focal point ablation

My EP and I had a long talk last Monday. It was my six week checkup since my ablation. He stated he does focal point ablation, and I asked why. He stated it has a lower risk of Stenosis, but increases the risk of another as he called it touch up ablation.

Pro-Con, which is better focal point or the one Natel does. Also, he said you
have less rick of stroke. The catherter does not get as hot, and the blood has a less chance to clot.

Any thoughts?

babb

JR Babb,

I think that since the CCF started using the ICE (intracardiac echocardiogram), the stenosis problem is pretty much a thing of the past. I am not certain of this, but I think that this is correct.

If your EP is correct that focal point ablations have a lower risk of stroke than PVI ablations, you should give consideration to the fact that you should probably double this lower stroke risk, because you very well may have to have a second ablation, and each ablation puts you at risk for stroke. Some EPs need three or four focal ablations to achieve the results of one PVI ablation, in which case you can multiply the stroke risk by three or four.

I believe the state of the art is the PVI ablation. I have read countless stories of afibbers having three or four focal point ablations and still not being cured. I believe it is very challenging for an EP to cure afib with a focal point ablation.

Newman

JR Babb,

I have to agree with Newman. Most EPs aren't confident of doing PVIs because of the degree of skill involved & overall very few have actually been trained to do the technique. I would bet your EP falls in that group. I am sure stenosis would definitely be more of a problem with someone who hasn't done many PVIs & especially if intracardiac echo along with visualization of microbubbes is not used.

Jim

JR - I also agree with Newman and Jim W. Lynn of this forum mentioned to me during her consult with Natale in Marin County, he said with the use of the ICE monitoring system, the risk of stenosis is reduced to virtually zero.

That's a huge statement since stenosis has been and will continue to be one of the major downsides of PVI. Since there are several of us all having ablations at the CCF within weeks and a few months of each other, it will be interesting to compare the results since we have had the advantage of his skill and the latest technology as well.

A comment was made to me by the discharge doc regarding clotting that may be of interest to you. He said that in the area of the burn, there is always clotting and the 48 hours post-procedure, is the largest risk time for a clot to break loose from those wounds. They also caution not to do heavy exercise in a 10 day period post ablation for the same reason.

The other large area of clot risk is the perforation site when they access the left side of the heart. Of course there is always a risk that a person could have a clot form in areas other than the heart during the procedure.

Last - When I first interviewed Dr. Natale, he commented that they used to do focal point ablation but found over time that the majority of rogue cells occurred in the area of the pulmonary veins and they felt it was more efficient just to go to that area and ablate there.

I view that in two ways - more effective - most likely; but also more time- efficient therefore, cost effective. The plus, though, is that the patient is not on the table for a longer period of time and also not receiving the extra radiation from a longer procedure.

Just some of my thoughts for your consideration...since you invited us to comment.

Good luck with your decision. You have to do what you feel is right for you. But don't "settle" for something in which you don't believe.

Jackie