A field report about Smackman's ablation today in Austin.
It all went very well, and it was very interesting watching much of it unfold with about 170 EPs from all over in the large amphitheater-like video education room at St David's Med Center.
It turns out Smackman has persistent but not long standing persistent and thus Dr Natale stopped just short of full LAA isolation after completing an otherwise complete persistent AFIB ablation when he found only a very small degree of post ablation signals from the LAA region. Under isoproterenol challenge he did notice a few very transient ectopic blips from the LAA, but considering his age in the mid 50s and the possibility that these brief blips may not turn into full triggers any time soon, he just ablated around the area to generally slow conduction some to the LAA region but without full isolation during this index ablation.
Good news too Dr Natale used the exciting new BioSense Webster Thermocool SmartTouch Contact Force catheter on Smackman and which he also used on Dennis C a few weeks ago as well! Being a pioneer leading EP really helps in getting trial samples just prior to FDA approval for the Smart Touch that is pending within the new month or two as it is. That can only help long term in consistency of ablations going forward.
And researcher, you might be interested to know Dr Natale was using mostly between 24 and 30 grams CF throughout with an occasional bump up to around 38 grams CF briefly in thicker areas like the LAA /Mitral Valve ridge. I also paid attention to esophageal temp while he was doing extensive ablation along the posterior wall of the LA and at no time did it go above 36 degrees C ... much lower than the typical cutoff point.
It's possible that the very brief blips of ectopics from the LAA will have to be addressed at some point should they prove to become an actual trigger source, but with everything else in his heart so quiet after the isoproterenol challenge and again, at his age and such, Dr N felt it best to take a wait and see on this potential last step. With the new built-in heart monitor Dr N implanted in Smackman today, and that is linked to below, it will 'reveal' if and when that ever might become needed as a touch-up down the road which is always a distinct possibility with persistent AFIB cases.
I had the pleasure to meet Smackman and his very nice family with his wife and grown daughter as well as sister-in law and his brother all of whom made the 8 hour drive trek from Louisiana.
Smack was looking good, though still a bit groggy, when I popped into his room only about 15 minutes after he had been wheeled in from recovery. I spoke to him again just a hour ago and he has been up and walking around already and feeling reasonably good and in NSR.
In addition to the new Smart Touch CF catheter, Dr Natale also installed the new Medtronics
Reveal LINQ implantable heart rate loop recorder, under the skin in Smackman's chest at the end of the ablation
This link above is to an Austin TV station video clip made today, Thursday around noon during the lunch break, an interview at the EP live 2014 conference in Austin today that was a combination of a separate interview with Dr Natale and a separate one with me that was spliced together. Originally, the part with me being interviewed was about them asking me what it was like to go between persistent AFIB and then suddenly being in NSR again after an expert ablation, at which point I said "Its like night and day ...." but in the editing room the TV folks took the liberty of splicing in the bit about the Reveal LINQ monitor as if that was what we were speaking about at the time a :-).
Now you know, or at least I now do, that even when you see someone saying something on TV, they might not
really be saying it, HA!
Actually, its fine in this case as it really is a cool little device and will really help in patient monitoring going forward after an ablation and was FDA approved just last week, but while it is a v dry welcome new addition it was hardly 'the star of the show' as the TV folks put a harmless spin on it.
In any event, I suspect Smackman will be released tomorrow and they are planning on relaxing a bit in Austin through the weekend before heading home on Sunday or Monday, and he has made a big step forward today toward ultimate freedom from AFIB.
Shannon
Edited 1 time(s). Last edit at 02/27/2014 09:50PM by Shannon.
