‘RF Balloon Ablation’ now being trialled.

[www.dailymail.co.uk]

Mike, now more dilemma for you..

Do you have a current ablation in UK (cheaper) or go to the experienced team in Bordeaux (more expensive) or wait for this new technology ablation procedure (and in the UK as well) to mature?

If the new balloon ablation procedure really is cut down by half to 90 minutes like they claim then shouldn't ablations be come cheaper and safer?

Dean

Like the video at the end. NZ man uses electric fence to get back to NSR! Lucky he didn't have any clots hanging about.

Flecainide is a blood thinning (anti coagulation?) drug, mentioned in the article???



Edited 1 time(s). Last edit at 04/30/2018 07:48PM by Joe.

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Joe
Like the video at the end. NZ man uses electric fence to get back to NSR! Lucky he didn't have any clots hanging about.

I have a friend who has afib. A few years back he was headed to the hospital for a cardioversion. When he touched the door to the hospital that was supposed to open automatically, it apparently had a short and shocked him. To his surprise, he suddenly realized that he was back in NSR. The shock had cardioverted him. So he just turned around and went back home.

I've taken a few jolts of 120 VAC accidentally in my life and it's not all that bad. Obviously not recommended, but truth is I considered trying it myself more than once. Don't think I'd even consider it in Europe with 240 VAC, though.

Cardioversion is DC, not AC. And it’s synchronized to the rhythm unless the rhythm is v-fib. Let’s not go sticking utensils into power outlets!

I think electric fences are high voltage and very low current as well as pulsed at a far lower rate than 50 or 60 Hz?

Indeed Dean!

Bordeaux still top of the heap for me. Although I've got to say that this guy Schilling in London IS the only EP - in the UK at least - who has his own hospital-audited success (and complication) rates published every year - for 2016 results (latest stats owing to 18 month follow-up) see here:

[londonafcentre.com]

I'd stress that the above stats are his OWN figures for his OWN personally undertaken private work at London Bridge private hospital (hence lowish numbers per year - although still 4 per week) rather than those of him AND his team of fellow EPs at St Barts NHS hospital also in London. Even so, still good figures and - as he points out - no-one else in the UK puts similarly collated stats out there.

I'm certainly very interested in this new RF balloon approach and will be watching carefully. In fact, I'll go one better than that and head down to see him for a private consult and see what I make of things/him for myself. For now, as I said, Bordeaux still choice number 1.

Whilst the new RF balloon approach cuts down time by 180 to 90 mins, this is still longer than cryo balloon PVI that Schilling now has down to around 60 minutes.

[Does anyone here have any views on this new RF balloon approach rather than the guy and the electric fence??!! Is anyone here aware as to whether or not it's being trialled anywhere in the US?]

Cheers,

Mike



Edited 1 time(s). Last edit at 05/01/2018 02:58AM by mwcf.

I think all those improvements on ablation techniques are fantastic, but they only relieve the symptoms of AF.

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Pompon
I think all those improvements on ablation techniques are fantastic, but they only relieve the symptoms of AF.

My take is that a properly and expertly carried out ablation will for 80-90% of folks (particularly paroxysmal AFrs) stop AF happening period. Rate control is the only thing that will - in most cases at least - 'relieve' symptoms of AF whilst it's happening per se.

That said, whilst a successful ablation stops AF from happening, it doesn't 'cure' the underlying reasons - whether genetic or lifestyle - why the AF was happening in the first place.

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Carey

Like the video at the end. NZ man uses electric fence to get back to NSR! Lucky he didn't have any clots hanging about.

I have a friend who has afib. A few years back he was headed to the hospital for a cardioversion. When he touched the door to the hospital that was supposed to open automatically, it apparently had a short and shocked him. To his surprise, he suddenly realized that he was back in NSR. The shock had cardioverted him. So he just turned around and went back home.

I've taken a few jolts of 120 VAC accidentally in my life and it's not all that bad. Obviously not recommended, but truth is I considered trying it myself more than once. Don't think I'd even consider it in Europe with 240 VAC, though.

If there was a Doomsday Scenario, where we couldn't get Medical help, I think we would be better off if possible to get a portable Defibrillator from somewhere for Home Cardioversion. So many factors here that wouldn't be the same if you tried to electrocute your Heart out of an Power Outlet. Synchronization, length of Shock and other uncontrolled Factors. How would this be done? Hard Wire Paddles into a Outlet, then have someone else Flip the Power on for only a split second? Also is 120 VAC accidental Shock, even comparable to 125-200J by ECV? I've had 125J ECV, where I was not fully under, and it felt like a Bomb Exploding in my Neck and Head simultaneously while my Head was getting hit by a Freight Train. Brutal but Brief.



Edited 1 time(s). Last edit at 05/01/2018 05:53AM by The Anti-Fib.

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mwcf
That said, whilst a successful ablation stops AF from happening, it doesn't 'cure' the underlying reasons - whether genetic or lifestyle - why the AF was happening in the first place.

I'd like hearing a lot more about research in that way, but it probably needs to consider the whole body functions in the same time and the way they play together. A challenge!
And likely a very hypothetic return on investment...

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The Anti-Fib
How would this be done?

Ha ha! I have no idea. I wasn't serious about actually trying to cardiovert oneself with electrical outlets. Although anecdotally it seems a random electric shock might sometimes stop afib, it's not something I would recommend trying intentionally.

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Pompon
I think all those improvements on ablation techniques are fantastic, but they only relieve the symptoms of AF.

Only?

Joules are not Volts. Different units. If you apply a voltage to a resistive load (R), you dissipate power as P = V^2/R. You'd then integrate P over the time that V is applied to get energy (E) in Joules. So,

E = int( V^2/R dt) (J)

Don't know how you're going to do that math with paddles and a light switch!

Please, nobody go electrocuting themselves.

My guess as to how a DC cardioversion machine works is that it charges a capacitor (hence DC) to a voltage such that E = 1/2*C*V^2 (100 J, 150 J or whatever they set it to). The voltage needed to establish the energy would depend on the size of the capacitor (C) in the machine (I have no idea what that might be, but fair to guess it's big, so V isn't so big that we're crisping people's skin). Then it dumps that charge into the patient rather instantaneously during a refractory period of the cardiac cycle. You do not dump charge into the heart during ventricular depolarization or repolarization (QRS or T wave) because you can actually cause v-fib that way. Hence, synchronized. The only time you do it un-synchronized is when there isn't anything to synch to, like polymorphic v-tach or v-fib.

It's a risky thing to do even under controlled circumstances. Really only ER departments and cardiac wards in hospitals have these machines. No doctor's office (even a cardiologists) has one. Lawyers won't allow it. The automated external defibrillators (AEDs) that you commonly see in shopping malls, gyms and on airplanes are exactly that - automated - and they will not shock an AF rhythm. Ever.

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Carey

I think all those improvements on ablation techniques are fantastic, but they only relieve the symptoms of AF.

Only?

For me, it's the truth. I've still afib, with lighter symptoms.
And, no, ablation does not cure afib. But I reckon relieving the symptoms is great work and the best that can be done as long as afib can't be cured.

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Pompon
For me, it's the truth. I've still afib, with lighter symptoms.
And, no, ablation does not cure afib. But I reckon relieving the symptoms is great work and the best that can be done as long as afib can't be cured.

You're assuming your partially successful ablation is what everyone experiences and that's just not true. Complete elimination of all atrial arrhythmias is the goal of an ablation and quite often that's exactly what's achieved. I went through no fewer than five unsuccessful ablations over the last 7 years, so I absolutely understand your viewpoint. But last August I underwent what I hope is my last one with Dr. Natale. Since that procedure I haven't experienced a single second of afib, flutter or even so much as a stray PAC. That's been confirmed by six months of Kardia monitoring followed by a Holter monitor for eight days. Not a single blip in eight months and at this point my expectation is that will not change.

Is that a cure? Well, we get bogged down in semantics here. Afib isn't a disease -- it's a symptom of a disease, and that disease is atrial myopathy. Did the ablation cure my atrial myopathy? Nope, it sure didn't. The substrate that allows afib to happen is still there and probably always will be, but it's been contained and rendered incapable of producing the symptom we know as afib. I think it's fair to call that a cure.

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wolfpack
My guess as to how a DC cardioversion machine works is that it charges a capacitor (hence DC) to a voltage such that E = 1/2*C*V^2 (100 J, 150 J or whatever they set it to). The voltage needed to establish the energy would depend on the size of the capacitor (C) in the machine (I have no idea what that might be, but fair to guess it's big, so V isn't so big that we're crisping people's skin). Then it dumps that charge into the patient rather instantaneously during a refractory period of the cardiac cycle.

I've never used an AED, but have trained on them. On this machine <[www.defibtech.com] they specify 50 J for youth and 150 J for adults.

This also fairly describes what happens on an electric fence. A capacitor is charged and then periodically dumped into the line . In my youth (I had one powered by a large 6v battery), I had experience with these as well as holding on to them for "fun." The only difference is the fence chargers tend to put out 1 - 12 joules, so much less than an AED <[www.kencove.com] Clearly it didn't take much to convert that guy back into rhythm. Also you don't have any control about timing.

I'm not suggesting anybody try this. The fence was unpleasant but other than that, no big deal.



Edited 1 time(s). Last edit at 05/01/2018 03:31PM by GeorgeN.

Here’s a couple on accidental electric shock actually causing AF. (Since no-one wants to talk about RF balloon ablation )

[emj.bmj.com]

[www.sciencedirect.com]

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mwcf
(Since no-one wants to talk about RF balloon ablation )

This may be helpful for the guys who are less skilled (not that it wouldn't help the top tier guys), however my take is that it isn't helpful beyond a standard PVI. Because of my 2.5 month episode at the beginning of my "career" 14 years ago, I'm likely a "complex" case and this would do me more good.

Again, my take is pick the best EP you can and let him/her choose the equipment.

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GeorgeN
This may be helpful for the guys who are less skilled (not that it wouldn't help the top tier guys), however my take is that it isn't helpful beyond a standard PVI.

I think that's probably right. It's basically a standard PVI done very quickly. Great for less skilled EPs and great for the bottom line of centers that employ them since it cuts down on procedure time, but probably not something the top guys would use.

Quote

Again, my take is pick the best EP you can and let him/her choose the equipment.

Quoting for emphasis.

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Joe
Like the video at the end. NZ man uses electric fence to get back to NSR! Lucky he didn't have any clots hanging about.

Here's one about a farmer who used several homegrown methods for self-cardioverting including:

- jumping off a barrel
- jumping off a ladder
- firing a 12 gauge
- jumping in the cold water tank, and yes:
- grabbing his electric cattle fence

Do it yourself cardioversion


Another one from the files:

Guy drilled through the wall into the 240 mains line, the shock knocked him to the floor, but he cardioverted

Drilling for NSR



Edited 1 time(s). Last edit at 05/02/2018 01:23AM by DavidK.

George, noted and agreed. Although maybe the RF balloon might result in lower PV reconnection rates even for top tier EPs? Although even that said Natale's 'gliding catheter' approach maybe has that nailed down better still already. Not that anyone other than Natale and his proteges in the US seem to be doing that so far as I can tell though.

Another thing I wondered is whether the RF balloon might result in a higher PV stenosis risk than where lesions can be created a bit further away from the PVs as they can be with the usual single spot RF approach.

I think your quote "Again, my take is pick the best EP you can and let him/her choose the equipment." still pretty much nails it in general - especially for anything a bit more involved than a straightforward PVI.

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Carey
I went through no fewer than five unsuccessful ablations over the last 7 years, so I absolutely understand your viewpoint.

I'm curious how many ablations the heart can sustain, and what happens after that? Thanks

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jpeters

I went through no fewer than five unsuccessful ablations over the last 7 years, so I absolutely understand your viewpoint.

I'm curious how many ablations the heart can sustain, and what happens after that? Thanks

I guess that after enough ablations the atria can't even sustain AF! But one will lose some if not all of the 'atrial kick' that contributes some 20% of the pumping of a normal heart beat.

But no AF IS no AF: 80% normal heartbeat is arguably way better - and definitely less symptomatic - than a heartbeat in AF.



Edited 1 time(s). Last edit at 05/02/2018 03:15PM by mwcf.

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mwcf
I guess that after enough ablations the atria can't even sustain AF! But one will lose some if not all of the 'atrial kick' that contributes some 20% of the pumping of a normal heart beat.

But no AF IS no AF: 80% normal heartbeat is arguably way better - and definitely less symptomatic - than a heartbeat in AF.

Well, it matters a whole lot how competent the EP is who's doing those ablations. Suffice it to say that if you need more than two, you're probably not dealing with a competent ablationist.

After my first three ablations I finally wised up and went to a new EP. During ablation #4 that EP found no evidence whatsoever that I'd ever had an ablation before. My pulmonary veins were fully connected -- no isolation at all -- plus I had multiple ectopic sources elsewhere. He had to repeat a full PVI and then some. As he said later, "You haven't had four ablations, you've had one." Think about that. Three ablations and the most basic goal of a PVI hadn't been achieved. The first EP was being too cautious, too timid, and making burns that weren't deep enough and lasting. Therefore, my heart just healed right over them so it's as if they never happened.

My first EP came with good credentials, education and recommendations, and he was a perfectly capable clinical EP who could treat afib medically, but he was obviously not a competent ablationist. He simply didn't know how to make durable lesions, so those first three ablations actually left very little scar tissue. Unfortunately, there are a lot of EPs like him out there. They have inadequate training and they do an inadequate number of procedures to achieve proficiency. Nevertheless, they keep doing ablations, a large number of their patients need antiarrhythmics to stay in rhythm afterwards, and yet they call them successes.

So, long story short, here I am with a total of six ablations. My P waves are diminished, indicating a lot of isolation in there, but I don't feel any difference at all. My ejection fraction is normal (slightly improved, actually), and my performance on my bike is unchanged. If I've lost any atrial kick, I can't tell. And above all, as you said, no AF IS no AF

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Carey
Suffice it to say that if you need more than two, you're probably not dealing with a competent ablationist.

I’m going to draw that line at one for myself, and seek top notch care if (when) this beast rears its ugly head again.

But that’s me. I’m tenacious. If you told me there was a bigger nuclear bomb you could drop on AF, I’d be pressing the red button before you could blink!

Suffice it to say that if you need more than two, you're probably not dealing with a competent ablationist.

A clarification to that comment by Carey might be needed.

I've had 3 ablations by Dr. Natale...
#1 November 2003
#2 August 2014 - LAA isolation
#3 April 2015

Heart is calm with normal function. No meds other than half-dose Eliquis since I was age 79 for #3.
and thanks to my Functional Medicine Board Certified Family Practice physician, no other health issues.

Jackie

What I should have added was more than two without achieving normal rhythm. Your 11-year span is clearly a case of your afib progressing rather than the ablation being a failure.