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New ablation technique in JACC

Posted by Cindy Oh 
New ablation technique in JACC
May 31, 2018 02:46PM
A physician friend emailed me this abstract of a study noted in the JACC. Anyone heard about it?

"Ablation of Atrial Fibrillation With Pulsed Electric Fields"

Sorry I can't get the link to work - have forgotten how to do that! But it sounds very promising!

Look forward to hearing from those in the know!
Re: New ablation technique in JACC
May 31, 2018 02:55PM
Here is the link:

Ablation of Atrial Fibrillation With Pulsed Electric Fields

An Ultra-Rapid, Tissue-Selective Modality for Cardiac Ablation
Re: New ablation technique in JACC
May 31, 2018 03:08PM
Particularly interesting to see Pierre Jais (Bordeaux) as a lead author in this. Certainly lends serious cred IMO. I wonder if Bordeaux was one of the 2 centres involved.....
Re: New ablation technique in JACC
May 31, 2018 04:10PM
More:

Electroporation

Seems like this technique seeks to move ablation back into the pulmonary veins rather than encircling them as is done with RF and cryo. What about ablation outside the PVs, as we all know is necessary in some folks for the permanent relief of atrial arrhythmia? I don't see an answer to that. Also, the paper mentions ventricular fibrillation as a possible side effect (during the procedure it would seem). That's certainly scary.

This is VERY early data. Certainly worth following, but ten'll get you twenty that it's not going to be busting into EP labs anytime soon. FIRM continues to serve as a reminder about "irrational exuberance" when it comes to AF. I still maintain that method (RF/cryo) and skill of operator are the deciding factors in AF ablation for now and the foreseeable future, and not any "shiny new objects" on the horizon.
Re: New ablation technique in JACC
June 01, 2018 04:26AM
There was a symposium a couple months ago in Park City, UT called the Western Atrial Fibrillation Symposium, which was attended by what I think most would call “all the foremost EPs and cardiologists interested in afib”, and this technique or technology (or whatever you want to call it) was one that Mandrola seemed to think held promise, from what I recall of his tweets and blog posts during that time. I’m pretty sure he too took the view that there was a long way to go / that it was not ready for prime time.
Re: New ablation technique in JACC
June 01, 2018 08:07AM
When FIRM was getting everyone excited I asked my EP about it. He replied "There have been many false dawns!"

Gill
Re: New ablation technique in JACC
June 04, 2018 11:15AM
Electroporation has been around for a while for dermatology applications.

There is a new mapping catheter that IMO looks promising because it measures in a non-contact mode detailed anatomy at nearly the same time as electrical activity is measured. Here is a paper with videos of a couple of patients from Imperial/UK. Sounds promising but still early in trials. What they wrote made sense in that all current mapping techniques require compromises on knowing the atrial geometry accurately (only approximate for Cardioinsight, Abbot-Topera, etc) or that voltage mapping can be sequentially gathered and spliced together accurately along with geometry. All in a moving chamber. Having near simultaneous measurement of geometry (48 ultrasound sensors) and voltage (48 electric field sensors) should be more accurate for both geometry and electrical activity and make it a lot easier to find drivers and triggers.

[www.futuremedicine.com]
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