes and don't know it.  What doctors tend to worry about are patients that go into Afib for days and convert back to sinus regular rhythm only after days or never.  Those are the ones that need to be on anticoagulants.  

Also, if your dad is symptomatic during Afib episodes and realizes he's been in Afib for more than 48 hours, I'd go to the hospital immediately to see if they can cardiovert him back to sinus rhythm.  It's always better to live with paroxysmal Afib than persistent Afib.  The longer you live in persistent Afib, the harder it will be to convert back.  

My dad has persistent AFib and takes a beta-blocker to reduce his heart rate.  However, since he's asymptomatic, he just lives his life.  

I will disagree with "researcher09" and his/her statement "There are also a significant portion though that will progress to heart failure."  Afib in and of itself does NOT cause heart failure.  It is the rapid heart rate associated with Afib that can (i.e., there's a possibility) lead to heart failure when that rapid heart rate is not controlled after MONTHS.  That means, you'd have to stay with a rapid heart rate above 105 for months at a time before you're at risk of heart failure.  However, there are great medicines now that effectively control your heart rate, so it wouldn't even be a concern of mine.  Hope it helps!
  

[theforceiswithyou]

I did one ablation at George Washington University Hospital in December 2014.  I don't think it is considered a "high performance" center, but I trust my doctor and she actually chaired the committee that formulated the standards of care for Afib patients nationally.  I was considering Johns Hopkins, but given my history with my doctor, I went with her instead.  Unfortunately, the Afib has come back from time to time.  However, it has been less frequent than before the ablation.  I also emphasize that lifestyle and knowing your triggers are important.  I have found with regular exercise and keeping your life as stress/anxiety free as possible also helped.  I now control what I eat, drink (no alcohol or caffeine whatsoever), and do.  I have accepted the fact that I will one day have to do another ablation.  With averaging about 1-2 episodes every 6 months while being only on one aspirin a day, I think I can try and see if I can keep surgery at bay.  It is after all, a surgery.  Plus, by waiting, I can hopefully benefit from better technology and mapping.  For example, back in the days, the only used RF ablation, now there's cryo.  It's all about what makes you feel good and keeps your Afib at bay.  Afib happens in many individuals, we're just "lucky" that we know about it and can monitor it.  

[researcher09]

What his doctor describes is called paroxysmal AF.  That is, it occurs randomly with no predictability or obvious triggers like caffeine or alcohol.  Like the other poster wrote, the most important thing for him now is to reduce the risk of forming a bood clot in the heart that gets circulated out into the body.  That is what the warfarin (or other anticoagulant is for).  There is a high probability that the AF will increase in frequency to the point where it becomes persistent.  If it is affecting his quality of life, then ablation is the way to go.  For some, AF doesn't affect their quality of life and they could go on forever with just anticoagulation.  Those are the lucky ones.  There are also a significant portion though that will progress to heart failure.  If I was 33 and have AF, I would not take the risk of letting it progress.  Also, the success rate for treating paroxysmal AF at expert centers are in the 90s% now.  The average medicare center (80% of USA procedures) is around 50% success rate.

Cost in the USA for an AF ablation out of pocket payment is about double that of Europe.  Cost in Bordeaux include a week of accommodation at the hospital.  The $25K quote was as of about 5 months ago when a lone AF forum member in Canada wanted it done instead of waiting 2 years (backlog in Canada).  The bill from the hospital to the insurance company in the USA is usually over $100K and the actual reimbursement is a fraction of that.

[Anonymous282858]

  Thanks all for the responses ..
  I really appreciate your responses ..
  
   Will it cost more than $25k for ablation..
  His doctor says he is ok sometimes and other times he has Af ... what does it mean and how to diagnosed when and what causes his AF.. are there monitors to pin point with more accuracy thx

[theforceiswithyou]

medicalanonymo - You seem to love your father very much and it is nice to see.  I am currently 33 years old and have had AFib for the past 4 years.  I was also diagnosed with SVT when I was 14 years old.  I have had many ablations.  Let me tell you what my cardiologist tells me:  Afib in and of itself is not deadly.  In fact, patients with Afib only have a marginally shorter lifespan as the rest of the population.  Many lead long and productive lives.  What doctors are mostly worried about are ischemic events (i.e., strokes).  Therefore, your father should be on a blood thinner.  Depending on the severity of his situation, it may be as small as an aspirin once a day or something stronger like Warfarin, Eliquis, Pradaxa, etc.  However, remember that it is not abnormal for older individuals to start anticoagulants as they age to reduce their risk of heart attacks and strokes.  In so far as ablations are concerned, the procedure is ALWAYS elective.  I have yet to hear a life or death situation where someone HAD to do an ablation.  There are different types of ablations, each with different advantages/drawbacks.  The "success rate" of a first ablation is about 50-70%.  The success rate of a second ablation is about 90%.  Ablations do not always cure everybody.  Like many said, I would recommend going to a doctor with a lot of experience.  Doesn't have to be the best renowned hospital, but make sure the doctor does at least couple hundreds procedures a year.   I personally would not recommend open heart surgery for something as benign as atrial fibrillation due to the significantly higher risk attached thereto.  Another solution your father may consider is a pacemaker.  It is obviously the last resort, but I think I would personally consider a pacemaker before open heart surgery.  My first ablation was not successful as I still have Afib.  However, my single best recommendation is to encourage your dad to lose weight and stay active.  It has helped me TREMENDOUSLY!  Also, tell him to note his trigger points.  Some common triggers are: stress, anxiety, alcohol, smoking.  He'll be fine, don't worry.  Don't hesitate to ask more questions if you're confused.  Cheers!

[researcher09]

Another thought - if your dad has to pay out of pocket, travel far and not in SF already, then you should also put European centers on your list as they are quite a bit cheaper for the same level of expert ablation.  For example, Bordeaux ablation with Haissaguerre/Jais/Hocini cost around $25K USD.  Much lower than out of pocket cost here in the US.  They are at the same level of expertise as Natale.  Also, Kuck in Germany, Pappone in Italy, thoraxcenter netherlands, etc ... are choices as well.

[researcher09]

Ablation is not a risky procedure if you select a high volume center.  The EP that developed FIRM moved to Stanford from UCSD this year.  There are two ways to map rotors currently, the FIRM approach using basket electrodes and CardioInsight external ecg vest.  Both approaches are still work in progress.  The baskets used in the FIRM approach have two limitations, the blind spot with current baskets is around 40% and basket sizing is an issue as well.  External ecg vest with 252 leads don't take into account heart motion from systolic and respiration cycle resulting in mapping errors of up to 10 mm, which is big relative LA size of 40-50mm.  So even if the rotor mapping/ablation concept is proven to be useful, current tools are still works in progress and randomized trials have not been done yet on either approach.

If you are in SF area, you can get access to one of the top ablation experts in the world by the name of Andrea Natale.  He goes to CPMC in SF monthly, he is based out of Austin TX and shares his clinical time between SF, Scripps SD and Austin.  Try to see if you can get an appointment with him.  Also check out the lone AF forum where you will find extensive discussion on all things AF and on FIRM since that began.  Stanford, I am not too keen on.   There is also Dr. Winkle in Redwood City if your dad's AF is still paroxysmal.

[itdood]

Sounds like the angiogram is the next step, it would be the standard of care for the very short history I see here and not knowing a lot of other necessary information to make that call.   If he doesn't have high blood pressure.  

If all that checks out and ablative therapy is the next step, I've heard good things for 5 box mini maze for *chronic* a fib.   Best of luck.