Long Term ablation study

I just found this interesting

[academic.oup.com]

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bettylou4488
I just found this interesting

[academic.oup.com]

You lost me at “I just found this interesting.” Just kidding. I did read the whole article but just about all of it was above my pay grade. I did think the gist of it was ablation can be a good thing. Looking for the cliffnotes version. Thanks for the link. Even though I don’t understand most of the research articles, I do take a little bit away from each one and the ensuing posts. Thanks again.

Keep in mind that paper was published in 2017 and it covers data collected in the previous 10 years, so it's looking at results obtained in the early days of AF ablation. There have been enormous strides in technique, understanding, and technology since then. If we had a study that began collecting data in 2012 (10 years ago), I'm confident we'd see significantly better results.

“ First, we do not ‘cure’ AF.”

Maybe some can achieve a successful ablation(s), but with declining age, genetic disposition, etc., one can develop new afib pathways areas not previously ablated which could result in one’s successful NSR remission to end.

IMHO a successful ablation maybe buying time for those lucky ones and not a cure that afib won’t return.



Edited 1 time(s). Last edit at 02/06/2022 06:50AM by susan.d.

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walt

I just found this interesting

[academic.oup.com]

You lost me at “I just found this interesting.” Just kidding. I did read the whole article but just about all of it was above my pay grade. I did think the gist of it was ablation can be a good thing. Looking for the cliffnotes version. Thanks for the link. Even though I don’t understand most of the research articles, I do take a little bit away from each one and the ensuing posts. Thanks again.

I was trying not to draw conclusions for people. (Mine was different than yours LOL! But I agree it is not an easy read!!). I have another article I want to post on medical decision making that goes hand in hand with this.

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Carey
Keep in mind that paper was published in 2017 and it covers data collected in the previous 10 years, so it's looking at results obtained in the early days of AF ablation. There have been enormous strides in technique, understanding, and technology since then. If we had a study that began collecting data in 2012 (10 years ago), I'm confident we'd see significantly better results.

I suppose but I bet there are studies out there.. I found this one disheartening. in the absence of data you kind of have to go with the last thing you know. But then again it should be individualized. I wonder how significantly different results...

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susan.d
“ First, we do not ‘cure’ AF.”

Maybe some can achieve a successful ablation(s), but with declining age, genetic disposition, etc., one can develop new afib pathways areas not previously ablated which could result in one’s successful NSR remission to end.

IMHO a successful ablation maybe buying time for those lucky ones and not a cure that afib won’t return.

I think that is part of the problem- what is success. I have seen three EPs in the last year and all three said 'success" for me may include medication. And I'm not opposed. One said doing it might buy me time. I have an appointment with him next week to discuss how much time. I am "young" so I might give it a go in hopes of success. I think open medical decision making is key. That is sorely missing in today's medical world. at least you have to dig deep to find it.. When I was at the cancelled ablation in October (because of a blood clot that was then found to not be there), I apologized for my million questions. One professional said, "if you don't take care of your healthcare no one else will." The room kinda became silent. I think he was a rebel LOL. I liked that. A nurse also said something similar to that to me when I was there.

Quote
bettylou4488


I just found this interesting

[academic.oup.com]

You lost me at “I just found this interesting.” Just kidding. I did read the whole article but just about all of it was above my pay grade. I did think the gist of it was ablation can be a good thing. Looking for the cliffnotes version. Thanks for the link. Even though I don’t understand most of the research articles, I do take a little bit away from each one and the ensuing posts. Thanks again.

I was trying not to draw conclusions for people. (Mine was different than yours LOL! But I agree it is not an easy read!!). I have another article I want to post on medical decision making that goes hand in hand with this.

You mean I was wrong!? Say it ain’t so. Well I did say I learn a lot from the ensuing posts. Still, I promise to read the next one but won’t tell anyone what I think—especially myself.

Quote
walt



I just found this interesting

[academic.oup.com]

You lost me at “I just found this interesting.” Just kidding. I did read the whole article but just about all of it was above my pay grade. I did think the gist of it was ablation can be a good thing. Looking for the cliffnotes version. Thanks for the link. Even though I don’t understand most of the research articles, I do take a little bit away from each one and the ensuing posts. Thanks again.

I was trying not to draw conclusions for people. (Mine was different than yours LOL! But I agree it is not an easy read!!). I have another article I want to post on medical decision making that goes hand in hand with this.

You mean I was wrong!? Say it ain’t so. Well I did say I learn a lot from the ensuing posts. Still, I promise to read the next one but won’t tell anyone what I think—especially myself.

LOL. no no. I mean I didn't read every word. it was more a 'feeling' which probably isn't the way to read scientific papers! you crack me up. Opinions are like bellybuttons.. everybody's got one

The study is of patients who "underwent ablation between June 2004 and June 2006". That sounds almost prehistoric.

The authors admit that the "ablation technology used is outdated and may have influenced success rates". In their "limitations" section they say that "technology improvements both for electroanatomic mapping systems and for catheter design, moreover the physicians’ learning curve, due to the nature of an observational study, cannot be assessed"

They note: "Previous studies have reported follow-up for up to 5 years and provide comparable success rates".

What "success" means appears a bit unclear: "recurrences were defined mostly by symptoms with some evidence from ECG or Holter documented AF". They followed up by seeing patients at 1, 3, and 6 months then twice a year.

The study authors conclude: "Performing repeated procedures and optimal management of cardio-metabolic risk factor are of paramount importance in preventing arrhythmic recurrences"

The editorial writers commenting on the study put it this way : "This study highlights the importance of convincing the electrophysiologists performing AF ablations to take a multidisciplinary perspective and promote overall risk factor reduction and control"

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David_L
The study is of patients who "underwent ablation between June 2004 and June 2006". That sounds almost prehistoric.

It absolutely is prehistoric. The differences between a 2005 ablation and a 2022 ablation are like night and day, especially in the realm of safety. Nobody should be reading anything about 2004-2006 data when modern data is available. And it is. I'm trying to find time to dig it up and I'll post it when I do.

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David_L

(...) What "success" means appears a bit unclear (...)

IMO, it'll always be, for this notion differs not only from patient to patient, but from Dr to Dr too.

The only thing all of them would agree about is "uncontrolled afib is life threatening". So, once afib is under control, everything else is mostly related to the quality of life.

What's the point getting a patient in NSR if he must take debilitating meds or bear awful ectopics?
EPs usually don't mind ectopics. If their ablation keeps the patient in NSR without meds, it's a success.

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Pompon


What's the point getting a patient in NSR if he must take debilitating meds or bear awful ectopics?
EPs usually don't mind ectopics. If their ablation keeps the patient in NSR without meds, it's a success.

So that's my main "fear" if you will. But how does one know this? I guess they don't. I had an appointment with my congential doc yesterday. I believe he has more accurate "data' on people like me. (Vs. the standard 70% that the EPs seem to give on the first ablation). He said the risk of long term unpleasant beats was low (1-5%).. but my chance of it working is also low. (I told him I would not tell anyone what he said LOL!). IDK. I have a few weeks to continue to think about it and pray about it...



Edited 1 time(s). Last edit at 02/09/2022 02:01PM by bettylou4488.

Quote
Carey

The study is of patients who "underwent ablation between June 2004 and June 2006". That sounds almost prehistoric.

It absolutely is prehistoric. The differences between a 2005 ablation and a 2022 ablation are like night and day, especially in the realm of safety. Nobody should be reading anything about 2004-2006 data when modern data is available. And it is. I'm trying to find time to dig it up and I'll post it when I do.

Before I got my ablation I watched a video of one on YouTube. The EP was explaining how the contact sensors worked and how they allow the EP to exactly manage the amount of RF energy to put into a part of the heart or PVIs. He said that just that alone made a huge difference in outcomes as before that they were in a sense flying blind. Then he said that they weren’t invented until 2015 or so. I’m sure the same is the case about the integration of the sensors and the 3d software that is used to map the ablation.