Ablation questions May 29, 2018 02:59PM |
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Re: Ablation questions May 30, 2018 03:52AM |
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Re: Ablation questions May 30, 2018 07:23AM |
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Re: Ablation questions May 30, 2018 01:56PM |
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Re: Ablation questions May 30, 2018 03:33PM |
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Re: Ablation questions May 30, 2018 03:33PM |
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Re: Ablation questions May 30, 2018 04:01PM |
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wolfpack
AF is a re-entrant rhythm (as is flutter and even v-tach). It is the ability of electricity to flow around and around in a circuit consisting of autonomous cardiac muscle cells rather than being "pulsed" from the SA node to the AV node. In flutter that circuit is often a circle in the right atrium. In AF, it's some kind of a mess in the left atrium. The PVI is supposed to introduce enough "impedance" in that mesh of a circuit such that re-entry is no longer possible. Ectopics, sure, but nothing that self-sustains.
Re: Ablation questions May 30, 2018 07:10PM |
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kbog
And geez, I can't imagine many people can afford to pay $40,000 out of pocket for a medical procedure (myself included)!!! I'm happy to hear about how Natale operates... I'm sure that kind of care is a big differentiator to people.
Re: Ablation questions May 30, 2018 07:15PM |
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mwcf
Interesting assertion. And as I alluded to as a possibility in my post above (para 6). I’ve never seen it written as such previously - I.e. that a PVI doesn’t only seek to prevent ectopics coming down from the PVs into the atria but also plays a significant role in preventing the re-entrant arrhythmia AF itself.
Re: Ablation questions May 30, 2018 07:47PM |
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Carey
A well-done PVI blocks all electrical signals from the PVs, so that prevents both reentrancy and ectopics from that area. The problem is the PVs are often not the only source of ectopics. They can come from almost anywhere in either atrium. Any average EP can do a PVI, but it takes a very experienced, well-trained EP to locate and ablate ectopic sources elsewhere.
Re: Ablation questions May 30, 2018 07:57PM |
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vanlith
A well-done PVI blocks all electrical signals from the PVs, so that prevents both reentrancy and ectopics from that area. The problem is the PVs are often not the only source of ectopics. They can come from almost anywhere in either atrium. Any average EP can do a PVI, but it takes a very experienced, well-trained EP to locate and ablate ectopic sources elsewhere.
What % of ectopics would you say Carey.....or anyone else.....come from other than the PV?
Re: Ablation questions May 30, 2018 08:41PM |
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kbog
What % of ectopics would you say Carey.....or anyone else.....come from other than the PV?
And... the only way to capture information re: the source is through mapping during an EP study or ablation procedure, yes? When asking doctors whether they will search for additional non-PVI sources during an ablation, are there important ways to phrase the question that might distinguish between similar but not equivalent responses?
Re: Ablation questions May 30, 2018 09:03PM |
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Carey
As you would expect, Natale is in-network with most of the major medical plans, and insurance companies don't usually care where you go for a procedure since they don't cover travel costs anyway.
Re: Ablation questions May 30, 2018 09:53PM |
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Re: Ablation questions May 30, 2018 10:27PM |
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Re: Ablation questions May 31, 2018 02:06AM |
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Re: Ablation questions May 31, 2018 04:25AM |
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Re: Ablation questions May 31, 2018 08:11AM |
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Pompon
Carey, Wolfpack,
I'm sure you're right saying the best EP can ablate any ectopic he wants. But this supposes any ectopic showing up while the patient is in the room. I'm sure the best EP can make them showing up.
But I think it's not that simple.
My experience makes me think new ectopics may appear in the weeks or months following the ablation. We're all different. In my own case, it's like a battery charging (I don't know how and why) then needing to discharge when it's full. Now that the easiest paths (PV's) are ablated, the battery searchs for other paths. The smaller, the harder they are, the more I have PACs. Some days, I may have ten thousands of them. The following day, my heart would hardly miss a beat. Just like the day following afib. So, what discharged in less than 1hr of afib before my recent touch up procedure now needs hours and hours of ectopics.
Re: Ablation questions May 31, 2018 09:14AM |
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Re: Ablation questions May 31, 2018 01:54PM |
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vanlith
You pretty much decided/confirmed what i am going to do.
Re: Ablation questions May 31, 2018 02:11PM |
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Re: Ablation questions May 31, 2018 04:20PM |
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Pompon
I keep in mind it may work after more than three procedures. I've read it on this great forum.
Re: Ablation questions May 31, 2018 07:03PM |
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GeorgeN
You pretty much decided/confirmed what i am going to do.
Not to dissuade you from going to Dr. Natale, but if you don't have US health insurance, the team in Bordeaux with Drs. Haïssaguerre, Hocini, and Jaïs are excellent and at a material cost advantage. My understanding is the cost is in the $20,000US range. In my subjective ranking, I'd put them a tiny bit below Natale, but still at the top of the ablating EP heap in the world.
George
Re: Ablation questions June 01, 2018 03:19AM |
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Re: Ablation questions June 01, 2018 04:08AM |
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Re: Ablation questions June 01, 2018 12:27PM |
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mwcf
vanlith,
Cost at Bordeaux is 16,555 Euro 'all in' including 4 nights stay in hospital accommodation for you and your partner (they monitor you via telemetry for 3 days after the procedure).
One needs to bear in mind, however, that a second 'touch-up' procedure - as and if required - would cost the same again. To the best of my knowledge a typically paroxysmal AFr would be looking at a 70-80% success rate for one procedure alone at Bordeaux.
Re: Ablation questions June 01, 2018 12:29PM |
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mwcf
vanlith,
Cost at Bordeaux is 16,555 Euro 'all in' including 4 nights stay in hospital accommodation for you and your partner (they monitor you via telemetry for 3 days after the procedure).
One needs to bear in mind, however, that a second 'touch-up' procedure - as and if required - would cost the same again. To the best of my knowledge a typically paroxysmal AFr would be looking at a 70-80% success rate for one procedure alone at Bordeaux.
Re: Ablation questions June 01, 2018 12:48PM |
Registered: 6 years ago Posts: 197 |
Quote
Pompon
Carey, Wolfpack,
I'm sure you're right saying the best EP can ablate any ectopic he wants. But this supposes any ectopic showing up while the patient is in the room. I'm sure the best EP can make them showing up.
But I think it's not that simple.
My experience makes me think new ectopics may appear in the weeks or months following the ablation. We're all different. In my own case, it's like a battery charging (I don't know how and why) then needing to discharge when it's full. Now that the easiest paths (PV's) are ablated, the battery searchs for other paths. The smaller, the harder they are, the more I have PACs. Some days, I may have ten thousands of them. The following day, my heart would hardly miss a beat. Just like the day following afib. So, what discharged in less than 1hr of afib before my recent touch up procedure now needs hours and hours of ectopics.
Re: Ablation questions June 01, 2018 02:26PM |
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Re: Ablation questions June 01, 2018 04:09PM |
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GeorgeN
Hey Mike, do you know if they ablate inside the LAA as Natale does (obviously neither would likely do that on pass #1 since that is the most conservative approach)?
Re: Ablation questions June 01, 2018 06:40PM |
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Re: Ablation questions June 01, 2018 08:31PM |
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mwcf
That's a question I don't know the answer to I'm afraid. I'll ask next time I email Prof Jais and let you know. I suppose as a fairly straightforward paroxysmal AFr it hadn't occurred to me that I might need any ablating of the LAA.
Re: Ablation questions June 01, 2018 09:45PM |
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