Coumadin & defibrillator implant procedure

[Marge]

I may be undergoing a procedure to implant a defibrillator (ICD) sometime in the near future. It has been recommended by my cardio, still have to talk to the electrophysiologist about it.
I'm currently on coumadin for atrial flutter. Does anybody know what the usual procedure is re: coumadin for the implantation procedure? (I want to be prepared if/when the issue comes up with the EP).

 

[Kathleen]

Hi Marge
I had both a pacemaker implant and an ICD implanted while on coumadin. I have taken the coumadin for 21 years so bridging was nothing new to me. I will be interested to see if the EP suggests and ICD since you have only had one medication for the afib. I can see them calling for a holter or an event recorder to see if it is vtach or vfib. I did the going off coumadin and having an INR to make sure the numbers were where they needed to be and then going in for the implant then the heparin then starting the coumadin and staying until it reached a theraputic number. I did develop a hematoma at the implant site the first time and a large one the second time. Good luck with your appointment and let me know if you need more information
Kathleen

 

[Marge]

I did do a holter -- in summer of last year. My primary had ordered an EKG and when it came back, he said he thought I might be in atrial fibrillation. So I went back to my cardio. He ordered a holter -- which he said indicated I was in atrial flutter not fibrillation.
That's when he put me on coumadin. I remember him saying that when he was in med school flutter was treated differently from fibrillation, because the stroke risk was supposed to be less, but now they are basically treated the same -- i.e. coumadin.

 

[Kathleen]

Marge
I did forget to mention that my EF was also 35 but that was not the reason for the pacer implant. I did have to have ablations of both nodes so the pacer was needed. I had been in afib for years 24/7. When I had the vtach the ICD was needed. Do some research on the need for an ICD and for the pacemakers after your appointment. I do have congestive heart failure and cardiomyopathy. Is your new med still keeping your high heart rate at bay.
Kathleen

 

[Marge]

Hi again, Kathleen!
I'm doing the research NOW -- not waiting until after the appointment! It's my Labor Day assignment, LOL.
I have found out that putting ICDs in people with 30-35 EF because of the EF is relatively new -- but is based on what look like some pretty solid studies that people in this EF range have much better survival rates with them.
I'm just hoping that the studies aren't funded by the ICD manufacturers; or, if they are, that their results aren't skewed!
ICDs are pretty expensive, and the mfrs. would certainly benefit from extending the field of potential recipients to those with a low EF regardless of whether they have arrhythmias and/or ischemic cardiomyopathy.

 

[RonP]

Coumadin & ICD

Coumadin & ICD

I've got a mechanical valve and take Coumadin for that. When I had my pacemaker/defibrillators implanted, they had me check into the hospital one week prior to surgery, weaned me off the coumadin with, I believe, heparin, to thicken my blood, did the surgery to implant the ICD, and then put me back on coumadin and made me stay another week while the blood again thinned. Then they let me go home. They do all of this in the hospital so that if you have a stroke or any other complications, you're right there so they can take care of you.

 

[Guest]

Wow, Ron must have a fantastic insurance plan!! Mostly what I see is people weaned off warfarin at home with Lovenox, admitted the morning of the defibrillator implant, restarted of warfarin (ots of times they don't use Lovenox after the procedure because the is a pretty high risk of hematoma) and home the next day or the day after. That seems to be what most insurance plans will pay for.

 

[RonP]

Al

Al

With seven sudden cardiac arrests/deaths already, three strokes, and seizures, they don't like to mess around with me. I also have the federal government Blue Cross & Blue Shield and also had the GEHA part of the time so they both paid good. I've spent thirty years with the government so they owe me something for me years.

 

[Guest]

My Mom has Federal BC-BS. I tell everyone to never drop that policy. I knew when you wrote about the 2 weeks in the hospital that must have been your insurance.

The only person that I ever heard of who had a better deal was an aunt of mine whose husband was killed in WWII. She never remarried. She was on Medicare almost since the day it started (she never had to pay premuims up front because she retired as soon as it started) , had the Fed BC-BS as a backup and if they did not cover it, she was entitled to Military/VA benefits. Her son told me that she never paid anything but her premiums in the almost 40 years that she was retired.

 

[RonP]

Blue Cross & Blue Shield

Blue Cross & Blue Shield

Al:

With the heart problems, rhythm problems, mechanical valve, ICD, seizures, and diabetes, Blue Cross seems my best choice with the Federal Government. Even though I'm retired, I still have to pay $293.78 each month out of my retirement, but I have to have insurance so what do you do? Most of the other available plans are even higher than this.

Ron

 

[Mary]

Hi again, Kathleen!
I'm doing the research NOW -- not waiting until after the appointment! It's my Labor Day assignment, LOL.
I have found out that putting ICDs in people with 30-35 EF because of the EF is relatively new -- but is based on what look like some pretty solid studies that people in this EF range have much better survival rates with them.
I'm just hoping that the studies aren't funded by the ICD manufacturers; or, if they are, that their results aren't skewed!
ICDs are pretty expensive, and the mfrs. would certainly benefit from extending the field of potential recipients to those with a low EF regardless of whether they have arrhythmias and/or ischemic cardiomyopathy.

Marge,
My husband is currently involved with a study funded by Guidiant to determine if a patient's VO2 max significantly increases after implantation of the ICD. He's in the respiratory therapy field and the hospital he works for is one of 10 in the country that are involved with the study. They administer a cardiopulmonary stress test 30 days after implantation (with the ICD turned off) and then again at six months with the ICD turned on. They want to determine the amount of VO2 increase, if any, the ICD/pacemaker provides.
The study is ongoing and won't be completed until each hospital site has tested 100 individuals and then they will have to review their statistical data.
So yes, the companies are funding the tests, but from our vantage point, the studies are being performed at hospitals by health professionals who have no bias.

 

[Kathleen]

Ron
My husband is and active Federal Employee and the amount you stated for coverage is the amount he has taken out of his check for family coverage. I have multiple health issues and we are thankful for this plan. When I am admitted to the hospital the admitting person will usually say that is an excellent insurance plan.
Kathleen

Al:


With the heart problems, rhythm problems, mechanical valve, ICD, seizures, and diabetes, Blue Cross seems my best choice with the Federal Government. Even though I'm retired, I still have to pay $293.78 each month out of my retirement, but I have to have insurance so what do you do? Most of the other available plans are even higher than this.

Ron