CAFE instructional videos?

Has anyone had success finding good CAFE ablation instructional videos on the net?

So far all I've been able to dig up are really superficial ones, which breeze over what is actually being displayed ("see it's squiggly before, now it's not" ), without being precise about exactly where the lesions are being laid down and their corresponding impact on the displayed waveforms.

Thanks in advance.

The more recent AF mapping research on scarred areas and electrical activity have changed the picture regarding CFAE. As originally interpreted by Nademanee, CFAE areas were thought to be scarred regions driving AF. The DEMRI results and electrogram mapping results show that CFAE areas are in fact where healthy heart muscles exist. The scarred areas are low voltage areas with little activity. Marchlinski, jais and others presented on these results recently. They also found that drivers of AF reside in the low voltage areas and ablating those areas improved success significantly compared to CFAE ablation. This is very similar to VT ablation after a heart attack. St. David's group is finding that ablating entire scar area(s) improved VT ablation success a lot.

See first video in the following link.

[www.innovationsincrm.com]

Another quick point here researcher and apache,

I don't have the time to go more into it until the newsletter is finished soon, Im on the home stretch and shooting for Wednesday but little time for anything else at the moment.

Nevertheless, its important to understand as researcher pointed out that top tier high volume ablation centers like St Davids and Bordeaux, Univ. of Penn, Univ. of Kansas etc, do not just ablate every CAFE seen on an electrogram screen,.. not even close. At one point long ago that was a protocol, but quickly fell out of favor among the most experienced operators as they discovered their own methods of fine tuning targeting of these Focal triggers where ever they are located and being more targeted and selective in which are deemed active triggers likely driving on-going arrhythmia and then ablating only those areas and not every CAFE seen by any means.

And as researcher noted these focal trigger areas or hot spots (regardless of the name de jour given to them) often occur in low voltage tissue where AFIB has been active and often scarring thus laid down. They also are common at the fringe perimeter of scarred zones kind of like at the leading edge of a brush fire where the center section may already be mostly 'burned out' (i.e. low voltage) except for perimeter rims of these zones which can be very active or within random focal hot spots within the low voltage regions which can be good targets for ablation.

Anyway ... one trial, STAR-AF-2, used an empirical fixed CAFE protocol to compare extended ablation to PVI alone in persistent AFIB,. That protocol did NOT address such targeted select non-PV trigger ablation as the extended protocol as both Bordeaux and Dr Natales groups do .., and as such the equivocal results of STAR-AF -2 which were very mediocre for all arms investigated in that study, mainly highlight the need to chose a highly experienced persistent AF ablation center where they do a majority of such cases and are not married to only doing fixed empirical CAFEs where all CAFES everywhere above a broad criteria of measure are ablated. Professor Haissaguerre also underscored this fact in his discussion of their experience with the Cardio-insight vest where he made it clear too that STAR-AF-2 said nothing at all about extended ablation protocols for persistent AFIB using such targeted non-PV trigger detection and ablation as the core of the extended real time portion of the ablation process.

Shannon