Right Side to Left Side for Ablations

I'm trying to understand the process of the more common "LEFT" sided ablations for AFIB. I had a right sided Ablation for Atrial Flutter in which I was told was about as easy as could be as it was Right Sided and was a very small area. But for most, if AFIB is Left-Sided, when going through the Vein with a Catheter, is the process to go through to the right side and puncture the Septum to get to the Left Side? Or if the Mapping shows the Arrhythmia(s) are on the Left Side, is there a way to the Left Atrium without going through the Septum?

From my understanding, the Left Side (more common AFIB Side) is more sensitive in general due to the Esophagus and other organs? Thanks in advance for any more detail on this.



Edited 1 time(s). Last edit at 05/31/2025 02:23AM by cornerbax.

They will always go into the right atrium and then through the septum to the left atrium.

Yes, the left side has some risks the right doesn't, but today in 2025 those are pretty much overcome with various means EPs have learned over the years and improving technology, with PFA being the most obvious example. I wouldn't be concerned in the least about this issue.

Carey, I'm very glad you don't charge per post. I would be broke if you did. Lol. Thank you again for the info. I have an ablation with Dr. Natale in a few months and was just curious. Thank you again for the response and great info I appreciate it.

cornerbax, IF you don't mind my asking, how long did it take from initial contact to 1st appt for consult & ablation or are you doing combo one trip? I'm in the waiting phase after submitting my paperwork and records authorization(s).

I was already a pre-existing patient as I was intending to see Dr. Natale in 2023 for my ablation. After a video consult he told me my mitral valve with severe regurgitation needed to be fixed prior to any ablation as that was his biggest concern.

I have since had my mitral valve repaired. When I reached out to Norma a couple of weeks ago she said Dr. Natale was out until early June. I think he is on vacation but he's out from his regular routine until early June. I believe he is back next week. She told me the approximate time frame for the ablation and I was fine with it as I am asymptomatic and my heart rate isn't too bad except the few instances of RVR with heavier exertion. Lastly, I did have to update all of my info and send my most recent echo/ekgs and post op reports which I did two weeks ago.

I will fly out for the ablation and have a video consult sometime before that. I told Norma I am in no rush for the video consult I just had a couple of quick questions. I know I need an ablation so there isn't much to ask other then a couple of questions I have. Hope this helps.

Thank you for your reply. I'm hoping for September but have no idea IF that is too optimistic on my part or wishful thinking on my part due to his high demand and wait list. I'm not so sure I'd describe myself as asymptomatic since mine occur in the middle of the night and during I'm sitting up in bed waiting for it to go away vs trying to function during daytime active time frame. I'd even be willing to be "wait list" and with my plan I could get there pretty quick or even catch a flight for even faster arrival.

I think we'll drive. Take our time, 2 maybe even 3 days, our days of doing 1K trips in one day are behind us just because they aren't fun, plus we have the time. I think it is about 700 miles though depending on IF we go northern route vs southern route. Get there a night or two before, especially IF I need a test or two there prior. Then surgery, probably another night + 2 more before leaving Austin. Then drive a quick 3 hours or so to Nacogdoches in East Texas and stay with my sister a few nights although might do hotel there just for the I "don't won't to be a bother" although I'm sure she will veto that.

Then head home.

Thanks again~!

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cornerbax
I'm trying to understand the process of the more common "LEFT" sided ablations for AFIB. I had a right sided Ablation for Atrial Flutter in which I was told was about as easy as could be as it was Right Sided and was a very small area. But for most, if AFIB is Left-Sided, when going through the Vein with a Catheter, is the process to go through to the right side and puncture the Septum to get to the Left Side? Or if the Mapping shows the Arrhythmia(s) are on the Left Side, is there a way to the Left Atrium without going through the Septum?

From my understanding, the Left Side (more common AFIB Side) is more sensitive in general due to the Esophagus and other organs? Thanks in advance for any more detail on this.

At least initially, a very high percentage of AF cases originate in the pulmonary vein ostia....the mouths. The only potentially (not really) reasonable access to the left atrium, where those mouths are, on the rear wall, would be up through the mitral valve or coming down one or more of those pulmonary veins. This would mean entering the pericardium and/or down the aorta into the left ventricle and up through the valve to perform the ablation, or entering the lungs or somewhere along the pulmonary veins and slithering the catheter down that path to the ostia where the lesions could be made. It is patently obvious that neither of these 'option's is the least bit practical due to the obvious risks involved, not to mention the horrible complexity. The alternative is to enter the groin, slither up the leg and into the right atrium, and then bend the catheter's tip and pierce the septum, which heals well afterwards.

The left atrium is more proximal to the esophagus, to the phrenic nerve, and even to the Vagus nerve. RF ablation involves touching tissue in the pulmonary vein ostia and applying RF, or thermal, energy to the tip so that it creates a burned spot. This takes a few seconds. During each, or any one of those burning processes, heat can travel through tissue and might cause similar tissue damage to either or all of those other items. Worse, the tip of the catheter might even penetrate into the myocardial tissue or the PV tissue and impart even more heat to those unwanted targets due to proximity. It might not be disastrous, but it has a very high probability of being so, especially if repeated several times during each of the catheter tip moves to an adjacent area of the ostium and applying the energy again.

If you are to have a PFA, it obviates the requirement to have a TEE. For RF ablation, you almost certainly will have that inserted while you are unconscious.

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Thank you for your reply. I'm hoping for September but have no idea IF that is too optimistic on my part or wishful thinking on my part due to his high demand and wait list.

In my experience, it is very difficult to project when you might get a date for your ablation as it is not strictly a first come first serve situation, but rather each patient’s situation is considered individually. If I were you, I’d get on the cancellation list as it is not a matter of “come tomorrow“ —you have a bit more notice than that generally. You are asked to stay in Austin for several days after the ablation where they keep in touch with you in case you need attention.

I was wondering about that for sure Daisy on the urgent or more sooner than later cases vs a first come first serve method. I’ll definitely let Norma know to add me to the cancellation wait list.

Thank you, Daisy for excellent information on scheduling!

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Qwackertoo
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I was wondering about that for sure Daisy on the urgent or more sooner than later cases vs a first come first serve method. I’ll definitely let Norma know to add me to the cancellation wait list.

If you aren't currently on a blood thinner, I believe you need to be on one for 14 days prior to the ablation. Hence, once on the cancellation wait list, you need to be consistently taking a blood thinner so you'll be sure to have been on it for 14 days prior, if you are offered a date with a short trigger.

Thank you, George. Yep on Eliquis. When I first started, sometimes I would forget my a.m. dose as I had always only taken 1 pill @ night, thyroid medication. And now also Atorvastin Calcium 40 g which seems odd to me and I have questioned the dosage in the past and had it reduced from 80 to 40 as all my numbers are now excellent and have stayed that way. The calcium part now bothers me since any excess calcium is seen as a negative when it comes to AF.

And to reinforce my decision to travel to Texas to Natale, received the "report card" yesterday via local medias for our hospital with my EP in which the hospital scored a Big Fat F.

I got a physical consultation in October. The guy I’m considering doesn’t do virtual. Who knows how much longer afterwards is his wait list for a pvc ablation. All I know is I can’t wait much longer because my heart is declining.

I’m happy to hear that you don’t have to wait long.

I've just canceled my June 18th Watchman procedure (and any needed touch-up/ablations) with Natale in Austin. Maybe this will provide an opening on the cancellation list. I've had 2 ablations with Natale and think the world of him, but have found a local LA EP who is very good with Watchmans.