Different Ablation Procedures

Hi all,

This is my first post. I'm a 51 year old male and had my first AFib episode a little over 2 years ago. I was put on various meds and my heart righted itself after a few days. Since then I've led a normal healthy life. In between the two episodes I've ran 8 marathons (one of which was in Bordeaux funnily enough) and done numerous other adventure races and general endurance type 'stuff'.

Unfortunately I had another episode on New Years Eve, this time it didn't right itself by meds and I was CV'd last Thursday which worked until Saturday when I went back into AFIB (when I was doing the hoovering).

I'm seeing my cardio specialist again tomorrow and he was already suggesting that I consider ablation, which I'm keen to do, however I'm a little concerned over the different methods used and I wanted to understand what current best practice.

My cardio guy described it as they'd pass three catheters into my heart, monitor the electrical signals and then ablate the area that they believe to be at fault.

The EP guy who I met when I was CV'd explained that he passes a single catheter from my groin into my right ventricle, up into the right atrium and then through the wall of the heart into the left atrium where he ablates a specific area where one of the arteries (veins ?) meets the atrium.

To be honest, the idea of it passing through the wall of the heart scares the life out of me. It also seems that there's no real monitoring to find the right spot and it all seems a bit of a blunt tool.

Can anybody point me to an explanation of the various different ablation procedures and their success rates ?

oldrunnerdude, Sorry to hear that you are going through this. AF happens to many endurance athletes. RE - "The EP guy who I met when I was CV'd explained that he passes a single catheter from my groin into my right ventricle, up into the right atrium and then through the wall of the heart into the left atrium where he ablates a specific area where one of the arteries (veins ?) meets the atrium." The heart chambers are accessed via the femoral vein typically and the catheter goes into the right atrium first. Then a small access into the left atrium is done with a transseptal puncture. The right ventricle is not accessed and nor needed to be involved in an AF ablation. These steps to introduce the catheter into the LA chamber is very low in complication risks assuming you go to a high volume center. The standard ablation for paroxysmal AF is pulmonary vein isolation. Those areas are where the AF triggers are. There may be other problem areas and an experienced clinician will search for those and treat them as well.



Edited 1 time(s). Last edit at 01/26/2016 06:16PM by researcher.

The one thing that I would say to you is simply this: find the absolute best electrophysiologist that you can find (there is a list on here somewhere) and do not mess around while NOT in NSR. I will repeat that. The best you can find and do not mess around while not in constant NSR. My initial cardiologist, whom I trusted with my life, was busy selling colonics and travelling while my Left Atrium was expanding, to the point where an ablation procedure was simply not feasible. I was very fortunate to find one of the best and am having my ablation on Friday. I am unsettled at the thoughts of what they are going to do, needless to say, but at the same time am more than confident that my EP is indeed one of the best and that the numbers are in my favour.

I am ill qualified to comment on the different procedures although I am familiar with most of them. They are going into me from three locations with catheters Friday; two in my groin and one in my neck. And they are using a relatively new catheter that provides a three dimensional picture to work with, which can only be a good thing when mapping out and ablating errant nerves.

You are in the right place for solid information you may rest assured. Digest it all carefully as in the end it is YOU that are in control of what is going on.

Good luck to you.

Murray

Murray L

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Tikosyn uptake Dec 2011 500ug b.i.d. NSR since!
Herein lies opinion, not professional advice, which all are well advised to seek.

Thanks Researcher and Murray L.

I saw my cardio specialist again today and we went through some of my concerns. He explained the procedure in more detail, which ties in with what you said researcher, and I'm happy to go ahead with the EP that he's proposed.

I'm hoping to get a date for the procedure this week.

I echo what Murray said. Find the absolute best EP you can. If you are in the US, Natale in Austin, TX. Natale has done more ablations than anybody else in the world (>8,000). If you are outside the US, my choice would be the team in Bordeaux. They are arguably the #1 & #2 in the world. A lot of their patient load is related fixing problems caused by others.

For afib ablation, this is more important that you can imagine. Your probability of success is highly dependent on the operator and their team. Also the probability you don't have, not just a failed ablation, but a really bad outcome like tamponade (punching through the heart wall).

Our moderator, Shannon tried to impress this upon his afibber sister and insist she see Natale. Without informing Shannon, she went ahead with the locally highly recommended EP. It was a very bad outcome and she's now confined to a nursing home for the rest of her life.

I second what the others have said. The most important thing is the skill and experience of the person whose hands are on the catheters. Success rates can be in the percentage ranges of the 30s for inexperienced EPs and the 90s for elite EPs like Natale or the Bordeaux team.

Give yourself the best chance of a good result by choosing very carefully.

As most people here already know, I had my ablation for long term persistent AF in Bordeaux in January 2003 and have been in sinus rhythm since then.

Gill (female, pronounced 'Jill')

Since you are paroxysmal, you would typically be looking at either a radio frequency (heat) or cryo (cold) catheter ablation. The intent is to prevent the errant electrical signals from affecting the heart muscle by isolating them via scar tissue. In PAF research has shown that most of these signals originate in the Pulmonary Veins, so you will see the term "PVI" or Pulmonary Vein Isolation, which is the standard or index procedure. After that they will look for other areas of activity and ablate those if they exist. RF has been around the longest and is most used, Cryo is (I think) as effective, and there is a cryo-balloon technique which is also relatively new but showing promise. Here is a video that has helped me get a better grasp on what they are doing:

[www.youtube.com]

And here is a report from Silicon Valley Cardiology on success rates of their practice - from 2014 but still relevant:

[siliconvalleycardiology.com]

As others have said, experience is very important, so find the best EP you can.