Ablation Bubbles

Ablation at CCF – to Jim W. and others

A couple of things came to mind when I was reviewing your reports. You mentioned during the procedure, you heard Dr. Natale talking about bubbling. I remember the attending MD telling me ( when I was in CCF this spring on one of my emergency visits) that the ICE monitoring device allows them to see when the tissue is overheating by the appearance of microscopic bubbles… This tells them it is too hot and to dial down. He commented that too much heat produces the stenosis. (sounds logical.)

A report I have says the Intracardiac echocardiography (ICE) is vastly superior to fluoroscopy. Studies have consistently found distinct advantages of ultrasonographic guidance at each step of ablation for AF. which allows:
1)Real –time imaging of the highly variable PV ostial anatomy
2) Confirmation of correct catheter position at the PV ostium –
3) Recognitiion of PV stenosis when it occurs
4) Visualization of clot formation during the ablation
5) Identification of proper electrode-tissue contact
6)Early detection of pericardial effusions
7)Visualization of the intra-atrial septum during the transseptal puncture.

So at least you can rest assured you had the latest and most reliable equipment. That should be a comfort to you. I know it is to me.

Jackie

Jackie:
Thank you for your post. I wonder if they used that on me at Hopkins. Seems like Hopkins would have had it. Looks much superior to fluoroscopy. Less likely to lose track of where the loop mapping catheters are, or are headed. I'll have to save that post.

Pam

Jackie,
Thanks for the information. I took it on full faith that CCF had the very latest equipment and methods, and still believe so. I'm going back for a repeat Monday....finally, after almost seven weeks of A. flutter (with some brief interval relief from cardioversion and flecainide (which quit working early on.) My original PVI for fib. was Aug. 12. The follow-up appointment didn't come easy, but I'm elated that I finally have a chance to get it taken care of with finality...with hope and prayer. Flutter is harder to deal with than fib....until Dr. Natale, himself, prescribed mega doses of diltiazem that finally brought my heart rate down out of the 150-200 range. Best of luck to you! You'll be surprised at how well you feel once the anesthetic wears off. I'll be thinking of you on the 12th. Char

Oh, Char - thanks so much for your good wishes - but I the good wishes belong to you! I'm so pleased to learn you are going back... You've been on my mind a lot knowing that you were having a hard time. This time will be the "charm" for you - I just feel it.

I'll be thinking of you, too. Thanks for responding. Please let us all know as soon as possible how you are doing.

I trust that you are correct, and I'll be feeling great soon after. At least that's what I have my "heart" set on.

Sincerely, Jackie

Hi Char,

Just wanted you to know that I mentioned your case to Michelle. She referred to you as "Charlene". I also talked to Dr. Natale about the possibility of flutter in my case because I had a flutter ablation in 1999, and wanted to make sure it was sufficient. He said(and did) he would check it for me. He told me that usually when someone has flutter after an ablation for AF that it very well could be that the PVI was not complete, so if that is so, the touch up procedure should take care of your problem. If it is just plain flutter coming from the right side of the atrium, this is very easy to cure.

I will be thinking about you(this cyberspace stuff is wild sometimes when I think about it). I'm sure all will turn out fine.

Take care & be well,
Jim W.

Char,

Best of luck.

Newman

Natale is a co-author of a relatively recent article (I can't supply the link) comparing the efficacy of the ICA technique with older proven techniques. The article showed that ICE yielded a higher success rate with lower stenosis. Those data showed a 90% success rate for the ICE cohort.

To all,

Thank-you so much for your kind wishes. We're never alone, are we?
I'll be reporting back as soon as I can.... Char