Common left pulmonary vein

I just found out today after my pre-ablation CTA that I have a common left pulmonary vein trunk. I was surprised to read that a-fib more common in this scenario. In fact, it can be an isolated trigger. If that's the case, ablation is a cure! I'm keeping my fingers crossed. Anyone have any more stats on this?



Edited 1 time(s). Last edit at 11/17/2017 07:52PM by libby.

No stats but I also have a common pulmonary vein and I'm not the example you're looking for to confirm your conclusions. Don't let that dash your hopes, though. What really matters is the training and experience of the EP doing the ablation.

Care to share the data you found that says afib can be more common with common pulmonary veins and that it can be an isolated trigger?

Since none of my EPs ever said anything about this, I got curious and checked with Shannon, who checked with Dr. Natale. Dr. Natale's answer is it makes no difference. Common pulmonary veins don't predispose you to afib nor are they more likely to be triggers.

[www.ncbi.nlm.nih.gov]

Here is the article I was reading.
Was yours a common left or right?



Edited 1 time(s). Last edit at 11/19/2017 10:54AM by libby.

Only 14 patients in that study had a common pulmonary vein, which is a tiny sample. I don't think it's meaningful. There would be a lot more published on this if it were real, and a guy like Natale who's done thousands of ablations would be aware of it. I think you can safely disregard the issue. As I said, what makes an ablation a success is the person doing the ablation, not how many pulmonary veins you have.

Quote
libby
Was yours a common left or right?

Left.

Thanks Carey for replying to Libby’s question as well for me and via Dr Natale.

I certainly had never heard of such a connection in all my years of investigation, but did check with Dr Natale yesterday as well, and he readily confirmed there was no increased arrhythmogenic connection between a commonly shared ostium with a pair of more distally branching pulmonary veins ... such as the left superior (upper) PV and the left inferior (lower) PV both branching off of a relativeky short common trunk arising from a single commonly-shared PV ostium (mouth).

One thing you learn after diving in to published medical research on Pubmed for years is that there is a wide variability in quality of research published. There are some studies with a low number of subjects being studied that by the nature and structure of the study can still provide some useful insights into the subject matter being investigated. but far more often such very small studies are plaques by less repeatable and thus less reliable assumed findings. At the very best, such very small number of study participants ‘might’ warrant an ‘hypothesis generating’ suggestion to perform mutiple much larger multi-Center studies with preferably a randomized designed control group as well before anyone should even begin to entertain the notion that the initial data from the above mentioned study should change well established experiences and opinions in the EP world.

Keep in mind too Libby, that actual tissue that makes up the PV ostiums and entire PV antrum area as well as the roof of the LA and the full posterior wall of the LA are all morphologically, embryologically and histologically identical to one another! Thus the all share a common tendency toward arrhythmogenesis and all these common areas where much of AFIB ablations are performed are not directly involved in the contractile function of the left atrium as well!

I certainly would not waste a moment more of my time ... nor should anyone else .... if I also had a commonly shared single ostium serving two more distally branching pulmonary veins, worrying that this was going to significantly complicate my ability to achieve durable freedom from all Atrial arrhythmias. As Carey so rightly noted, your odds of achieving the holy grail of freedom from all AT/AF ... as I and so many others on this forum have been so fortune to now enjoy ... is best insured by not only dedicating oneself to reducing life style risk factors (LRFM or just ‘RFM’) and improving ‘self-health’ as may be appropriate in different ways for each individual afibber. But, most importantly in our long Forum experience, the key step for the majority of us now enjoying long term freedom from the Beast, was to not procrastinate too long after a solid 6 months to 1 year dedicated effort all of the above Self-Health protocols if at the end of these periods we had not successfully almost entirely put the lid on the kettle of our Atrial arrhythmia.

If after a major Effexor at electrolyte repletion and RFM you are still having even modest breakthroughs of AFIB,then ware no more time ONLY pursuing these Self- health steps alone.in stead while always continuing with the better life style efforts the smart afibber will add to the mix a truly expert ablation process guided by the MOST experienced and respected AFIB ablationist you can possibly arrange for yourself, preferably an EP who has many thousands of AFIB/AFlutter ablations under their belt and whose case load of patients includes a majority of persistent and long standing persistent AFIB (LSPAF) cases.

This two prong approach maximizing the best of functional/integrative medicine and RFM with the very best of Electoohysiology is, bar none, the most effective approach to reclaiming ones life and putting all this gedoe with AFIB and arrhythmia well into your rear view mirror!

Best wishes Libby,
Shannon

"all these common areas where much of AFIB ablations are performed are not directly involved in the contractile function of the left atrium as well!"

That's comforting!

"Lifestyle medicine, then ablation by an expert" - Thanks, Shannon!

How many ablations has Dr. Natale done?
How long is a typical fluoroscopy time for him?

Hi Libby,

Dr Natale has done over 10,000 AFIB/AFlutter ablations ... and counting at his highest volume ablation research center in the world spread between his home center at St Davids Medical Center in Austin and CMPC in San Francisco ... in his unprecedented career as the single most experienced AFIB ablationist on planet earth, bar none! No one else has even approached that many, though Professors Haissaguerre and Jais in Bordeaux France must both be close to roughly 7000 to 7,500 each by now as the next two on the total ablation experience totem pole.

Dr Natale also has done far more persistent and Long standing persistent (LSPAF) cases than anyone else in the world with over 75% of his case load representing these most challenging kind of cases. Dr Rodney Horton who is an outstanding EP and ablationist colleague of Dr Natale’s at St Davids Med acevter eaiky has 7,000 AFIB/AFlutter ablations under his belt as well and us almost surely the second most experienced Atrial ablation expert, under Dr Natale, in the US.

That is why Dr Natale is such an easy first choice for those who do not wish to compromises at all when it comes to your one hearts caress our Forum is such a long running anecdotal confirmation of!

Dr Natale minimizes Fluoroscopy as much as is wise to do, though his average Fluoroscopy stats will be somewhat higher than some other EPs who focus mostly on less challenging cases than Dr Natale’s tough case load which, by definition, will require somewhat longer Fluoroscopy times on average compared to an EP who mostly works in simple paroxysmal cases where he or she might be using very little Fluoroscopy comparative to longer more complex cases like persistent and LSPAF.

Thus it is a misleading apples and oranges comparison to just take a single average Fluoroscopy number from Natale and compare that to a typical PVI-only ablation EP who cherry picks only less challenging cases whenever they can, in part, to target a low Fluoroscopy stat. Shooting for zero Fluoroscopy should NOT be a prime metric for choosing an ablation EP! You want a doc who can use the minimal amount of Fluoroscopy but just the right amount too to get the job done right in the least total number of ablations with fewest reconnections and fewest repeat ablations.

Again, Natale has by far the lowest reconnection rate I have seen in comparing hundreds of ablations reports over the years ... that is the real measure of an elite level ablationist!

Hope that helps Libby.

Shannon

I too have a common pulmonary vein and had ablation that decreased AF episodes but did not stop them. EP scheduled me for repeat ablation. Last one was cryoablation. This time scheduled for RF.  CTA wasn't done prior to first ablation. I'm having one 2 day's prior to this next ablation. That's seems good that they know about the common vein before going in.