After seeing a cardiologist yesterday for the 3 month post Ablation check up....(just over a year after the procedure,) I'm told that during that procedure they found that I have a leak in one of the valves in my heart which has caused a slight murmer. Now, nobody told me any of this at the hospital last year.
Ok, so, yesterday the cardiologist went on to say that he will arrange for me to have yet another monitor and also a CT scan of my heart basically to confirm whether or not I still have AF and if not then I can stop 2 of the medications I take, one being Lixiana ( Edoxaban). The there he said to stop is Bisoprolol.
Now can anyone with a bit more knowledge than me tell me if this is the way to go? That medication is to help prevent a stroke and I'm just a bit confused as to why I'd be taken off it.
My understanding of MVR is that because the blood can flow backwards as opposed to forwards, this can then raise the risk of a blood clot forming and so the risk of a stroke is raised also. Do I have this all wrong?
I'd be grateful for some clarification on this as I'm honestly not one for panicking at all, but this situation that seems to have come out the blue (no pun intended because of my name), has made me feel just a little bit anxious.
Stay well everyone,
Blue x
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nikonBlue
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In 2021, NICE concluded that further studies were required before recommending that anticoagulants can be stopped after ablation in certain situations.
I can understand you being a bit anxious over this.
Edoxaban
My understanding is that the need for anticoagulation is associated with your individual risk factors which are scored using the CHADS2 method. It's easy to google this and to understand what your score is likely to be given your underlying health conditions (if you have any). For example, my score is 1 due to hypertension, so I have remained on anticoagulation medication despite having 2 ablations.
I don't know if MVR elevates the CHADS2 score, but your cardiologist will know.
Bisoprolol
I would assume that you are on beta blockers for heart rate control given your AF diagnosis. If that is the case, and you BPM is within 60-100, then I can understand why your cardiologist is suggesting coming off this (although it has to be tapered off properly).
I am sure your cardiologist has a good plan for you moving forward, but it is good to have a little knowledge about the meds when you discuss the plan with him/her.
Thanks for your advice and reassurance! I wasn't aware that this was a common situation in AFers and non Afers so that's reassured me. I'll see what cardiologist says after the ct scan and monitor again and take things from there.
Mitral valve regurgitation is a very common finding in people with AF and those without AF, and becomes more common with age. Everyone over the age of 40 will have some degree of regurgitation, even if only very minor. It only becomes a problem when regurgitation becomes severe, and in many people it never reaches that stage. The heart remodels in response and in the case of MVR the left atrium becomes enlarged to accommodate the backflow. It’s not necessarily serious, it all depends on how severe the regurgitation is.
These changes can predispose people to develop AF, hence why it’s a common finding. Unfortunately many cardiologists will tell someone that their echocardiogram is “fine” so many people have the idea that they have no changes or abnormalities at all, but from a cardiologist’s viewpoint there’s nothing there that needs treatment, hence everything is “fine”. When we find out that we have these findings it’s usually very unsettling until we learn it’s actually quite common. The important thing is that we need to be monitored for changes and have repeat scans every 1-2 years, or possibly every 5 years, depending on how mild or severe the regurgitation is. AF can make these problems worse, and mitral valve regurgitation and left atrium changes can cause AF, so it’s a bit of a negative feedback situation
Sometimes after the AF is treated the MVR improves and the left atrium shrinks, and for people who need valve surgery, they find their AF improves afterwards But valve surgery is a major operation compared with ablation.
I don’t know about stroke risk, you’ll need to ask your cardiologist. I’m not aware of valve regurgitation being a risk in itself. I think AF is a greater risk but you need to ask someone who knows what they’re talking about.
Don’t stress too much about the regurgitation. The important thing is that you have your scan and they can assess its severity. If it’s mild or moderate it will be a case of keeping an eye on it in case it progresses, but it may not. Your ablation may have helped things too. I can’t say anything about your anticoagulants as the decision to prescribe depends on your individual risk factors and different consultants can have quite differing views.
Thanks for the info, I feel a wee bit reassured now that I realise it's actually a common thing. I'll get these other tests done and see what's what with it all and take things from there.
I was told by 2 different specialists and also a tech who read my ecg and other scans that I have a "minor mitral valve leak" but that it's nothing to worry about. (F age 75) When I asked if there is a connection between the leak and my PVCs the cardiologist who was doing my angiogram said there could be. There are different triggers for different people.
Yes, mitral valve problems can predispose people to PVCs and PACs. I suspect my long history of ectopics and eventually AF were due to these changes too, although viral illness seemed to kick it all off.
As there is one point for being female and one for being 65+ you must have a comorbidity to have a score of 3. In which case it seems very odd that your cardiologist thinks you can come off the Edoxaban. I would query this.
My thoughts exactly. My meds check this morning at my go's I did ask about this and the nurse suggested that in actual fact I'd most likely be on meds for the foreseeable. Thanks for the info.
Other suggestion I can give you, make sure you get the info from a specialised doctor. I lost count of the nurses, pharmacists and doctors not specialised in AF that told me I was going to be on anticoagulant for life (while it's very well known in the field that healthy young people shouldn't be on anticoagulants). They don't understand the stress their chit chat causes. Lost count of people telling me a lot of irrelevant information, like the dietary ones, because I'm so different from their expected case. You'd be surprised but what I learned is that there is very little known about this so called "common" condition. It has been overlooked for decades because it was considered the disease of the elderly patients and therefore not worth treating. Luckily for us in the last 20 years the medical field started to take AF seriously.
I was told I had MR from Echo’s done over the years. I catastrophised and anticipated a valve replacement etc etc. When I had my ablation 2 weeks ago the TOE showed “trivial” MR. That made my day.
I have not read all the replies so don't know if this has been addressed:
My understanding of MVR is that because the blood can flow backwards as opposed to forwards, this can then raise the risk of a blood clot forming and so the risk of a stroke is raised also. Do I have this all wrong?
The risk of blood clots arise from blood pooling. So I think the risk is that the valve does not push all the blood through and some seeps back and that creates the risk of pooling ... which in turn creates a stroke risk. (I think).
hi, exactly my own understanding of MVR which is why I felt a bit confused at why he's suggest I come of the very meds that are (hopefully) helping to prevent a stroke. As I said I'm not a particularly panicky person but this was worrying me. I shall see what is said re the CT scan and the monitor, though why he wants the monitor again I'm not sure. Over the years I've had so many monitors.......I feel like the bionic woman!!
I had the same news. As an ex marathon and long distance cyclist the news came as a shock. As has been stated in other wise replies. Most people as they grow older have some flutter. Being monitored going forward is important. I still cycle, walk, climb hills as before. So wouldn't worry about it. Best wishes.
Hi, I'd have thought you'd need to stay on blood thinners, my experience, but biso more flexible. I found after ablation or cardioversion it dropped my heart rate too low @ 45 and I would feel rubbish so docs allow me to stop it after a procedure and only start it again when I go back into AF. I'd had 3 cardios and 3 ablations, same after each one.
Re mitral valve leak I had one that got worse as I got older and had to be repaired. However, because of my heart position the scans weren't effective at showing how bad it was and I had to have a TOE, camera down the throat to really see it.
I was told the same when first put on anticoagulant, so felt very confused when the doc at the hospital was saying that I could stop. I'll be staying on them.
Find out what they think the beta blocker is for. If he thinks it's pushing heart rate too low consider peridropil which has worked wonders for my endurance as I really do need the valve replaced but it would involve opening me up for a second time. Consultant doesn't really understand why it helps, but it's definitely been a game changer for me.
I guess I'll need to wait and see if there's any clearer info to this once they do the CT Scan. I'll remember this though and note the name of the peridropil.
I just skimmed a 2019 research paper on your question. There was some thought at the time that mitral regurgitation (MR) might even have some protective effect against ischemic stroke in individuals with AF, I suppose somehow related to increased fluid dynamics in the heart. The one 2019 research paper I looked at found neither a protective effect against, nor a greater risk for ischemic stroke for either mild or severe MR in individuals with AF.
I have moderate Tricuspid regurgitation as well as persistent AF. I am not currently on anticoagulants due to my age (58) and no comorbidities. I was concerned that the leaking valve and the back flow it caused might contribute to stroke risk but I have seen an EP privately, as well as one on the NHS and both advised that it doesn’t.
The private EP explained that a degree of back flow occurs into the main veins bringing blood back to the heart every time the heart contracts, as there are no valves between the veins and the atria to prevent it, so blood flowing “ the wrong way” doesn’t cause clots to form in itself. The problem with leaky valves is that they can cause the heart to become more inefficient if they progress, as you know. I’m currently down to have an echocardiogram every three years to monitor mine. Having said all that, given that you say your ChadsVasc score is 3, I would have thought staying on ACs would be the best course in the circumstances.
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