Question for Bordeaux ablatees & Shannon

I'm just wondering whether folks here who've had a successful procedure at Bordeaux required just the one procedure or a touch-up/second procedure also?

Shannon, do you have any info in this regard please?

Thanks,

Mike F

I'll be shocked and amazed if Shannon has numbers like that for the Bordeaux group, but I think it's safe to say that only a small percentage of patients at elite centers like Bordeaux and TCAI need second procedures.

Mike

I had my ablation in Bordeaux in January 2003, after many years of paroxysmal AF and 18 months of long term persistent AF, so I was probably a difficult case.

They did all the lines that were known to work at that time, ie isolated all 4 pulmonary veins, roof line, and line from the left inferior pulmonary vein to the mitral annulus. They also did the right side flutter line 'on the way out'.

Two days after the ablation AF recurred. Within a couple of hours I was back in the lab for a second procedure. Afterwards Professor Haïssaguerre said that he thought their might be a gap in one of the lines but this was not the case. There was a particularly toxic focus in the coronary sinus which was extremely difficult to find and ablate, and he said he wasn’t sure if he had managed to get all of it.

Happily I have been in sinus rhythm since then. Occasionally it feels as though AF is trying to start up but I am not worried - an EP in London once told me that the lines would not prevent AF from starting, but would stop it from sustaining itself.

I get a LOT of ectopic beats, up to 8000 on a 24 hour Holter, which used to be very uncomfortable. But I take magnesium, potassium, taurine and d-ribose every day, which seems to dampen them down - they still happen but I don’t notice them.

(Ms) Gill

Gill,

I have a similar issue as you. With afib feelings but its not kicking in, thank the Lord. I have however for whatever reason began having the ectopics after 1.5 years post (2nd left atrium) ablation. Do you mind me asking your doses to settle down the ectopics,
Thanks

Tim

Tim

I follow Jackie's instructions - perhaps she will jump in here. Everyone is different and you have to experiment to find what works for you. The doctors in Bordeaux say that ectopics are a nuisance, not a problem - worth remembering that.

I started with magnesium to bowel tolerance, made no difference to the ectopics. Then I added potassium, still no difference. Added taurine, slight improvement. Added D-Ribose and I thought the ectopics had stopped; however a 24 hour Holter showed just as many, I just don’t feel them any more.

Now each day I make up a 'potion' using:

Waller Water concentrate to bowel tolerance, adjusting the amount each day as needed (recipe for Waller Water is somewhere on this site)
Now brand potassium gluconate powder, 6 teaspoons
Taurine powder, ½ teaspoon
D-Ribose powder, 2 scoops (scoop comes with Doctor's Best brand).

And I also take Country Life Chelated Magnesium - 3 tablets

I have a blood test every 6 months or so to check levels and kidney function because any excess magnesium or potassium is excreted by the kidneys.

A lot of supplements are very expensive, not as strong, or not available in UK. I travel to the US a couple of times a year and bring loads back with me. Waller Water is great - cheap, and easy to make in UK, gives me lots of magnesium.

(Ms) Gill



Edited 2 time(s). Last edit at 03/21/2018 01:08PM by Gill.

Here is Jackie's PDF: <[www.afibbers.org]

Here is the Waller Water (magnesium bicarbonate) recipe: <[www.afibbers.org]
I have drunk this as a concentrate.
You can purchase magnesium hydroxide powder in bulk: <[www.amazon.com]
I've made magnesium acetate from milk of magnesia (magnesium hydroxide) & organic apple cider vinegar in a 2:7 ratio. Magnesium acetate will convert to magnesium bicarbonate in the body. I use this fairly commonly. A recipe is here: <[www.afibbers.org] More info on mag bicarb: <[www.dropbox.com]

George

Thanks George, I didn’t have time to dig out the links.

Gill

Hi Tim - As Gill wisely points out, we are all different in nutritional status of the core nutrients that help support both electrical conduction as well as the underlying overall nutrient status. What is great for one, might be overload for another.... The Strategy is general guidelines for which nutrients can help with heart support and overall well-being in that regard. It really needs to be updated because there are other considerations that we've since learned about that help as well...but those are the basics. So much depends on 'individuality.'

If you would like me to help get you started, send me a PM and I'll be glad to help review what you're currently doing and see what else might help. Dosages are individually unique as well and worth investigating.

I definitely agree that the alkalizing effect on one's pH is a very important factor and usually overlooked and is a great way to consume that form of magnesium as the bicarbonate is so unique and healing. I would not ever want to be without the WW.

Jackie

(Please forgive any typos for the time being as I’m typing this parked in my car on an Iphone with my currently impaired right eye vision and will try to correct any mistake later when I get home to my computer screen)

Carey we do have a long history of tracking Bordeaux patients from EU and Canada. In fact, from the 2005 through 2009 period (perhaps into 2010) Hans Larsen the creator of this wonderful modest-size oasis in the Online AFIB universe and who is a career chemical engineer from British Columbia whose 50 year career included his analysis of huge numbers of chemical engineering studies and Meta-analysis’, such that he applied that skill in conducting a number of very well-done patient survey studies in past archived issues of The AFIB Report that are freely available to read or download from our AFIB Report archives.

And often the two most frequent centers/EPs whose track records were accounted for in this series of very well done patient surveys from among our group’s ablation patients were, not surprisingly, often past Dr Natale patients at his various center, and also the next most frequent EPs work reflected in these surveys was from Michel Haissaguerre/Pierre Jais/Melene Hocini from The Bordeaux group ... also not surprising as our then ‘go to’ best choice for EU and Canadian patients who did not live in the US and had no US insurance.

It’s been close to 9 years now since our last official patient surveys and there are obvious limitations in these type of volunteer survey studies, but we very much did find Dr Natale at Cleveland Clinic, CPMC, St Davids and at Scripps to range right at the very top in terms of satisfied customers across these surveys, with the least amount of reported procedures/total work required for durable freedom and/or longer term satisfied customers, and the Bordeaux group was right up there very close to Dr Natales stats captured from our group stats with the next most ablations done by a single group.

It is an anecdoteal reporting to be sure, but powerful anecdotal survey reports that Hans made sure were structured with as much rigor as possible considering the nature of the these kind of patient survey reports. And in many ways, these surveys are quite accurate reflections from our forum experience too with different EPs and groups though, of course, are much less accurate when a given EP was reported on who only had a few Ablations included in these surveys

All these survey studies are available free online in our AFIB Report archives from our group. And while we had the most respondants, by far, from Natale patients and thus he had the most data reported,

That also means that if he were having any significant problems those too would be far more likely to have shown up as well and same with Bordeaux as the next highest volume Center we had a good number of patient reports from back in that era of these surveys.

It is not surprising to see Dr Natale centers have the most data points reported with such a strong US concentration of patients on the forum, and the Bordeaux group was clearly the next most reported group with a good number out of the total cohort of EPs who were represented by those patients participating in all these surveys coming from Bordeaux (largely from our EU and Canadian patients who clearly got our message about NOT compromising on choosing the most exoerinced ablationist they possibly could travel .. even very long distance ... to put their hearts care into such elite operators hands.

Even for Canadians, especially back 10 plus years ago before Dr Natale pushed the field toward recognizing the LAA and Coronary sinus as key under-recognized sources of ongoing atrial arrhythmias that were not even being looked for, much less recognized and addressed, in more advanced cases of challenging arrhythmias like persistent and LSPAF, it still made sense to fly to France to get the best care they could afford paying out of pocket since back then a non insurance ABL, paying cash in Bordeaux was around 15,000 Euro, while going to Austin cost $40,000 for Canucks (or anyone else) who were uninsured in the US and thus paying cash. it’s actually not that much of a difference especially if your car likely has active LAA triggers as a prime source of ones arrhythmia.

I have clearly seen over the last 6 years of far more in-depth releasing of ablation reports from a wide range of EPs and groups , including a decent number still from Bordeaux and, by far, the larger number of Ablation reports from Andrea Natale patients Also show, by far, the lowest number of recorded reconnections reported in a second or third Ablation Report in which he performed the Index Ablation on the patient and then I got the ‘touch up’ ABL Report when a given patient required more work to fully achieve durable freedom from all atrial arrhythmia longer term .... and in which the comparison EPs Ablation reports also reflected what percentage of their own repeat follow up ablations on cases they also had done the Index ablation on had a significant reconnection rate.

Clearly, I’ve got the most accurate numbers from Dr Natale due, in part, to the overwhelming majority of his cases represented in the stacks of Ablation reports sent to me regularly from all comers on our forum, and also due to Natale’s unprecedented experience-level especially with over 75% of his total annual Case load representing persistent and LSPAF patients ... again an unheard of number of such challenging cases compared to any other EP in the world I am aware of!

Plus, another contributor to Natale’s vanishing low reconnection rate of ~3% to 5% from the literally hundreds of his ABL reports I have read, is also due to his adoption of the ‘Gliding Catheter technique’ he developed and pioneered and that a number of his protégés have also adopted. Even otherwise elite level EPs who are still doing mostly the standard ‘dot by dot’ perpendicular Catheter angle into the atrial tissue method, don’t seem to crack the 12% to 15% reconnection rate on patients they also did the Index ABL on, and that is favoring in the big improvement in lower reconnection rates made possible by skillful application of the newer contact force catheters!

Before contact force catheters and just using the ‘dot by dot’ technique that still roughly 95% of EPs using RF ablation rely on for the vast majority of their ablation lesion creation, it was not unusual to see big time operators at high volume centers with a 15% to 25% reconnection rate on work they had already ablated in an index procedure ... and that was really good in that context!

The average EP doing a typical Anatomical-only PVI and maybe some Posterior wall ablation for the more adventurous of such typical modest scale operators, it was not uncommon to see from 50% up to 90% reconnections in work some of these average experience had already done in an Index ablation, and then found large percentage of these prior ablated lesion reconnected during the EP study portion of a second ablation in which they had done the Index ablation!

Luckily, there has been a big drop in reconnections among those skilled in contact force Catheter ablation, but Im convinced too from what I’ve seen in recent years through my unique window on so many different EPs ablation reports, that significantly lessor reconnection rates can still be achieved by also mastering the Gliding Catheter technique in all
those areas of the left and right atrium where it might be appropriate to use.

Hope that gives you some more nuance to consider Mike F. Its not all just a black and white analysis.

The next lowest reconnections rate I’ve had the opportunity to see have been from a few of Dr Natales protégés also employing the gliding catheter technique as well as often using the Smart Flow Smart Touch Catheter that is near Ideal for the gliding catheter method, this SFST catheter also includes an irrigated tip creating a true laminar envelope of cooling fluid around the entire metal tip even when the Catheter is laid parallel and flat on the atrial tissue surface!! Plus, it also has a contact force sensor in the head as well.

Cheers!
Shannon

Wow. Many thanks Shannon. I think! Unfortunately Natale or one of protégés isn’t an option for me....... Bordeaux is pretty much as good as it’s going to get..... I’m guessing that they’re not (yet, at least) using the ‘gliding catheter’ method to avoid reconnection at Bordeaux.... I’ll ask and see. From the timbre of your post I’m guessing that they do not. Here’s hoping that if I go I’ll be in the 85% of paroxysmal AFrs that don’t get a reconnection. As an aside, even the cryo-balloon continuous (rather than point to point RF) approach used by EPs like Prof. Schilling in London achieve 80% success first go and 90% second go and, as such, are still presumably encountering some PVI reconnection problems.

I’m interpreting your message in overall terms that Jaïs nd Hocini arevstill by far the best bet for me over anyone here in the U.K. including Schilling and Ernst?

Many thanks again Shannon and with best regards,

Mike



Edited 2 time(s). Last edit at 03/21/2018 05:50PM by mwcf.

Thanks Gill, much appreciated