Posted by Steve Giddings on April 26, 2002 at 07:29:41:
In Reply to: Re: Maze Selection Criteria posted by Carl Plaskett on April 25, 2002 at 22:31:23:
I believe there are very good medical reasons for decreasing the risk for chronic a fib down the road, not to mention the economic benefit of doing a procedure that keeps a person in nsr.
Remember that a fib is the leading identifiable cause for stroke - 30%. For individuals in af, the risk is small and similar to the general population at age 50, 1-2% per year, but increases to 8-10% per year by age 75. That risk can be reduced by about 2/3 with coumadin but not to normal. Aspirin has some benefit but is less effective than coumadin. This risk of bleeding complications on therapeutc doses of coumadin is relatively small, but increased from the general population. You can deal with most except for hemorrhagic stroke. There is also an increased incidence of non-stroke dementia, congestive heart failure due to decreased pump efficiency.
I think the maze is a bargain for insurance companies. If you add up the cost of antiarrhythmic drugs (which are quite expensive) visits to the ER, doctors' offices, etc.,my guess is that cost totals out well over the $25,000 negotiated cost to my inurance company for my entire maze hospitalization 3 years ago. That included the cost of the pre-op cardiac cath and 12 days in the MICU post op sitting aroundf waiting do go back into NSR from a junctional bradycardia. I'm not even considering the catastrophic costs of complications from af. If I were an insurance bean counter, I'd have a list of preferred providers who would consider the referral for maze on my desk for cases like ours, lone af in otherwise healthy adults less than age 60-70.