non-valvular AF?

[windsurfer]

I read the term non-valvular AF suggesting that there may be valvular AF. Is there some connection between valve problems and AF and what is it? Is it risk from surgery or from tissue or mechnical valves? Is the risk different for different valves e.g. aortic valve vs mitral valve?

Thank you ahead of time for your help,

Bob

 

[RCB]

Lone A-fib

Lone A-fib

I read the term non-valvular AF suggesting that there may be valvular AF. Is there some connection between valve problems and AF and what is it? Is it risk from surgery or from tissue or mechnical valves? Is the risk different for different valves e.g. aortic valve vs mitral valve?

Thank you ahead of time for your help,

Bob

Bob,
The term you are looking for is "Lone A-fib". This happens when a person doesn't have any other heart related problem except for A-fib and is the most common type. The life time chance of this is 1 in 6, if your over 40 it is 1 in 4. If you have heart surgery that involes cutting in to the heart, your chances for A-fib increase. If you have your mitral value worked on, your chances for A-fib increases over other valves. No difference between tissue and mech. values, with the exception that if you end up having more surgeries, that will increase you risk. As more and more people live longer with repeated HVR surgeries, there will be more and more problems with A-fib. More and more EP cardiologist are beginning to do more types of ablation. For several of the best EP doctors at CC, I heard the wait for an appointment is around 6 months.

 

[windsurfer]

LAA occlusion

LAA occlusion

Thank you, RCB. My cardiologist is recommending I get my LAA closed since I'm not a good candidate for coumadin. In this way if someday I get AF then this will reduce the chances of a stroke since they usually form in the left atrial appendage (LAA). Since I don't have AF now and am getting an AVR next week I wasn't sure I needed the LAA. I searched the lit and they recommend getting it closed if you have AF which I don't have. I wanted to get a sense of the risk of my getting AF after surgery - either as a result of surgery or because of the aortic valve stenosis. If risk high then LAA occlusion may make sense, if low then perhaps not - why tamper with what nature has given us. I haven't decided yet.
Bob

 

[windsurfer]

risk for AF from AVR

risk for AF from AVR

Bob,
If you have heart surgery that involes cutting in to the heart, your chances for A-fib increase.


Do you know what the risk for AF from an isolated AVR are e.g. 20% or 80%. Where could I find out about this risk? I'm having an AVR in less than a week and still don't know whether I should have my LAA removed or closed. I do not have AF, nor any of the other risk factors other than aortic stenosis. My only unique situtation is that I have a malabsorption disease that makes oral medication absorption quite unpredictable so managing INR will be difficult if I ever should need coumadin.

Thank you,
Bob

 

[RCB]

Bob,
If you have heart surgery that involes cutting in to the heart, your chances for A-fib increase.


Do you know what the risk for AF from an isolated AVR are e.g. 20% or 80%. Where could I find out about this risk? I'm having an AVR in less than a week and still don't know whether I should have my LAA removed or closed. I do not have AF, nor any of the other risk factors other than aortic stenosis. My only unique situtation is that I have a malabsorption disease that makes oral medication absorption quite unpredictable so managing INR will be difficult if I ever should need coumadin.

Thank you,
Bob

I have seen no study that precisely quantifies this, only the statistic that
show AF occurs more often in MVR pts. than AVR pts. There are other factors that cause AF- age, family history, previous attacks of AF and number
of reops to name a few. I never had a hint of AF till my third AVR-they contolled it with drugs till '95 then nothing seems to help, not even an ablation,valvulplasty, MVR and a Maze(which included the removal of the LAA). If this is your first AVR, I think your chance are small(a guess would be under 10%) that you would get AF. The general thinking at this time, is to remove it while they are in there( the same as if you have bowel surgery they remove the appendix). Here is an interesting article:

http://arrhythmia.hofstra.edu/emc/

Good luck on your choice!

 

[windsurfer]

If this is your first AVR, I think your chance are small(a guess would be under 10%) that you would get AF. The general thinking at this time, is to remove it while they are in there( the same as if you have bowel surgery they remove the appendix).

Your 10% guess seems right. I met with the surgeon this afternoon by luck and he said for all his valve jobs (including mitral which is higher) are about 14% - wasn't sure if that was permanent AF or temporary - forgot to ask. He also said that some big heart centers like the Cleveland Clinic remove the LAA while they are in there anyways as you suggested. I decided to have it removed.

Thanks again RCB!

Bob

 

[windsurfer]

CCF and LAA removal

CCF and LAA removal

RCB, I see that you have the most and earliest valve surgeries - the latest being at CCF. Also that you seem to research AF - since you are in AF all the time now. Do you know if CCF removes the LAA on most valve patients these days or do they close it or do nothing in many cases. If they remove it then I would feel that romoval must be safe. However, since more surgeries especially those most invasive to the heart lead to greater risk of AF, I wonder if LAA removal (certainly a very invasive procedure) could actually lead to AF - AF that without such a procedure in a first time AVR would only be 10% probability may go substantially higher. But if CFF is doing LAA removal routinely then I doubt it increases the risk of AF.

Thank you for your insights and article references.

Bob

 

[RCB]

RCB, I see that you have the most and earliest valve surgeries - the latest being at CCF. Also that you seem to research AF - since you are in AF all the time now. Do you know if CCF removes the LAA on most valve patients these days or do they close it or do nothing in many cases. If they remove it then I would feel that romoval must be safe. However, since more surgeries especially those most invasive to the heart lead to greater risk of AF, I wonder if LAA removal (certainly a very invasive procedure) could actually lead to AF - AF that without such a procedure in a first time AVR would only be 10% probability may go substantially higher. But if CFF is doing LAA removal routinely then I doubt it increases the risk of AF.

Thank you for your insights and article references.

Bob

Bob,
My experience has been it depends mostly on the pt. and insurance.
If a pt. is prone to AF, most insurance would pay for the procedure as being part of a Maze procedure. However, there is no standard "Maze" as many
Different surgeons call their attempt to ablate tissue "_________ Maze". I don't think it is SOP to remove the LAA in most HVR surguries with out a previous history of AF, because insurance would not pay for it.
I really feel your surgeon will make most of these decisions. If you don't feel confortable with his answers- get one you do feel good about.
Good luck and remember you will be fine!

 

[windsurfer]

insurance issue

insurance issue

Bob,
,.. I don't think it is SOP to remove the LAA in most HVR surguries with out a previous history of AF, because insurance would not pay for it.
,..

Good point - never thought of the insurance angle. If not covered, does that mean all subsequent events related to it are not covered e.g. if bleeding resulted and had to redo it or whatever - that could be an open ended cost issue?

I would hope that if the correct medical decision is to do a procedure - that the insurance would honor that - otherwise insurance companies and not medical professionals are making decisions about things outside their area of expertise.

Bob

 

[bvdr]

Bob, when I had my MVR my LAA was not removed but rather sewn down. This was at Duke. Several months later I was in another hospital after having had an intestional problem from ischemia caused by a presumed clot from my mitral valve. The doctors taking care of me there came in one day and suggested I have that procedure done. Of course I then told them it already had been. I just found it interesting that they were considering it important enough to justify doing it as an independent surgery. In their minds it not only reduces the problems of atrial fib but also eliminates an area known for clot formation.

I do want to wish you the very best this week and please know that you too will be in my prayers. I'm looking forward to hearing from you post-op.

 

[windsurfer]

LAA removal

LAA removal

bvdr, I leaning to have my LAA removed but most apparently don't unless they have AF. My cardiologist argues that if I get AF someday then the risks are lower. But I don't like changing what nature put there unless there is a problem. Now that my surgery has been postponed I have more time to research that choice.
Bob

 

[bvdr]

bvdr, I leaning to have my LAA removed but most apparently don't unless they have AF. My cardiologist argues that if I get AF someday then the risks are lower. But I don't like changing what nature put there unless there is a problem. Now that my surgery has been postponed I have more time to research that choice.
Bob

Bob, I was already having problems with atrial fib pre-op so maybe that was a factor in the equation as well. I'm glad you are educating yourselves pre-op. I also had time before surgery to get myself acquainted familiar enough with what was going on so that I was quite prepared going into surgery. Don't forget to get copies of all your test results and keep them in your personal file.