Seeking advise about an implantable loop recorder.

[kurtgv]

I am a 72 year old male in good health. I had persistent AFIB for many years – probably caused by 40 years of alcoholism. Four years ago, I quit drinking after a mild stroke and began exercising religiously and adhering to a healthy diet. A little over a year ago I had an ablation done, and now I take 100 mg of Flecainide per day. I monitor my sinus rhythm daily using a Kardia Mobile device and I have had NSR for over a year.

I complained to my cardiologist about how expensive my Eliquis prescription is. I also told him that I worry about bleeding from an injury because I am prone to falls due to a balance problem.

He suggested an implantable loop recorder in lieu of an anti-coagulant. It will be covered by my insurance.

Any thoughts or advise about this?

Thank you very much!

[mjames1]

I'm going to guess your cardiologist wants to put you on a PIP (as needed) anti coagulation/thinner strategy and is using the loop recorder either as a primary afib detection device, or as a back up to your Apple Watch's afib detection function.

This may be similar to the REACT-AF trial protocol which is now enrolling in the US, where the PIP group will only take thinners if an afib episode lasts longer than 60 minutes and then only take the thinner for 30 days. The underlying concept is that less thinner exposure means less bleed risk, as long as the stroke risk remains the same. In REACT-AF, a specially programmed Apple Watch will be the only measuring device.

While the trial is just starting, many US ep's, including mine, are already letting some of their patients use that or a similar PIP thinner strategy, based on previous pilot studies. But it should be noted that the trial itself has just started and most ep's are waiting for results before implementing this strategy.

Like I said up front, I'm just guessing that is what is going on, but you really have to ask your cardilogist and please let us know when you find out. BTW what country are you being treated in?

Jim

[kurtgv in reply to mjames1]

Jim,

I am in the U.S.

Eliquis here comes with a $500 copay for a 90 day supply. That is the co-pay even if you have health care insurance,

My cardiologist did not mention a PIP. The ILR would serve as a safety net that picks up any abnormal heart activity and if it looks like my AFIB is back I will resume taking Eliquis.

[mjames1 in reply to kurtgv]

That makes sense. Based on current knowledge, some ep's believe a successful ablation removes stroke risk, and some ep's do not. It seems like both of our ep's think it does. The trial I mentioned earlier will give us further information on that question among others. Let's hope your loop recorder remains quiet

Jim

[kurtgv in reply to mjames1]

Thank you Sir

[petmice in reply to kurtgv]

Has Eliquis jumped in price? I hit my deductible last year (courtesy of an ablation in February) and haven't paid attention to numbers for a long time - I am now a little nervous to see how much I'll have to pay when I pick up my first Eliquis of 2024. Early last year my Eliquis co-pay card got it for $10 a month - I'm hoping that card still works this year.

[kurtgv in reply to petmice]

I jumped thru all the hoops to see if I was eligible for an Eliquis card. I was really excited; a $10 copay instead of $500! But, alas, I am not eligible because of the Medicare coverage that I have. If you have that card consider yourself very fortunate since there is no generic on the horizon.

[petmice in reply to kurtgv]

Now I'm getting nervous - I sign up for Medicare this year...

[BobD Volunteer]

Not sure how or why a loop recorder could replace anticoagulation. There is no evidence to show that even successful ablation removes stroke risk. I do know that in America they are experimenting with pill in pocket anticoagulation ( you only take it if you have any AF) but not something I would like.

[kurtgv in reply to BobD]

BobD,

The idea is that my doctor would be alerted from the data sent by the ILR that I have had an AFIB episode. Maybe while I was sleeping and unaware of it. If that happens then I go right back on the Eliquis.

[MWIC in reply to kurtgv]

That makes sense to me - so they want to see if it is viable to take you off Apixaban by determining if you are still having any episodes you may not be aware of - this suggests that if no episodes recorded that the anti-coagulation may not be necessary - guess the risk would be if you come off and the monitor is removed, if it comes back at any point you may not be aware

[Jonathan_C]

I have a loop recorder and will comment on the experience of that alone - the procedure to implant the recorder was fairly minor (no more traumatic than having a mole cut out of you), but this was followed by discomfort in the area it was implanted for longer than I expected (that may have to do with the kind of resistance exercises I do), but I guess from about 2 months after the implant was inserted I haven't noticed it. I can see it in the mirror if i look closely, but its not noticeable to other people.

I have a small receiver next to my bed that collects and sends my daily data around 2 am.

I am in persistent afib and on an anti-coagulant. So the purpose of mine is different to yours. To date, it has picked up one pausing of my heart, which happened when i was asleep and my EP wasn't alarmed about it.

[petmice in reply to Jonathan_C]

My loop recorder was implanted to track my atrial flutter. After an ablation for the flutter, it picked up my afib. It left enough of an afib record to warrant an ablation for that. Now it should be picking up whatever it is my heart is doing (cartwheels? I see my EP soon).

All along I have been on Eliquis. I like the security of having the recorder monitoring my heart and the blood thinner keeping any heart shenanigans from causing a stroke (my sister-in-law died of a stroke, so I take that very seriously).

[Poochmom]

I agree with Bob. An implanted loop recorder will Not do anything for stroke risk. It’s not like the doctor is going to deal with it in real time especially at night.

If you want to discontinue Eliquis the only way I see it without taking aspirin ( ie watchman) is to clip or remove your LAA. It is done as part of a mini maze but possibly it could be done as a stand alone. It is a surgery though so. Don’t know if any surgeon would do it. Worth a try though if that is your goal. That would eliminate your stroke risk by 97% even if you go back into AFib you wouldn’t need an anti coagulant.

[Cookie24 in reply to Poochmom]

What is the difference between "Clip or remove LAA"? If the Watchman is placed us aspirin required forever?

[Poochmom in reply to Cookie24]

The two doctors I know of that do this, the one in the US clips it with an atriclip. The one In Japan removes it because of cost effectiveness for them. There is no difference in quality it is a matter of doctor preference. There are other doctors in the US that also clip it but usually during a MiniMaze. It would be worth asking about just the LAA part though. Some may do just that.

Yes when you have a watchman placed you have to take aspirin for life. My understanding is that aspirin becomes dangerous the older we get. With the LAA clipped you take nothing.

[TracyAdmin Partner]

Hello, thank you for sharing your medical history with us. You may wish to download the resource 'Insertable Cardiac Monitor' booklet from the AF Association webpage: api.heartrhythmalliance.org...

With regards to insurance cover, you will need to discuss this with your medical insurance provider.

[Thomas45]

Why not use Warfarin as an anticoagulant. It's much cheaper than the DOACs like Eliquis. PIP coagulation sounds like Russian roulette to me.

[kurtgv in reply to Thomas45]

Because I understand that you have to be tested every month. Sounds like a hassle.

[Thomas45 in reply to kurtgv]

You don't have ri be tested every month. I have my own test meter. I get an email from the arrhythmia nurse every two months, test myself and send result back. No hassle at all.

[kurtgv in reply to Thomas45]

I did not know that. Any side effects from warfarin?

[Thomas45]

Finger nails can become brittle, mainly thumbs in my case.

[kurtgv in reply to Thomas45]

OK, thanks!