Determining which cells to ablate

Just curious, and I apologize if this has been posted somewhere previously, but how does an EP determine which heart cells need ablation in order to correct arrhythmia? What is the process?

With the mapping catheter. That being said, it totally depends on the EP and his or her experience level. Any AF ablation is going to isolate the pulmonary veins by “drawing” a circle around them using the burning catheter (or cryoballoon, and this where cryo starts and stops - can’t do anything else). After that, more experienced EPs will start mapping the posterior wall of the left atrium, the coronary sinus, and even the left atrial appendage (LAA).

Ghost,

Here is a great 1 min video that explains the process.

[medmovie.com][/url]

Thank you both!

I watched the video, very enlightening. But does the heart need to be in afib in order to determine which cells need to be addressed?

No. It can be helpful to the EP doing the procedure, but it's not strictly necessary.

It's very rarely the case that an EP cannot quickly trigger AFIB in a person prone to AFIB who appears in the EP-Lab in ablation morning in NSR. That is very common especially with PAF patients (paroxysmal AFI who often are in NSR when they check in for an ablation. Keep
in mind that you typically will not find a persons coming for an ablation who has been in long term NSR with little to now intervening AFIB/AFlutter, such folks who are having even sporadic AFIB are, by definition, "prone to having AFIB episodes".

Experienced EPs have no problem triggering AFIB on demand during an ablation either via elaborate pacing algorithms that robustly trigger AFIB in such folks who are prone to AFIB or in worst case scenario they can blast them with 10 minutes of Isoproterenol at 20mcg/min infusion while the patient is out cold on the table and that will surely bring out the beast if the person is at all ... that is why the EP, or their staff in charge of approving people for ablations, require a recent EKG (almost always with a 12 lead EKG or a Zio Patch report etc. confirming recent AFIB/Flutter before signing someone up for an ablation.

Isoproterenol is highly effective at ferreting out a latent but still active AFIB trigger during a procedure.

Shannon

I don't pretend to understand all of that, but I got the basics. You don't need to be in afib for the doc to figure out what cells need ablation.

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Ghost
You don't need to be in afib for the doc to figure out what cells need ablation.

Nope.

You just need the right doctor!