Could radiation ablation become mainstream treatment soon?

Per my own understanding, the current minimal invasive ablation carries some risk as it has to punch through the atrium wall to get to the left side. Could the non-invasive radiation ablation become mainstream someday in the near future? As it's non-invasive, I guess it would be faster and safer.

[www.sciencedaily.com]

I don't see that happening. Radiation might be non-invasive, but it's hardly without consequences. I doubt it would ever be used for non-life threatening arrhythmias.

Exactly right Carey, at this point the still highly experimental non-invasive radiation ablation is strictly being look at to ablate scar-related VT. Plus, Kong the notion that transeptal puncture is something that is highly risky is not the case any longer, especially when done by highly-experienced ablationists, which I trust all of our readers are, by now, fully convinced is the number one priority in selecting an EP to conduct your own ‘expert ablation process’.

Forget focusing on any particular high-faluting technology or new whiz-bang sounding system to save the day! Your single most important choice in this entire AFIB business in terms of reliably restoring durable true freedom from all atrial arrhythmia, is by staying steadfast and highly discriminating in that choice of who to partner to care for your heart via ablation, that has an unassailable track record of consistent success with ALL forms of atrial arrhythmia including persistent and long standing persistent cases, even if your form of arrhythmia is still mostly moderately advanced to advanced paroxysmal AFIB.

These highly-experienced full-spectrum ablationist are the ones most apt to be highly skilled at consistently chasing down and eliminating any Atypical flutters or ATachycardias that might spring up during, or after an Index ABL ... and are the more rare ablationists than the average PVI-alone anatomical-only EPs who may offer such limited AFIB ablations as just one of many various EP procedures they typically perform in a given week or month.

First make the right choice up front even if you must travel for 5 to 6 days to put your hearts care in the hands of a true expert who mostly does only AFIB ablations in their daily practice and whose talent and consistent results are such that they annually can easily recruit several hundred Afibbers to entrust their own hearts care to their hands.

There are certain exceptions in which lower volume ablation operators are still very skilled and may be worth a roll of the dice, but the point is the further you compromise down the consistent experience level, generally the bigger the roll of the dice that choice might be. Actually, in the majority of US cases we get on this forum, the best choice is the easiest to call up front, as is obvious from the long track record of excellence of a particular true maestro level EP so often documented here.

There are other excellent ablationists of course that I also strongly recommend for the right scenario and usually when ‘plan A’ cannot workout for the patient due to travel restraints or rare insurance issues.

But the main point is, don’t get swayed and over enamored by still yet unproven technology, no matter how promising it may appear from the initial hype. The basements of many large medical centers are littered with dusty old equipment that was once touted as the next great thing since slice bread from a marketing hype machine that gets far ahead of any documented and truly confirmed efficacy and/or safety ... the FIRM swan song being a relatively recent example of run away hype far exceeding reality of results yet delivered, even well over 5 yrs after it’s initial breathless promise at 2012 AF Symposium in Boston that FIRM tech would usher in a new paradigm in ablation technology far in advance of any real evidence for such a bold claim.

Just this week the most powerful evidence yet via a superbly crafted meta-analysis we will post more on in the coming week here, has pretty much put that nail in the FIRM coffin for at least the current expression of this technology.

A key point to reminder is first watch the true high volume centers and highest volume operators who are doing almost nothing but Ablation related procedures every single day and make careful note of what tech and what systems they have truly adopted in their everyday front line ablation work. That will give you the best clue as to what is well vetted technology and what may still be just a temporary experiment or exploration in that EP Lab.

And by picking well the most experienced and consistently successful Ablation EP you can arrange for yourself, you don’t even have to bother with what tech they should use in your case. Making the right choice upfront also should include your peace of mind that your EP will make the very best choices in gear and methodology they are using to achieve their enviable track record to begin with.

What is really ludicrous is when we laymen and women start dictating to our EP what gear you demand they use in your case, often based on some overly-hyped reports we may have read and even though the patient is anything but an expert in the field! A lot of folks on other forums I’ve seen even chose the EP first and foremost by what tech the doctor may promote on their website.

Now that is truly putting the cart before the horse!

Choose the best possible ablationist for your circumstances first, and let them freely decide what gear, system or tech to use in your case.

Shannon



Edited 1 time(s). Last edit at 03/18/2018 09:40AM by Shannon.

Thanks Carey and Shannon for the insights. Though I had only 5 episodes so far, I’m thinking about getting an ablation with Dr Natale. As I can’t handle the fear of always anticipating the next episode.

I live in California. Does it make any difference if I see Dr Natale here or should I better go to Austin? Thanks!

One more question. How does Dr Natale trigger afib in the lab? What if he can’t trigger afib? Wold he still do the ablation?

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kong2018
One more question. How does Dr Natale trigger afib in the lab? What if he can’t trigger afib? Wold he still do the ablation?

With burst pacing and drugs. They give you isoproterenol, which makes your heart hyper-excitable, and then stimulate it with rapid frequency electrical impulses. That combination will provoke most arrhythmias if they're there.

Yes, he will still do the ablation even if he can't provoke it. Actually, that's usually the last step of the procedure. He already knows you have afib or he wouldn't be doing the procedure in the first place, so this step is reserved to the end to find out if he's successfully ablated all that needs ablating.

Thanks Carey. Would ablation stop the afib progression?

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kong2018
Thanks Carey. Would ablation stop the afib progression?

No, ablation can't stop the progression of the disease, which is how it's increasingly being viewed -- as a disease. The term "atrial myopathy" is being used and the whole notion of "lone afib" is being discarded.

That said, a successful ablation will stop afib from happening because it creates electrical barriers around the sources of the afib. It doesn't make those sources quit firing so they can't call it a cure; it just isolates them and renders them harmless. Assuming your ablation is done by a highly experienced EP, those barriers will be durable and last for life. But it's always possible that years down the road you might develop new sources of afib outside the isolated areas. If that happens, you would need a touch up procedure. That's progression of the disease and all we can do is file it under Getting Old Sucks.

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kong2018
I live in California. Does it make any difference if I see Dr Natale here or should I better go to Austin? Thanks!

I don't know how far you'd have to travel, but I'm in California, too, and I would not hesitate to go to Dr. Natale at Scripps in La Jolla.

Perhaps others will ring in here with more specifics about which place would be best and why.

I doubt it makes a bit of difference whether you see Natale in one place vs. another.

For me it’s about one hour drive to La Jolla. I go to San Diego routinely a few time per month.

Ken - An hour's drove sounds very doable... how fortunate for you.

Here's a clip from the Heart Rhythm Society describing Atrial Fibrillation


Atrial fibrillation may be a primary electrical abnormality of the heart, be associated with underlying heart problems including problems with heart valves, coronary arteries, heart muscle, congestive heart failure or be related to problems with the thyroid gland or other disorders of metabolism.

Today there are many ways to treat and control atrial fibrillation including medications and procedures.

Continue: [www.hrsonline.org]


Jackie