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 inby researcher - AFIBBERS FORUM
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Liz, good for you and continued luck with your pacemaker. You will still need anticoagulation to take care of the stroke risk as pacing doesn't rid you of AF episodes. The friend I spoke of played tennis tournaments so a lot of rotation movements of the chest and stretching of the shoulders. In that setting, the last surgery I referred to was the sixth in 20 years. Mostly for battery rby researcher - AFIBBERS FORUM
I think the primary risk is with the leads. There are now leadless pacemakers if you only need single chamber (RV for example) pacing. The majority will need BiVent. There you are seeing ~4% per year complication rate depending on how active one is. If you are immobile and have bradycardia, then complications are lower than those that are younger and active. The risks are dislodgement, bad pby researcher - AFIBBERS FORUM
Thanks. Good to know for CA folks. Along the same topic, I want to rant a little about a hospital mailer I just received yesterday from Memorial Healthcare (LA/OC areas). I get this along with others monthly because of a highly competitive market where I live. This specific mailer was clearly targeted at the planned retirement community near the Saddleback Memorial hospital. In it, they weby researcher - AFIBBERS FORUM
This seems unavoidable. Metronic needs to straighten this out ASAP. PS. It may still be better than not doing anything as we don't know what the baseline silent stroke risks are with AF. Intermountain Utah has done some studies using their own data but almost all of that is comparing RF ablation vs AAD/waiting.by researcher - AFIBBERS FORUM
I still check in once a week or so. Sorry for the recurrence after 5 years of NSR and too bad about Nademanee's retirement. He was one of the best. If travelling is not a concern, then Natale in SF would be a top choice. Then there are the upcoming generation of top guns like John Day in Salt Lake (same flight time as SF). There is also St Joseph's Desai who has handled very compleby researcher - AFIBBERS FORUM
Thanks for the kind words. Liz, that's a tough question and I haven't thought about it much. I think it is probably a mixture of genetics, life style and environment. Perhaps a third each like other things such as cancer. His father passed around 90. His younger brother made it to 82 and died from kidney failure - he also died with shrapnel from the Battle of the Bulge. He led a hby researcher - AFIBBERS FORUM
Just dropping a note about my father in law with AF. He is still very sharp but in physical decline. Lots of lessons learned through the years. He wasn't suppose to live this long given his prostate cancer diagnosis and surgery 30 years ago. He is a tough old bird. Many lessons learned. 1. Technology wasn't so good when he was diagnosed with AF. Can't think of a reason noby researcher - AFIBBERS FORUM
Really have to watch your own back when it comes to ICD implants for VT so soon after a first episode. Even for cases where implant may be appropriate such as after an ischemic heart attack, the guideline is a wait of 6 months. It may be the best option for a center that doesn't have the VT ablation expertise since there are only 20 or so centers in the country that have high enough voluby researcher - AFIBBERS FORUM
Kaytee, Thanks for the reply. Did you specifically asked for a referral to Dr. Schilling or did you only request London centers? Thanks in advance for the clarification.by researcher - AFIBBERS FORUM
What is the process in the UK for referral out to an ablation specialist when the skills are unavailable at the center where you normally go? I am asking for a relatively young man that failed the first VT ablation and it is apparent that the center he goes to will not have the skills to handle his case. There is a high probability that he needs to have epicardial mapping and ablation for cureby researcher - AFIBBERS FORUM
I hope you found the cause. I believe my heart hammering incident a few years ago was caused similarly by a mix up in thyroid meds.by researcher - AFIBBERS FORUM
I think Prof Jais accent may have been a little hard to transcribe as I noticed Stuart Thomas being at U. of Sydney so that would mean Westmead Hospital. I didn't check the other ones. Prash Sanders is correct from memory.by researcher - AFIBBERS FORUM
He gave his last formal presentation at the recent VT symposium knowing that it will be his last.by researcher - AFIBBERS FORUM
Your LAA emptying velocity is really good so I am not sure what the wave form means if anything. I would be curious to hear what Natale has to say. If you lost LAA contractility, the velocity would be a lot lower.by researcher - AFIBBERS FORUM
I don't look at your situation as being messed up at all. Being in NSR and not AF is a big benefit in terms of progression to heart failure and other potential health related issues. If you were still in AF, then blood thinners would be required for life as it is for my father in law. If you can't take the blood thinners, there is always the option of installing a LAA occlusion deviby researcher - AFIBBERS FORUM
You can request info from CCF directly via their website. Most EP departments will be glad to help if you are a patient doing first pass screening to short list centers. I would avoid those with attitude. I ran into that for Scripps Memorial and I told the director I won't bother him any more, in preparation for father-in-law if he was to be suitable, he wasn't. Upenn post their annby researcher - AFIBBERS FORUM
Looks like the biggest advantage of the newer blood thinners is that diet (vitamin K) doesn't interfere with how well the blood thinning works so there is something to be gained. As far as uncontrollable bleeding (I am guessing that is what the lawsuits are about) is concerned. There are now antidotes available to bind the drugs so it is no longer an issue. People with kidney issues or arby researcher - AFIBBERS FORUM
I checked CCF (Pinski and company) several months ago and they only do 10 VT ablations a year split about evenly between the 3 EP's. I did not check central Florida hospital and they are probably worth checking If I have to take a guess, I think Berman at Augusta would be the highest volume EP in your region. If I was on the east coast and it was my heart, I would go with Upenn or Stevensby researcher - AFIBBERS FORUM
In skilled hands, PVC and VT ablation has high success rate. Natale's group in Austin do 400 of these a year. There are scattered centers around the US that do a decent volume of these. It is more difficult to do than AF so you do want to make sure the EP has the skills and volume. A couple of other top centers are UPenn and Brigham and Women's. Most places that do mini-maze do notby researcher - AFIBBERS FORUM
Utah Intermountain study - This data set comprised of 6000 patients taking warfarin for AF and other issues. They compared how the patients with AF did versus non-AF patients. This really speaks to the importance of rhythm control to minimize the risk of dementia.by researcher - AFIBBERS FORUM
Yikes regarding having to resort to amio for a 4 yr old.. I wonder if she knows about remote magnetic ablation for the kid. That would be the only way to do it for hard to navigate hearts. It is the standard of care for ablating congenital hearts as well. Success rate is high with low complication rates but need referral to specialized center with the system and dedicated pediatric EP ablatiby researcher - AFIBBERS FORUM
This sounds like flutter and it would not be unusual for AF ablation to resolve into flutter. If it is right sided and it sounds like that is what it is since you are in NSR when it happens, then it is a relatively simple procedure to ablate. Atypical flutter on the left side would require more skill to map and ablate. Most experienced centers will test for right sided flutter immediately afteby researcher - AFIBBERS FORUM
Bordeaux is no doubt your best option. I do note that in the current issue of Journal of AF (Natale's open publication), there was a team of EP's at Athens that wrote an article on management of Brugada patients including ablation. If they do Brugada ablation which is highly complex, then they should be able to handle AF ablation. You will have to check with them and find out about eby researcher - AFIBBERS FORUM
Wise choice Fravi. Although I am sure Dr. Brugada is capable of doing an excellent job for you. He is very preoccupied with Brugada patients currently. He is doing a trial with others on ablation of Brugada syndrome and it is a very complex ablation procedure. When I was researching options for my father in law's post heart attack VT, he was no doubt one of the world's experts on VTby researcher - AFIBBERS FORUM
Lots of different general terms and phrases to describe the same thing. Another one is channelopathy or more specifically cardiac-channelopathy.by researcher - AFIBBERS FORUM
I hope your doctor can find you a better alternative than Amio as it has a long half life and you will need to be off of it for your referral ablation. Amio also has a risky toxicity profile as I am sure your doctor explained.by researcher - AFIBBERS FORUM
Joyce, I don't know if there was ever a study looking at AF ablation and age. There was one done on patients with ventricular tachycardia. These are patients with structural heart issues such as prior heart attacks and cardiomyopathy with ICD implants, so much worse shape than AF only patients. In that study, age was not a big factor below the age of 75. The biggest factor was kidney funby researcher - AFIBBERS FORUM
More info. Their paper below show a long term follow up study, up to 7 years, at a single center where majority cases are done by RF. It does a nice job detailing their experience in comparison to others. Both older and newer versions of cryoballoons are covered. The newer cryo balloons may be too effective in lowering temperatures to the point where phrenic nerve injury risks are elevated coby researcher - AFIBBERS FORUM