New research

I found this article in my search about AF.

One million Brits suffer from AF. Apparently, scientists have invented a non-invasive method to pinpoint the electrical "storm waves" which trigger AFib. Surgeons currently have to insert a catheter to try to find them and the method is not effective. The information is key to diagnosing and treating AFib which can cause heart failure and strokes. Experts have developed a method to pinpoint it in 93 per cent of cases. They used a computer model with a virtual human heart-torso linked to an electrocardiogram. Professor Henggui Zhang of the University of Manchester in the UK said, "This is very exciting research. It could lead to new developments to tackle heart problems more effectively and simply." AF is usually treated with drugs or a pacemaker.

I wonder if Shannon has heard anything about this

Liz

Yes Liz,

It's another derivation of non-invasive phase mapping vest using a similar approach to the Cardio-insight vest but with differences too in the algorithms applied.
It's all theoretical and with the decidedly mixed results so far with FIRM and as yet no randomized controlled trial data with the Cardioinsight vest to give us any solid indication that this computational analogies of how arrthymogenesis 'might' get started, let's see some real proof in the pudding first before anyone gets excited in even a little bit over a report like this.

If something of value is really there, it will prove itself so in due time. I've learned with all these algorithmic 'models' of arrhythmia, to adopt a cautious blend of an open mind with a healthy dose of 'show me' skepticism. The FIRM disappointment is a case in point, where the hype behind an initially promising sounding computational model of how AFIB might work, has far exceeded anything that a growing list of truly independent studies have been able to confirm as real world replicable positive results so far. Certainly nothing at all beyond what is acheived by a well-executed PVI ablation-alone ... along with some creative verbal convolution when it came to the all too 'flexible' reporting of endpoints and outcome language used in many of the 'so-called' FIRM-positive studies done almost invariably by developing company principals, or in conjunction with paid advisors/in investors in the system.

Most EPs I know are know adopting a similar healthy skepticism until one or more truly independent and randomized studies further validate that FIRM technology actually offers anything at all, beyond the accompanying PVI added to every FIRM and every Cardioinsight procedure. Maybe Cardioinsight, or this latest British angle on this kind of algorithmic models may yet bare better results by objectively and repeatedly confirming that adding these approaches to a PVI truly buys us anything beyond a good PVI.

But for the time being, i strongly advise just take a wait and see attitude to these kinds of reports and not let the cart get too far in front of the horse due to some drumbeat about the 'latest breakthrough' that is suddenly going to make AFIB ablation easy for everyone to perform and get near perfect results. It all sounds great just like the FIRM hype did at first before reality set in.

The last 4 truly independent FIRM-related studies that have come out after the OASIS study last May have all only underscored the dismal findings of OASIS about adding FIRM, and 4 earlier independent studies prior to OASIS starting from early 2015 up to last May also threw a bunch of cold water on the concept. It's a real shame and is disappointing to see how the FIRM story has played out in the last year. Buyer beware is the motto arising from that experience, and once we get this final third phase of the website revamp finished in the coming couple of months, I'll likely write a third installment to my so far published two-part 'State of FIRM' investigation in issues 140 and 141 of The AFIB Report to share what I've found to be a disappointing story overall.

Nevertheless, it's always important to keep an open mind too for new approaches in the event a new angle has more merit, just be careful about annointing any new approach promising an easy fix that will turn any EP into a maestro ablationist in short order.

I'm flying back home first thing tomorrow morning (Tuesday) from Austin and the excellent ISLAA conference last weekend help here this year (next year ISLAA will be held in LA) and more on all that in the weeks ahead.!

Shannon



Edited 1 time(s). Last edit at 03/08/2017 06:00AM by Shannon.

I was at my heart doctor a few days ago for my bi-yearly checkup, I had mentioned that a lady my daughter knows has had 4 ablations (the 4th being about a month ago. My doctor did a drawing showing that there are 4 veins or arteries (I am not sure which he said) that enters the heart which the doctors then do the burn all around the openings. He said that sometimes they don't get all of the area burned so that is why AF can again occur and they have to go in again. Sounds simple but it is the heart after all.

Liz

That's a real simplified summary. Those are the 4 Pulmonary Veins. The most basic type of Ablation is to Electrically Isolate (burn) these Veins from the rest of the Heart. This is called a PVI Ablation.

Some of us mutants have 5 pulmonary veins!

4 is the most common, but it can be 3, 4, or 5, depending on how things went in Mommy's tummy oh so many years ago! That is why the MRI mapping prior to an ablation is important. Establish the exact anatomy before sticking the catheters in.

Wolfpack,

Yes indeed, people's hearts come in all sizes and shapesand various anatomical variations including the normal 4 PVs and not too infrequent 3 PV ostiums will
grow where the third one is typically larger at the ostium than the other two normal PVs and the third one usually braches off guickly pastvthe inner part of the ostium. I have not seen 5 yet on the various ablations I've witnessed, but just on Monday when at St Davids after The ISLAA conference held in Austin this year, and when dressing in the smock outfit with lead apron so I could stay in the EP Lab watching Dr Natale do his handiwork, I noticed three PVs in an LA on the Carto EAM image in one of the cases that day :-). That is fairly common. But 5 distinct PVs is a new one to me.

Also, you do not require a pre ablation MRI or CT to count the number of PVs as that can be detected with ICE, EAM or fluoroscopy too, though using a CT typically or MRI up front does give a high rez image of the Left and right atria.

Dr Natale typically only orders a preablstion CT for those coming to him for the first time who have had a prior ablation elsewhere by a different EP to confirm the patient has zero pulmonary vein stenosis from the prior ablation(s).

Shannon

Well, now you know one! Here's from my MRI report:

Thoracic MRA:

1. There are five pulmonary veins entering the left atrium (three on the right and two on the left). The
right middle pulmonary vein is small. The right lower pulmonary vein consists of three veins that join
prior to entering the left atrium. All veins are patent without significant stenosis proximally. The
bi-orthogonal Iuminal dimensions are listed below:

RUPV: 1.6 x 1.0 cm; 73 cm/sec

RMPV: 0.7 x 0.6 cm; 71 cm/sec

RLPV: 1.9 x 1.6 cm; 45 cm/sec

LUPV: 1.8 x 0.8 cm; 71 cm/sec

LLPV: 2.1 x 0.8 cm; 80 cm/sec

-----

If I recall correctly, Duke uses it as part of the 3D anatomical mapping system. I even got a printed picture showing the lesion set superimposed on the MRI image. The left side is circled with a carinal line. The right side is circled without a carinal line, obviously, as that would've "welded" my middle vein shut!



Edited 1 time(s). Last edit at 03/08/2017 10:13AM by wolfpack.

Elizabeth

Was this from a newspaper report? The Daily Mail perhaps?

The last bit, which said "AF is usually treated with drugs or a pacemaker." is so inaccurate that I would be suspicious of the whole piece.

Gill

Gil:

It was in "The Tribune"

New method may improve treatment for irregular heart rate
London

Researchers have developed a new algorithm to identify the origin of irregular electrical 'storm waves' in the heart, a finding with major implications for the future treatment of a killer cardiac disease.

(Follow The Tribune on Facebook; and Twitter @thetribunechd)

Atrial Fibrillation -- one of the most common forms of abnormal heart rhythm -- is caused by these waves and is a major cause of stroke as it increases the risk of blood clots forming inside the heart.

Current methods involve the use of a catheter to isolate the storm waves. However, this is very invasive surgery and it is extremely difficult to identify the origin of the waves in order to treat the condition, said researchers from UK's University of Manchester.

In the study, published in ther journal PLOS Computational Biology, researchers used a virtual human heart-torso and a 64-lead electrocardiogram (ECG) vest to study the correlation between the origin of the storm waves and the features of the ECG signals.

Using the properties of the atrial activation and the signals, they were able to develop a novel algorithm which could pin down the location of Atrial Fibrillation non-invasively, as well identifying different types of the condition.

"This technique can identify the origin of Atrial Fibrillation extremely effectively, which may provide a powerful tool for treatment in the future," said lead author Henggui Zhang, Professor at University of Manchester.

"The research, could lead to new developments to tackle heart problems more effectively and simply," Zhang added.

Atrial tachy-arrhythmias, including atrial fibrillation (AF), atrial tachycardia (AT) and flutter (AFL), are the most common cardiac arrhythmias, predisposing to heart attack, stroke and even possible cardiac death.

Atrial fibrillation presents the greatest complexity and occurs in about 1-2 per cent of people and studies have shown that it is on the rise in the developed world due to the ageing population.


Liz

Walking in off the street and reading Shannon's explanation and the Tribune article, I'd consign the latter to the dust bin. If an ablation is very invasive surgery (no, it's not), good Lord, I'd hate to see what the Trib's author thinks of a hip replacement.

Of course an ablation is an invasive surgery, they have to thread a catheter through a vein into the heart. A lot of people have had an ablation and are fine, but anytime there is surgery, especially on the heart there can be problems. I live in Michigan and about 4 years ago a man (he was a doctor) died because of an ablation at U. of Michigan University hospital in Ann Arbor, Michigan.

Liz



Edited 1 time(s). Last edit at 03/08/2017 09:58PM by Elizabeth.

Yes, an ablation is invasive; any puncture of the body is invasive. That's where the skill and number of procedures performed by the doctor at the business end of the instrument(s) is so critical. I just believe that the author of the article was overwhelmed by the hype.

Thanks for the emphasis, Liz. Ablations are most definitely invasive procedures.

I'm sure you recall the calamity that befell Pam Walters during her ablation at Johns Hopkins which eventually resulted in her husband writing a book on the tragic event.... and then our forum member from California who had tamponade during the ablation procedure and eventually needed cardiac surgery to remove the pericardial sac. He suffered immeasurably from both significant emotional and physical pain. Fortunately, he recovered with time and is enjoying life.

That's why we continue to emphasize the importance of seeking out a top tier or 'elite' EP who has vast experience and exquisite skill so the outcome is both safe and effective.

As you said.... it is your heart, after all. We should never become complacent in thinking that just anyone can do an ablation and that it's not an invasive procedure.

Jackie

Collateral Damage
by Dan Walter
[collateral-damage.net]