U-M Ablation study

Chris H, Mike F. and all:
I forgot to mention this on prior post. This was the catheter that destroyed my mitral valve and papillary muscles, chordae tendonae. The poor EP, once I awakened from the coma, and was being discharged, he came into my room and sat on the side of the bed trying to explain to me what had happened and how it happened. He brought this catheter with him to show me. It was in a sheath and could be moved easily and gently in an out of the sheath. As it was pushed out of the sheath, the end curled gently into a loop, and as it was pulled back, it easily and gently straightened out and slide into the sheath. He was so puzzled as to how it could have wrapped around all that tissue and NOT relax back and straighten out. I was also flabergasted. I can see it in my mind now. I know it was as big a shock to him as it was to me. I would think they are making, or have made inquiries into the safety of this catheter. I would think this manufacturer is also looking into it, but apparently they are still in use. This is the quote from the article:


"Oral and Morady have served as consultants and speakers for Biosense-Webster, the company that makes the catheter that detects the electrical impulses in heart and vein tissue."

Pam







Oral and Morady have served as consultants and speakers for Biosense-Webster, the company that makes the catheter that detects the electrical impulses in heart and vein tissue.

Pam, I may not remember but I think Biosense-Webster makes the "lasso" cath that CClinic uses. When over on the left side of the heart, it is positioned in each pulmonary vein (one at a time of course) to help indicate ablation success.

If it is extended far enough and near the mitral valve it could get swept into the left ventricle as the flow path goes that way. The mitral valve has loose tissue that could well hang up a "lasso". Just one of the things that can go wrong if positioning is in error.


Anton

Anton:
That is exactly what happened to me. It was the lasso mapping catheter, and the loop detects rogue impulses at the pulmonary vein ostia. When the catheter is in the sheath and inserted and guided up the vein and into the heart, the loop remains sheathed, it remains sheathed while traversing the atrial septal sinus, then at the point of the RSPV (right superior pulmonary vein) the catheter is pushed forward and slightly out of the sheath just enough for the end to curl into a loop. The one they were using was new and called Biosense-Webster Decapolar Mapping Catheter. As they finished mapping the RSPV, and were moving to the LSPV, the catheter remained in the loop position. The doc turned away to look for another size catheter loop, and with one atrial systole, the loop rushed down through the mitral valve into the LV. My husband asked them, "well, don't you resheath the catheter when moving it around from one PV to the other?" and they said, "well we will now." Then I felt like part of their learning curve. The difference was that this catheter had 10 sensors on the loop instead of the usual 5, and the doctors thought perhaps that was the reason that the loop latched and wouldn't release and straighten out. I think there were a few problems that happened at the same time. One, the catheter should not have been allowed to enter the left ventricle where the mitral valve apparatus was, and two, the catheter fault, as it looped around heart muscle tissue and wouldn't release and pull back into the sheath.
I don't know how many EP doctors are really aware of that danger, because, I believe, many cases go unreported. My doctor was very forthcoming about it. My event was reported and in fact published in Journal of Cardiac Electrophysiology, 8/13/02. A man posted me from another board. He sent me an off board e-mail to ask abourt what had happened to me. He said his friend's wife had a PVA and the same thing happened to her, except she never came out of the coma, and has been in a nursing home for 2 years, in a coma. I asked him if his friend would write to me or call me and he said he would ask him, but I never heard anything. I know that that case was never reported, because it happened before mine. When it happened to me, my doctor said that there were only 2 reported cases in the world, which I have already described, neither being in Raleigh NC., where this incident occurred. I think it has happened alot and doctors are ashamed to come forward, fearing damage to their careers and futures and just would like to sweep it under the carpet, which only leaves the rest of the world at risk for the same injury. How unfair. For those who do know, what do potential PVA patients then ask their EP: "Do you plan to use a Biosense-Webster Decapolar Mapping Catheter?" or "How do you plan to ensure that the loop doesn't get into the left ventricle?"
One of the things they told me was that it is hard to see at all times exactly where the tip of the catheter was using Flouroscopy. Thats why I think the new ICE technology will make such a difference, since it has an internal 3D view, maybe the loop will be less likely to get lost.

Best Regards,
Pam

Pam- -Wow, that's one chilling story! I suppose when thinking about the other case you mention, you can count a few blessings. Were they able to do repairs? And you're right it's good of the EP to be that forthcoming. I hope such cases haven't happened a lot.

The ICE cath is certainly a valuable tool but CClinic still uses Lasso and fluoroscopy to assure positioning and ablation success. Some day one of these newer techniques will prove to be easier and cut down on possible mishap.

With new respect,
Anton

Anton:
Yes, they took me to surgery and, finding the valve irrepairable, they implanted a titanium prosthetic valve. Post op there was every kind of complication: I was extubated too soon and went into acute congestive heart failure and had to be reintubated and put back on a ventillator, then went into a coma. I was in a coma for 2 weeks with fevers and prolonged hypotension. The hypotension caused what is called a watershed stroke. (not thrombotic or embolic). One lung collapsed and they had to put chest tubes in to reexpand it. While in the coma, I had no blink reflex and so stared at the light in the ceiling 24/7 and my eyes weren't patched and I developed what is called exposure keratopathy, or ulcers on my corneas, which left scars. The stroke caused some problems with cognitive thinking and short term memory and equilibrium. and my outer portion of my right hand is numb and weak. The right side of my face droops a little. For so long my whole familiy thought that I was going to die. Family members were flying in from all over the country. I am told that they sang to me, showed family pictures and just talked to me trying to wake me up. We just have a little house about 60 miles away and my family rented an apartment behind the hospital, in order to accomodate what ever family members were in town at any given time. They were back and forth all day and all night. I think it was harder on them than it was on me. Especially since I remember so little. I know that I thought that I was drowning, and indeed after I woke up, actually thought that I had died, and was in some sort of after life, and told visitors things like "I drown you know!" I don't remember all those things, but they all tell me. Especially hard on my husband and son and daughter. My mother told me that she had never seen my son cry before. It broke my heart. I was only 49 when all this happened.
Sorry that got so long. All for an ablation. I suppose sometimes I am undully harsh on those who think this is a simple safe procedure and I have to remind myself that I was in such a vast minority. However, I really would like to know actual stats. That can never happen, as I believe this complication so often goes unreported. After it all, I still have afib., and just opt for rate control with beta blockers and Lanoxin. I will be on Coumadin for the rest of my life, whether I have afib or not, because of the titanium valve. Now I just read peoples dates with ablation and watch my calender so I can say a prayer for them.

Stay well, Anton,
Pam

Thanks for telling your story Pam, it's incredibly moving. Scarey though, and I may not share that one with my wife who worries too much already. How wonderful to have such family support. And your problems with cognitive thinking seem to have ended, or they don't show in your clear and logical writing.

I've gotten my AFlutter ablated but still have AFib, and the ablation EP also confirmed a VT problem (LVOT) that also is tricky to ablate. My choice is to seek out ablation or go locally for an ICD implant with defibrillator. Dr. Natale has answered he can do both VT and AFib but in seperate operations, and I'm still trying to find out more on the VT details. They probably tired of all my questions about AFib! My AFib ablation, scheduled in March, now seems a long time to wait, now with VT as part of the equation. Your cautions regarding ablation are well founded, and I can appreciate your concerns.

Hope you're doing well,
Anton

Pam,

I am very sorry about your disastrous outcome. I pray that some miracle will come your way soon to help your condition.

njb

Anton:
Help me out here. LVOT = left ventricular ______ tachycardia? I would be much more concerned about VT that AF. Can't they move you VT ablation up to something sooner than March? Do you get control of it through antiarrhythmics? That is something that shouldn't be waited on. Anyone I know who has it is admitted pronto for ICD placement.

Just concerned,
Mother Hen,Pam

Mother Hen:

Reference is to location of focus:LVOT = left ventricular outflow tract; not an easy place as the RVOT is.

Asked Cleveland if they can't move it up with little response yet.

ICD would be much quicker but I've so far chosen to wait for further VT expert input. VT appears only to accompany AFib whaen exercising so now careful with HR. Napping is good! No antiarrhythmics (proarrythmia risk)

Thanks for the concern and wise words.

Fool in Waiting, Anton