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Appt. for FIRM ablation evaluation
Hi everyone -- not a question, but a report. I have a mid July appt. for an evaluation by the head of electrophysiology at Ohio State University Medical Center. I'm sending my records and they are putting me on the schedule (they are now scheduling for September). The fellow I talked with said they don't have the equipment all the time, which leads me to believe it is leased and moves from site to site. Does that seem weird to anyone? Also, he said they had all the other systems -- sterotactic, carto?, several names that sound like robotic systems. I am going to run this by my pcp and see if he has an opinion. My husband wonders if Medicare will pay for it since it is new? Anyone have a thought on that? The last I read, you need only to have failed ONE medication to qualify for an ablation, and I have done that, at least, 2 if you count the Atenolol that didn't do the job. Anyway, if anyone is interested in this type of ablation, contact Dr. Narayan at San Diego (google FIRM ablation) and he will refer you to a site near you. I'll let you know what happens. The scheduler did tell me they were having very good results with this method. I hoping to be offered better odds than I have been closer to home -- 50-50 or 60%.
An update on FIRM. Trials are still ongoing to see how useful the concept is. In the mean time, others are also looking at rotors using non-invasive mapping. Cardio Insight has an EKG vest that contains 256 electrodes. It needs to be used in conjunction with a CT to image the beating heart geometry and then the rotors are merged with with CT image. Lots of high power computing involved. So the process goes like this, hours prior to the ablation, vest/CT is done and results are computed. The EP sees where all the triggers are, and they see all of them. Then they do a step wise ablation going after all the triggers. They are done once they can no longer trigger AF. This is now being done routinely by Haissaguerre and Jais in France. A year ago, it would take a few days to compute and image the rotors. Now they are getting to just-in-time. One important thing that they found with non=PVI rotors is that they tend to drift and ARE NOT stationary. So the box approach of WACA ablation may still be the best answer.
Jais commented on the FIRM process which is very similar but using a basket electrode in the atrium to locate rotors. He stated that the blind spot using the basket type electrodes is 40% of the total inner atrial surface. That is a problem that I have always found needed addressing when the method was first discussed. Now that Jais has quantified the blind spot percentage, my view is that even if FIRM is found to be useful in trials, there will be an execution issue with measuring rotors with basket electrodes.
On the other points raised here previously, Stereotaxis is a great piece of equipment (used recently and successfully on two friends, AF and SVT). The problem is that there are not many around and many hospitals can't afford it unless they already do lots of catheter ablation procedures.
Jais commented on the FIRM process which is very similar but using a basket electrode in the atrium to locate rotors. He stated that the blind spot using the basket type electrodes is 40% of the total inner atrial surface. That is a problem that I have always found needed addressing when the method was first discussed. Now that Jais has quantified the blind spot percentage, my view is that even if FIRM is found to be useful in trials, there will be an execution issue with measuring rotors with basket electrodes.
On the other points raised here previously, Stereotaxis is a great piece of equipment (used recently and successfully on two friends, AF and SVT). The problem is that there are not many around and many hospitals can't afford it unless they already do lots of catheter ablation procedures.
I went about 7 years after my initial episode without having another full blown episode. I was taking Atenolol and looking back I think I was having some short episodes that were resolving themselves. Most of it was brought on by stress. About 3 years ago it turned into persistent, meaning the episode would not resolve itself without a cardioversion. So for the past 3 years I've been on coumadin, norpace, atenolol and xanax. All these drugs have their drawbacks, so it's time to look for something better to control it. If you only had a lone episode and have no underlying heart issues, you may well not have another episode. I met people who had an episode under great stress and then went 20 years before another. I'll be hoping you fall into that category. This is an area of medicine that isn't going to be deadly right now like, for instance, a heart attack. I think it is given less attention because its side effects play out over years and if you're doing "okay", afib isn't considered a huge priority. That said, I do think the treatments that do exist are evolving and getting better over time. I would like to have one of those "Star Trek" treatments where they wave a wand over you, push a few buttons and all is well:) Hopefully, if yours ever does come back, there will have been some advances to treat it. At any rate, I wish you luck and will be posting my findings and outcome on this board. Take care, DD
I've had only one episode and it was about a year and a half ago. I'm not on medication other than baby aspirin and I have had no problems since the episode. Nevertheless, due to the recurrent nature of afib, I fear someday I may have to face it again and the idea of a highly successful afib ablation procedure is encouraging to say the least!
Thanks for your kind words. I will report what I learn. this board gives me such a lift when pondering all these decisions. I truly appreciate the input and support. I have great hopes for this procedure and will know more in July if I am a good candidate for it. I forget, are you a fellow afibber?
Thank you for your support. It means so much. I feel like I can get on the board and get an answer when I get scared, uncertain or just need some support. You always make me feel a little better about most of my issues. Thank you for being there -- you truly make a difference for me. DD
We have Medicare and a Blue Cross Blue Shield supplemental policy. So far, there have been very few items that we have had to pay anything on. We have Medco for Part D for Rx's and it has a $200.00 deductible for brand name drugs. I have to pay it for my Norpace, then $45.00 a month for my co-pay. All the generics are $8.00 for our co-pay. It's working well so far and we have never gotten to the "donut hole," which I understand will be disappearing in the next few years. I will find out before I make the trip to Columbus what the insurance coverage looks like and I will share that information on the board. They did say they were having really good results with persistent afib with FIRM, which is where most of the standard procedures fail me. If I were still in paroximal sp? afib, my odds would be better. I do so appreciate your input, we do have a lot in common. This board has been such a godsend for me. The more information I have, the better off I am -- to a point. I can get to the point where I'm overthinking things and have to remind myself to back off. My husband is a laid-back sort of a guy and he helps balance out my panic first, think second personality:) Thanks again for the input.DD
I did some google research on the firm ablation and it sounds extremely optimistic. Best of luck with this and please keep us all informed with your progress. Sounds to me like if the firm ablation performs as well as expected, this could be a cure for afib tantamount to that of svt. Thank you for bringing this new exciting option for afib cure to light.
COMMUNITY LEADER
Well Medicare is a help, and in most cases I believe, is the threshold that a medical expense has to pass before the secondary insurance cuts inl That is the case for my secondary insurance which is really just catastrophic coverage, it picks up everything after we spend a little over $4,000.
A recent experience for cancer treatment by Chemo where a (patented, I assume) series of shots to restore the immune system (white blood cells for one) cost us over $1,600 on our way to the secondary insurance maximum out-of-pocket. Medicare pays 80% of their allowed cost (which Medicare keeps lowering) so even if the provider accepts the Medicare rate, a $8,000 service still cost $1,600 to the patient.... less whatever the secondary insurance pays. Happily this is the first year we have hit the maximum out-of-pocket, and the year is only half over, so the insurance pays 100% for the rest of the year - for us that included prescriptions.
I am not trying (or don't mean) to take this thread off-topic but DD raised the issue of what Medicare pays. We all know that is a two benefit operation, the Medicare rate is always lower than the "list price" and in my experience even lower than most insurance companies are able to negotiate, so even if one has to pay 20% it is of a lower total bill and Medicare pays the much larger 80%.
DD, you know I am in your "corner" - we have shared many a tale on AFib.
A recent experience for cancer treatment by Chemo where a (patented, I assume) series of shots to restore the immune system (white blood cells for one) cost us over $1,600 on our way to the secondary insurance maximum out-of-pocket. Medicare pays 80% of their allowed cost (which Medicare keeps lowering) so even if the provider accepts the Medicare rate, a $8,000 service still cost $1,600 to the patient.... less whatever the secondary insurance pays. Happily this is the first year we have hit the maximum out-of-pocket, and the year is only half over, so the insurance pays 100% for the rest of the year - for us that included prescriptions.
I am not trying (or don't mean) to take this thread off-topic but DD raised the issue of what Medicare pays. We all know that is a two benefit operation, the Medicare rate is always lower than the "list price" and in my experience even lower than most insurance companies are able to negotiate, so even if one has to pay 20% it is of a lower total bill and Medicare pays the much larger 80%.
DD, you know I am in your "corner" - we have shared many a tale on AFib.
I don't have any practical advice for your situation as I have no experience to share but I do wish you the best. I personally encourage everyone to follow their heart and even if that means trying each and every avenue available to them. At least you will know you tried. I wish you the best of luck that you are a good candidate and that medicare will cover it for you. (((HUGS)))
It is my understanding that odds for a successful svt ablation are about 90%. Alas, mine for a standard ablation are 50 to 60%. I am very glad you were in the 90%. I also appreciate your sharing your research on the different types of robotic equipment, very enlightening and useful knowledge to have.
I was dependent on medication for about 3 years. I tried to talk to my usual cardio about getting off of digoxin and he kinds just ignorant about it. The biggest change since the surgery is being off the digoxin. I mean the surgery has def. helped but not taking the dig for me is huge, a lot of my other problems have gone away.
BTW, did you have any thoughts on Medicare payment? Just wondereing. My husband says the papers I receive in the mail may cover this or at least who to contact.
I don't recall, was your ablation for Afib? Persistent Afib (which I have) is harder to fix and I am not being given great odds for a standard ablation. My ep suggested a BIGGER surgery (robotic mini maze, open heart with the "open") which is much harder to recover from. FIRM has been in existence since 2006, with excellent results and is being taught to other centers around the country, hence the "newness." I appreciate your input and am so happy for you and your excellent outcome, but I guess we all have to find our way to what is the best solution for our particular situation.
If my understanding of the problem is correct, I think another last resort option would be a pacemaker with AV node ablation. It would make you entirely pacemaker dependent, but would keep your heart rate in check.
COMMUNITY LEADER
I don't recall what your ablation was for, but I suspect not for AFib.
Yes, in the case of fibrillation "the sooner the better"... I have been in AFib so long fibrosis has surely set in, and thus I am not a candidate for ablation.
This decision was set before I fully understood the fibrosis issue, but even at that time (5 years ago) my enlarged left atrium and other heart history including a mini-maze procedure done during open heart surgery, and my "good" (all is relative) results practicing "rate control" and "clot mitigation" resulted in a decision for a life-time use of medications, then too I am an senior age person.
I have recently, at my own request to my cardiologist, moved to Atenolol from my Beta Blocker, and it is very effect in rate control.
I haven't had a discussion with any doctor on my current condition beyond continued monitoring of my condition including periodic echo and stress tests, but I fear that if my condition becomes uncontrollable the only fix would be a transplant.
Clearly a younger person, such as you, should seek a cure/fix, not medication crutches.
Yes, in the case of fibrillation "the sooner the better"... I have been in AFib so long fibrosis has surely set in, and thus I am not a candidate for ablation.
This decision was set before I fully understood the fibrosis issue, but even at that time (5 years ago) my enlarged left atrium and other heart history including a mini-maze procedure done during open heart surgery, and my "good" (all is relative) results practicing "rate control" and "clot mitigation" resulted in a decision for a life-time use of medications, then too I am an senior age person.
I have recently, at my own request to my cardiologist, moved to Atenolol from my Beta Blocker, and it is very effect in rate control.
I haven't had a discussion with any doctor on my current condition beyond continued monitoring of my condition including periodic echo and stress tests, but I fear that if my condition becomes uncontrollable the only fix would be a transplant.
Clearly a younger person, such as you, should seek a cure/fix, not medication crutches.
So I personally have never heard of FIRM ablation before and after doing a little research on it (not much to go off of) it seems they use it a lot for Afib patients. I just had my ablation done last week on Monday the 13th and before my surgery I did a lot of research on catheter ablations. Stereotaxis, is one of the leading machines used in Afib patients, the machine uses two giant magnets on the sides of the table you lay on to move the catheters around. I believe they use it a lot for Afib patients because the catheter used is the consistency of a cooked spaghetti noodle, and they are able to get to places in the heart they are not able to get to with a normal catheter or without the stereotaxis. CARTO I believe goes along with the stereotaxis machine. CARTO uses 2 sets of 3 magnet plates, one you lay on and one that is held above you. These magnets combined with some kinda of imaging, create a 3D image of your heart so the Dr's can see whats going on in there.Also with the stereotaxis and CARTO system, its a lot less radiation then the normal ablation. It does sound a little fishy that the machine moves around and such, but I get it the stuff expensive. If your worried about the actual ablation, speaking from experience (last week) the lead up is honestly the worst part. I wanted my ablation done with the stereotaxis because its a lot safer (cant poke a hole through my heart, they cant screw up my vein with the catheter, and less radiation) I was told they were going to use the CARTO system, but I was being done in the stereotaxis lab just in case they had to use it. I dont know if they used it or not, but I must say I felt at ease with that knowledge. and the Stereotaxis machine is a very very sexy machine lol and to be honest, I would be a little hesitant with the FIRM ablation with it being fairly new. Stereotaxis isnt that old either, but I have found a lot more information on Stereotaxis than FIRM. If I was in your shoes, I wouldn't wait to use the FIRM, I would just try to get the ablation done as soon as possible. Trust me its WAY worth it, I feel like a tard for waiting 3 years to have mine done lol.
COMMUNITY LEADER
Yes, it sounds a little strange to me that there are critical tools that are not owned by the institution doing heart work. But, I understand robotic equipment is very expensive and recall the surgeon who did my mitrial valve repair came to the hospital (heart institute) from work in other more major centers and he was experienced with robotic methods, but could not purchase them his current hospital, where he was the director or the heart institute, did not have sufficient funds.
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