Decided to have an Ablation - PFA - Questions I have had lone paroxysmal atrial fibrillation for the last eight years. I have an event about five times a year, lasting 4-6 hours. For my last event I was in atrial fibrillation for 24 hours and had an ECV to get back to NSR. I’m 63 years old, was an endurance runner. I have spent many years attempting to control my atrial fibrillation. Zero caffeine, zero alcohol, vitamin D, changing my running regimen, diet, etc. etc.. I know immediately when I enter atrial fibrillation. I have kept records of every event. The occurrence rate really hasn’t changed much. My advice would be to forget trying to fix this and get treatment as early as possible. Since I have now required an ECV to convert to NSR, I have decided to go ahead with a PFA for my atrial fibrillation. This has generated a number of questions and I’m hoping to get some help on the forum. Thank you. 1. Any thoughts on the clinical significance of the damage to red blood cells during the PFA? https://www.ahajournals.org/doi/10.1161/CIRCEP.124.012732 2. Some EP’s claim they can use zero fluoroscopy. How is this possible? Should this influence the choice of EP (the amount of fluoroscopy they use). 3. During the ablation procedure can the EP determine if the PV’s have, in fact, been isolated? How is this done? 4. Does PVI prevent both initiation and continuation of atrial fibrillation 5. If you have atrial fibrillation after the PFA, how soon after the ablation can you have an ECV.? Does the ablation need to heal before a subsequent ECV? 6. Since PFA is immediately effective does PFA still require a blanking period? 7. I’m confused on the importance of mapping for a PVI. If you are only doing the PV why map the rest of the heart? 8. If 90% of atrial fibrillation starts in the PV’s. Is it possible to determine prior to procedure if you’re in the 10%? 9. If you have a PFA, can you have further ablations using RF? 10. How soon after a PFA can you travel internationally? https://www.afibbers.org/forum/read.php?9,198598,198598#msg-198598 Thu, 22 Oct 2026 19:09:27 +0000 Phorum 5.2.23 https://www.afibbers.org/forum/read.php?9,198598,198665#msg-198665 Re: Decided to have an Ablation - PFA - Questions https://www.afibbers.org/forum/read.php?9,198598,198665#msg-198665
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NBeener
Natale: [tcainstitute.com]

Santangeli: [my.clevelandclinic.org]

ETA: should have refreshed the page before posting this ;-)

(tu)]]> mbd AFIBBERS FORUM Fri, 24 Jan 2025 01:03:01 +0000 https://www.afibbers.org/forum/read.php?9,198598,198663#msg-198663 Re: Decided to have an Ablation - PFA - Questions https://www.afibbers.org/forum/read.php?9,198598,198663#msg-198663 tcainstitute.com]

Santangeli: [my.clevelandclinic.org]

ETA: should have refreshed the page before posting this ;-)]]> NBeener AFIBBERS FORUM Fri, 24 Jan 2025 00:21:47 +0000 https://www.afibbers.org/forum/read.php?9,198598,198662#msg-198662 Re: Decided to have an Ablation - PFA - Questions https://www.afibbers.org/forum/read.php?9,198598,198662#msg-198662
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Carey

I think that would be great. How do I make that happen? Who do I contact?


His scheduler's name is Norma. Give her a call at 512-615-6205. (That's her direct number.) Tell her you're considering an ablation and would like to schedule a telemedicine consult with him. She should be able to get that done for you.

Thanks]]> mbd AFIBBERS FORUM Fri, 24 Jan 2025 00:07:02 +0000 https://www.afibbers.org/forum/read.php?9,198598,198659#msg-198659 Re: Decided to have an Ablation - PFA - Questions https://www.afibbers.org/forum/read.php?9,198598,198659#msg-198659
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mbd
I think that would be great. How do I make that happen? Who do I contact?

His scheduler's name is Norma. Give her a call at 512-615-6205. (That's her direct number.) Tell her you're considering an ablation and would like to schedule a telemedicine consult with him. She should be able to get that done for you.]]> Carey AFIBBERS FORUM Thu, 23 Jan 2025 23:57:51 +0000 https://www.afibbers.org/forum/read.php?9,198598,198657#msg-198657 Re: Decided to have an Ablation - PFA - Questions https://www.afibbers.org/forum/read.php?9,198598,198657#msg-198657
"You know what I think would be really helpful for you? You should schedule a virtual consultation with Natale or Santangeli and get their input."

I think that would be great. How do I make that happen? Who do I contact?

Thanks,

mbd]]> mbd AFIBBERS FORUM Thu, 23 Jan 2025 22:02:45 +0000 https://www.afibbers.org/forum/read.php?9,198598,198656#msg-198656 Re: Decided to have an Ablation - PFA - Questions https://www.afibbers.org/forum/read.php?9,198598,198656#msg-198656
If that's really what you want then just find an EP who does only cryo. Finding an EP who uses RF or PFA and who does only PVIs even if more is needed will actually be more difficult.]]> Carey AFIBBERS FORUM Thu, 23 Jan 2025 21:42:15 +0000 https://www.afibbers.org/forum/read.php?9,198598,198653#msg-198653 Re: Decided to have an Ablation - PFA - Questions https://www.afibbers.org/forum/read.php?9,198598,198653#msg-198653
Yes. But you have completely missed the point. The goal is minimize the probability of that occurring, because not everyone can have their first ablation with just one or two EP masters.]]> mbd AFIBBERS FORUM Thu, 23 Jan 2025 20:55:43 +0000 https://www.afibbers.org/forum/read.php?9,198598,198652#msg-198652 Re: Decided to have an Ablation - PFA - Questions https://www.afibbers.org/forum/read.php?9,198598,198652#msg-198652
Correct me if I'm wrong but you give the impression that any EP other than the two you recommend aren't to be trusted, other than doing PVI's?

Warped? Are these not true statements?

"The success rate for the initial PVI is 60-70% and after a second PVI is 85% (not 90%). This is without any non-PV ablations."

"For those folks in the 85% group, going to a "master" wouldn't have made any difference. There are probably 10's of thousands PVI ablations done in the US. Unfortunately it is just not practical for everyone to go to a master to get just a PVI. I would think the majority of the "masters" patients fall into the 15% group. A much better use of their time, no?"]]> mbd AFIBBERS FORUM Thu, 23 Jan 2025 20:41:36 +0000 https://www.afibbers.org/forum/read.php?9,198598,198651#msg-198651 Re: Decided to have an Ablation - PFA - Questions https://www.afibbers.org/forum/read.php?9,198598,198651#msg-198651
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mbd
I feel the worst decision would be to go with an EP who thinks he can fix non-PV sources,

What?! Seriously? What do you mean "thinks" they can? They do it day in and day out. I'm a living example and there are dozens more here like me.

I think you've elevated this issue far beyond reason. Once your PVI is complete but you're still in afib or it can still be provoked, do you really want your EP to just shrug, close up, and tell you that you'll need another procedure? That's what you seem to be saying.

What I expect from an EP would be a PVI, and then after the PVI is complete if afib has been terminated and can't be provoked, the EP would stop there and call it a day. Otherwise, the EP would be capable of finding and ablating the other source(s) and would do exactly that. Their goal would be to have me in NSR when I leave that lab.

You know what I think would be really helpful for you? You should schedule a virtual consultation with Natale or Santangeli and get their input. I think the handful of papers you've read have given you a warped understanding of ablation procedures.]]> Carey AFIBBERS FORUM Thu, 23 Jan 2025 20:21:40 +0000 https://www.afibbers.org/forum/read.php?9,198598,198649#msg-198649 Re: Decided to have an Ablation - PFA - Questions https://www.afibbers.org/forum/read.php?9,198598,198649#msg-198649
The success rate for the initial PVI is 60-70% and after a second PVI is 85% (not 90%). This is without any non-PV ablations.

I wasn't referring to myself when I said young. I wanted to illustrate that treatment should perhaps be tailored to where the patient is in their Afib journey.

I do have a decision to make, either select a highly experienced EP in PVI's with a proven track record of durable isolation. Or select an EP from just a handful of masters in the art of non-PV ablation. I feel the worst decision would be to go with an EP who thinks he can fix non-PV sources,

For those folks in the 85% group, going to a "master" wouldn't have made any difference. There are probably 10's of thousands PVI ablations done in the US. Unfortunately it is just not practical for everyone to go to a master to get just a PVI. I would think the majority of the "masters" patients fall into the 15% group. A much better use of their time, no?

I'm 63 years young 😀

mbd]]> mbd AFIBBERS FORUM Thu, 23 Jan 2025 19:26:11 +0000 https://www.afibbers.org/forum/read.php?9,198598,198647#msg-198647 Re: Decided to have an Ablation - PFA - Questions https://www.afibbers.org/forum/read.php?9,198598,198647#msg-198647
Yes, He told me, when he came by after the surgery, that he was in process of re-burning the third of the four pulmonary veins when my heart suddenly stopped fibrillating and resumed normal sinus rhythm. They watched for a while, maybe even challenged the heart again (I'd guess he did, but again I was unconscious..), and found that the rhythm was durable. So, my assumption is that he elected to do no further ablation, and for that I am in agreement and grateful.

And for your second question, my understanding is that he was redoing the PVI since it had seemed to stem the arrhythmia at the time he released me initially . As the lesions healed over the ensuing days, a small gap must have opened and allowed some signal to emerge from the circular dam of lesions he had put around my veins. (Or, equally likely, my progressive disorder established a new focus that just happened to become active at the same time, except it was still near the pulmonary veins...?) His assumption was that it was a gap, and he had re-ablated two veins already when he found the gap in the third vein.]]> gloaming AFIBBERS FORUM Thu, 23 Jan 2025 18:42:08 +0000 https://www.afibbers.org/forum/read.php?9,198598,198644#msg-198644 Re: Decided to have an Ablation - PFA - Questions https://www.afibbers.org/forum/read.php?9,198598,198644#msg-198644
Thanks for the suggestion.

Here is my ChatGPT session on fibrosis that is very educational and extremely helpful.

[chatgpt.com]]]> mbd AFIBBERS FORUM Thu, 23 Jan 2025 16:27:16 +0000 https://www.afibbers.org/forum/read.php?9,198598,198643#msg-198643 Re: Decided to have an Ablation - PFA - Questions https://www.afibbers.org/forum/read.php?9,198598,198643#msg-198643
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mbd
I’ll give my logic one more try…….Can we agree that 90% of paroxysmal AF can be stopped by PVI and these 90% do not have triggers outside of the PV’s. That means in 90% of these cases the mapping procedures above would be unnecessary. Agreed?

No, not really. If that were true, success rates for cryo should be 90% and they're not.


Quote

“The two EPs I recommended will definitely not do that for you.” Are you sure that would be the case for a young male with no other health issues but paroxysmal Afib? If you are correct, I believe HUP would disagree with that approach.

Yeah, I'm sure. Their approach is always to find and eliminate all sources of afib in a single procedure, and they usually find them. The minutes it takes to do that are well worth the avoidance of a repeat procedure. That's one of the reasons their success rates are much higher than average.

You keep saying you're young but I don't recall you giving an age. May I ask what your age is?]]> Carey AFIBBERS FORUM Thu, 23 Jan 2025 16:05:08 +0000 https://www.afibbers.org/forum/read.php?9,198598,198642#msg-198642 Re: Decided to have an Ablation - PFA - Questions https://www.afibbers.org/forum/read.php?9,198598,198642#msg-198642
Fascinating, thanks for another great explanation.

I don’t quite understand it either, but it sounds impressive! I forgot to include quotes “” since it was copied from their web site. Maybe someone can figure out exactly what it means. [www.pennmedicine.org]#

Was the second ablation that “plugged” the gap successful? Do you know if the EP mapped and/or ablated other areas of your heart in this second ablation?


NBeeber:

The amount of fibrosis hasn’t previously been mentioned by my cardiologists, or in reference to the test results. Thanks for the advice. I’ll definitely do some digging.]]> mbd AFIBBERS FORUM Thu, 23 Jan 2025 16:00:16 +0000 https://www.afibbers.org/forum/read.php?9,198598,198640#msg-198640 Re: Decided to have an Ablation - PFA - Questions https://www.afibbers.org/forum/read.php?9,198598,198640#msg-198640
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NBeener

You've made reference to atrial size as an important predictor of long-term ablation success. Have you also undergone any studies (eg, strain echocardiography or LGE-MRI) to evaluate the presence or degree of fibrosis in your case?

That's really the other most important prognostic factor in afib and ablation outcome.

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mbd
I did have a nuclear stress test and MRI a couple of years ago.

Did either of those tests indicate whether/how much fibrosis you have?

As I say ... you're putting a great deal (I'm not judging whether it's enough or too much) of thought into many aspects of a possible ablation. I wouldn't want you to give short shrift to another factor that has a huge bearing on outcomes.]]> NBeener AFIBBERS FORUM Thu, 23 Jan 2025 13:48:42 +0000 https://www.afibbers.org/forum/read.php?9,198598,198639#msg-198639 Re: Decided to have an Ablation - PFA - Questions https://www.afibbers.org/forum/read.php?9,198598,198639#msg-198639
I don't quite understand this, especially the first sentence. Are they doing six times the number of ablations that other hospitals do on average across America?

Yes, my EP state that his first crack at my heart was going to be a PVI. I wasn't conscious when he did all the did, so I don't know what all went on while I as out. He did tell me that he challenged my heart prior to releasing me to recovery. I must have passed, but six days later I was in my ER with AF again, and it was fast and intractable. Long story after that. On his second attempt seven months later, he found the gap he'd missed somewhere around my third pulmonary vein.

I think you might need to watch a video or two on heart structure. The pulmonary veins empty oxygenated blood into the posterior high wall of the left atrium. Endothelial tissue from the atrium sometimes wends its way into the mouths of those veins, and that tissue is receptive to voltage propagation. In people with paroxysmal AF, the pulmonary veins get voltage inside them near their mouths, and since some of the atrial endothelium has migrated into those mouths, it picks up the extra focus voltage and propagates it outward across the atrial wall, making the atrium contract. Except the SA node is also sending a competing signal, usually a fraction of a second prior to or after the fibrillating signal. The point of isolating the pulmonary veins is to make a circle of damaged tissue, which is impervious to the voltage, around all the vein ostia. This is what is meant by 'isolating'. And yes, they still have to map that area to find the precise location where they need to burn.]]> gloaming AFIBBERS FORUM Thu, 23 Jan 2025 07:25:21 +0000 https://www.afibbers.org/forum/read.php?9,198598,198637#msg-198637 Re: Decided to have an Ablation - PFA - Questions https://www.afibbers.org/forum/read.php?9,198598,198637#msg-198637
I didn’t think my questions would take us so far down the rabbit hole!

Using the mapping catheter to test for isolation of the PV’s is NOT the same as mapping the whole atria. As I think I explained earlier mapping involves: “provocation maneuvers included cardioversion of AF if present at baseline, incremental isoproterenol (ISO) infusion (3-30mcg/min), and atrial burst pacing to induce focal atrial tachycardia (AT) or induce AF followed by cardioversion on 3-6mcg/min ISO or during high dose ISO washout.” These things are not required to test for PVI isolation post PV ablation.

I’ll give my logic one more try…….Can we agree that 90% of paroxysmal AF can be stopped by PVI and these 90% do not have triggers outside of the PV’s. That means in 90% of these cases the mapping procedures above would be unnecessary. Agreed?

I’m not talking about complex cases with multiple failed ablations or for ablations for permanent Afib.

The Hospital of the University of Pennsylvania, performs six times the national standard of AF procedures. The purpose of their study was to eliminate these unnecessary mapping procedures. An honest question, why are they trying to do that, eliminate the mapping?

I’m not 100% convinced of anything! Just trying to gain as much knowledge as possible to make the best possible decision.

I think it is unfair to call an EP that has been doing cryo for decades inexperienced or untrained. I certainly wouldn’t want him/her to start working on my LAA but that’s not the issue.

“The two EPs I recommended will definitely not do that for you.” Are you sure that would be the case for a young male with no other health issues but paroxysmal Afib? If you are correct, I believe HUP would disagree with that approach.]]> mbd AFIBBERS FORUM Thu, 23 Jan 2025 03:44:44 +0000 https://www.afibbers.org/forum/read.php?9,198598,198636#msg-198636 Re: Decided to have an Ablation - PFA - Questions https://www.afibbers.org/forum/read.php?9,198598,198636#msg-198636
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NBeener
You've made reference to atrial size as an important predictor of long-term ablation success. Have you also undergone any studies (eg, strain echocardiography or LGE-MRI) to evaluate the presence or degree of fibrosis in your case?

That's really the other most important prognostic factor in afib and ablation outcome.

I did have a nuclear stress test and MRI a couple of years ago.]]> mbd AFIBBERS FORUM Thu, 23 Jan 2025 03:10:37 +0000 https://www.afibbers.org/forum/read.php?9,198598,198635#msg-198635 Re: Decided to have an Ablation - PFA - Questions https://www.afibbers.org/forum/read.php?9,198598,198635#msg-198635
If you're really convinced that you want a 100% PVI-only ablation with no mapping, no ablation of other sources of afib, etc, then find an EP who uses cryo and does exactly that. You may enjoy complete success. Just be aware you'll probably be dealing with a less experienced, less highly trained EP. The two EPs I recommended will definitely not do that for you.]]> Carey AFIBBERS FORUM Thu, 23 Jan 2025 01:48:12 +0000 https://www.afibbers.org/forum/read.php?9,198598,198633#msg-198633 Re: Decided to have an Ablation - PFA - Questions https://www.afibbers.org/forum/read.php?9,198598,198633#msg-198633
I thought EP's test the PV's for isolation after ablation. So your saying they map PV's? I thought mapping, if performed is done on the atria. If the PV's are isolated what are they mapping on the PV's?]]> mbd AFIBBERS FORUM Thu, 23 Jan 2025 01:10:30 +0000 https://www.afibbers.org/forum/read.php?9,198598,198632#msg-198632 Re: Decided to have an Ablation - PFA - Questions https://www.afibbers.org/forum/read.php?9,198598,198632#msg-198632
8. No. Hence he piercing of the septum first, and then commencement of the mapping. If it turns out to be Ye Olde PVI, that's what he'll do. That and no more than a challenge and a quick recheck if the challenge produces more ectopics.]]> gloaming AFIBBERS FORUM Wed, 22 Jan 2025 23:29:53 +0000 https://www.afibbers.org/forum/read.php?9,198598,198631#msg-198631 Re: Decided to have an Ablation - PFA - Questions https://www.afibbers.org/forum/read.php?9,198598,198631#msg-198631 Carey AFIBBERS FORUM Wed, 22 Jan 2025 19:52:30 +0000 https://www.afibbers.org/forum/read.php?9,198598,198630#msg-198630 Re: Decided to have an Ablation - PFA - Questions https://www.afibbers.org/forum/read.php?9,198598,198630#msg-198630
I believe I have found answers to questions 7 & 8

7. I’m confused on the importance of mapping for a PVI. If you are only doing the PV why map the rest of the heart?

8. If 90% of atrial fibrillation starts in the PV’s. Is it possible to determine prior to procedure if you’re in the 10%?


For question 7: I'm in agreement with gloaming "My EP shook his head when I asked if he does LAA ablations or in other places. He said he only does a PVI initially because that's where the heavy preponderance of paroxysmal AF sufferers are...and I was paroxysmal. He added that if I failed that ablation, he would consider other approaches, but not the first time."

To look for non-PV triggers (NPVT’s) requires isoproterenol infusion, cardioversion, typically requires vasopressor support and increased procedure time. This adds complexity and duration to the procedure, which both ADD risk.


For question 8: The study I referenced from the Hospital of University of Pennsylvania shows that you can statistically predict who is most likely to be in the 10%.

The decision whether to go looking for NVPT’s and the LAA on the first ablation becomes based on the patient; size of atrium, persistent Afib, age, OSA, prior cardiac surgery, etc, etc.


It seems the medical consensus for a young male with no other health issues but the paroxysmal Afib the first step would be just a PVI.

For me, I will now be looking for a very experienced EP with thousands of catheter PVI’s under his/her belt and that has the most experience with PFA’s.

mbd]]> mbd AFIBBERS FORUM Wed, 22 Jan 2025 18:12:11 +0000 https://www.afibbers.org/forum/read.php?9,198598,198629#msg-198629 Re: Decided to have an Ablation - PFA - Questions https://www.afibbers.org/forum/read.php?9,198598,198629#msg-198629
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mbd
Are you suggesting that for paroxysmal atrial fibrillation and a first ablation the LAA/CS should be either isolated or ablated?

No, nothing should be ablated that isn't a source of afib. Mapping carries no risk and there's absolutely no reason not to look for sources of afib beyond the PVs. If found, it would be negligent to just ignore them. But no EP goes around ablating non-PV areas "just because."]]> Carey AFIBBERS FORUM Wed, 22 Jan 2025 15:45:54 +0000 https://www.afibbers.org/forum/read.php?9,198598,198628#msg-198628 Re: Decided to have an Ablation - PFA - Questions https://www.afibbers.org/forum/read.php?9,198598,198628#msg-198628
That's really the other most important prognostic factor in afib and ablation outcome.]]> NBeener AFIBBERS FORUM Wed, 22 Jan 2025 14:52:40 +0000 https://www.afibbers.org/forum/read.php?9,198598,198626#msg-198626 Re: Decided to have an Ablation - PFA - Questions https://www.afibbers.org/forum/read.php?9,198598,198626#msg-198626
All the discussion really helps with the decisions. It’s important to factor the individual person; persistent or paroxysmal, atrial size, other heart problems, etc.]]> mbd AFIBBERS FORUM Wed, 22 Jan 2025 04:46:12 +0000 https://www.afibbers.org/forum/read.php?9,198598,198625#msg-198625 Re: Decided to have an Ablation - PFA - Questions https://www.afibbers.org/forum/read.php?9,198598,198625#msg-198625
The study also includes, “A set of pre-procedural risk factors can risk stratify patients at high risk for non-PV triggers and guide choice of optimal ablation strategy at first procedure.”

[www.ahajournals.org]

In order to detect non-PV triggers, “provocation maneuvers included cardioversion of AF if present at baseline, incremental isoproterenol (ISO) infusion (3-30mcg/min), and atrial burst pacing to induce focal atrial tachycardia (AT) or induce AF followed by cardioversion on 3-6mcg/min ISO or during high dose ISO washout.” Is required.

Identifying a subset of patients with higher likelihood of having non-PV triggers can guide more efficient use of these provocative maneuvers.]]> mbd AFIBBERS FORUM Wed, 22 Jan 2025 04:30:40 +0000 https://www.afibbers.org/forum/read.php?9,198598,198624#msg-198624 Re: Decided to have an Ablation - PFA - Questions https://www.afibbers.org/forum/read.php?9,198598,198624#msg-198624
It seems for the study that you referenced, patients only had the LAA & CS ablated/isolated IF the PV was isolated AND non-PV triggers were NOT present.
("Empirical isolation of LA appendage (LAA) and coronary sinus (CS) was performed if the PVs were silent and no non-PV triggers were detected.")

Check I'm reading this correctly. From the study, if you have a robust PVI and still have atrial fibrillation you can get a 90% success rate if you ablate the non-PV triggers (without working on the LAA). If you are still having atrial fibrillation with a robust PVI, without any non-PV triggers then you can get a 82% success rate by ablated/isolating the LAA/CS

Are you suggesting that for paroxysmal atrial fibrillation and a first ablation the LAA/CS should be either isolated or ablated?]]> mbd AFIBBERS FORUM Wed, 22 Jan 2025 03:57:00 +0000 https://www.afibbers.org/forum/read.php?9,198598,198623#msg-198623 Re: Decided to have an Ablation - PFA - Questions https://www.afibbers.org/forum/read.php?9,198598,198623#msg-198623
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mbd
“Conclusion:
In patients with recurrent AF despite durable PVI, no ablation strategy used alone or in combination during the redo procedure appears to be superior in improving arrhythmia-free survival. Left atrial size is a significant predictor of ablation outcome in this population.”

You said “in the right hands” your results are significantly better. Intuitively that should be true but has it been shown to be true, other than anecdotally. Is there a study that shows top tier EP’s have a better success rate? You certainly are in good hands with the very best, but just how much worse are “average” EP’s at multi centers where this study was conducted?

Any idea if “local” EP’s are even trying to perform this type of non-PVI complex ablations?

Despite the fact that 56% of the patients in that study had persistent afib, I didn't see any mention of LAA isolations; and, as Natale proved, if you want a ~90% success rate in terminating persistent afib, the LAA has to be in play. Unfortunately, the majority of EPs in the world don't know how to isolate the LAA and won't attempt it. A smaller but significant percentage won't attempt anything beyond a PVI.

I don't know of any published studies comparing EP experience and training with ablation success, and I doubt such a study will ever be done. As you said, it's intuitive that increased experience and training leads to improved results. That's true across all branches of medicine and has been for a hundred years, so there's little reason for anyone to study it. I can only report on my own personal experiences and the experiences of the people Shannon and I have known here and elsewhere (which is a LOT), and that "data" is absolutely compelling. That's why there are only two EPs in the US I will recommend unconditionally, and only a much smaller number I'll give conditional recommendations for.

Is there more than anecdotal evidence? Yes. Have a look at this study, which looked at patients who had failed more than 2 previous ablations. I quote the conclusions of the study:

Quote

Conclusion: In patients experiencing AF recurrence after multiple failed PVI, despite PV reconnection, non-PV triggers were found to be responsible for AF maintenance in the majority and ablating those triggers increased ablation success. Additionally, in the presence of permanent PVI and no non-PV triggers on isoproterenol, empirical isolation of LAA and CS provided high rate of arrhythmia-free survival.

Hey, it's your choice, but if I were in your shoes I would opt for the EP who knows how to solve the entire problem in one procedure rather than spending another year dealing with a failed ablation and having to undergo a second procedure. The risks of ablating outside the PV area really wouldn't figure into my equation because they're so minimal they're almost trivial.]]> Carey AFIBBERS FORUM Wed, 22 Jan 2025 00:28:52 +0000 https://www.afibbers.org/forum/read.php?9,198598,198622#msg-198622 Re: Decided to have an Ablation - PFA - Questions https://www.afibbers.org/forum/read.php?9,198598,198622#msg-198622 mbd AFIBBERS FORUM Tue, 21 Jan 2025 23:47:01 +0000