Got off the phone with Tsco a while ago as he was just about to dive into his tasty salmon dinner at St Davids after his late start ablation today as the third case in Dr Natale's schedule this afternoon. They won't remove his groin bandages and get him up and about until around 11pm central (Austin) time.

The great news is Tsco not only did fine but did not require LAA isolation today as I figured he might. Even Dr Natale told him yesterday in his consult that he said the odds were high he would need to address the LAA due to the very long nature of his style with Arrhythmia ... 19 years ago since his first of three SVT right atrial ablations, the third and last SVT ablation he had at Cleveland Clinic in 2005 to 2006 I think he said and that was the end of SVT for him, but like what happens the vast majority of the time with certain types of SVT is that it almost always is a prelude to full blown AFIB which Tsco had ablated with his first true AFIB procedure by his long time EP in Kentucky who did a FIRM + PVI ablation a about 2.25 years ago.

Tsco held up fairly well during the last two years, but did have a few bumpy periods along the way until AFIB/flutter came back last March.

At first he considered going back to his EP for the follow up ablation, but due to his long history of first SVT and then AFIB/Flutter showing up and odds that he might need more extensive work, so he decided to go to Austin to have Dr. Natale take over from here and finish up his ablation process.

Not surprisingly, a very good choice as it turns out in his case too, Tsco learned today after his ablation that all four of his PVs had reconnected, essentially as if the first AFIB ablation hadn't happened...

Its not that uncommon for one of two PVs reconnect after a first PVI AFIB ablation but all 4 is more rare and is doesn't indicate a great day in the lab that day for the EP.

Also sometimes you will see just one of two spots around a give PV needing to be re-ablated from the first ablation, the think you dont want to see is having to see the previously ablated PV re-conducting again from multiple spots. Everyone. even the most experienced maestros like Natale will have occasional PV spots that need to be reconnected from one of their own index ablation patients during a follow up ablation, but his average now is under 5% of triggers found that contribute to the repeat ablation being needed are from reconnections found in repeat ablations from his caseload, whereas the rest of St Davids team quotes under 10% and the average really good EPs still doing the dot by dot ablation method around the PVs get 25% to 40% reconnections and many lesser experienced EPs range from 50% to 90%!!

The use of contact force catheters can reduce reconnections quite a bit especially for the average experienced ablation EP, but it has some caveats too that require experience and skill with that system too to perform safely as well.

Its hard to underestimate the value of going to operators with less than 10% reconnections compared even with 25% to 35% re-connectors and obviously for the larger number of EPs who are still at 50% and higher in reconnections happening in their own PVI cases.

Tsco had an extended PVAI yesterday that includes posterior left wall isolation and isolation of his SVC and with jsut a few spots needing to be addressed inside his coronary sinus.

He was very relieved and happy that he had made the choice that he did and got a complete ablation in Austin.

Tsco should be out tomorrow around noon and back home on Saturday.

That's the encouraging update folks, I'm sure he'll be back online before long and share more on how it was for him so will leave that all up to him.

Shannon



Edited 3 time(s). Last edit at 06/16/2016 07:57PM by Shannon.