Confused now - Dr. Natale just liked this post

[twitter.com]

"PVI (with current energy sources) can cause collateral damage."

Isn't PVI what Dr. N does?

Perhaps — like we all have done — google scholarly sites instead of IMHO Twitter to get answers.
[www.ncbi.nlm.nih.gov]

Or many other sites that may help by googling “afib pvi ablation scholarly articles”. Good luck.

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susan.d
Perhaps — like we all have done — google scholarly sites instead of IMHO Twitter to get answers.
[www.ncbi.nlm.nih.gov]

Or many other sites that may help by googling “afib pvi ablation scholarly articles”. Good luck.

The person who made the twitter statement NLAMA quoted is cardiologist Dr. Oussama Wazni, head of electrophysiology at Cleveland Clinic. I too find it interesting that Dr. Natale seemingly agrees with the statement ("PVI (with current energy sources) can cause collateral damage") by liking and retweeting it. Twitter is actually a very good source of information if you know how to use it for that purpose.

Maybe not the right article since after reading it, it mentioned 2013. Lots of advancement since, plus Dr N is probably the best at it, which I speculate would considerably lower the risks. I still believe you should check out scholarly studies.

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PoetKim
Twitter is actually a very good source of information if you know how to use it for that purpose.

You are right. I just worry by- posting a broad statement that Twitter can scare people because anyone can post...with the exception of qualifying medical people who uses Twitter to post.

Wow! I took a look who (76) was following Dr N on Twitter. The list includes president Trump, brothers Chris and Andrew Cuomo, governor of Texas, Anderson Cooper and many others. Quite impressive!

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susan.d
Wow! I took a look who (76) was following Dr N on Twitter. The list includes president Trump, brothers Chris and Andrew Cuomo, governor of Texas, Anderson Cooper and many others. Quite impressive!

Dr. N is a celebrity!

Hey NLAMA,

My take is that this issue isn't nearly so consequential as it my appear to you at first glance, this back and forth between Dr Natale and Dr Ousamma Walid (a former colleague who worked under Natale when Dr N. was Director of Cleveland Clinic's AFIB program during the early 2000's) is easy to misunderstand when read out of context and with the limitations of twitter as well..

Of course, lesion's are created as the very foundation of every RF and CRYO ablation, and will be for future PFA ablations as well, the difference with PFA is that the 'lesions' are in the form of micro-pores quickly created by electroporation, rather than by RF burns or CRYO freezing.

PFA targets only cardiac myocytes found in atrial tissue, and any adjacent non-cardiac-myocyte tissue around the desired PFA-applied area is spared even the very modest spread of 'collateral' thermal impact to the immediate adjacent area as occurs to a modest degree with the two current thermal ablation energy sources.

Yet, the actual areas were these PFA micro-pores are placed still results in selective cellular death to those specific cardiac myocytes that are uniquely sensitive to electroporation. And this, in order to terminate fibrillating triggers in specific areas in the left and right atria to achieve durable PFA ablation.

However, keep in mind that we are taking about relatively small and narrow lesions even when created by RF or CRYO, and they heal up nicely in about 8 to 12 weeks, tops. There isn't any lasting cardiac degrading 'damage' in most all of the areas in the two atria in which RF or CRYO ablation lesions are specifically applied. The one exception being the impact on mechanical function when RF-based LAA isolation is required to achieve lasting LAA-isolation and thus restore durable NSR to persistent or LSPAF patients..

The vast majority of where all of the 'non-LAA' RF lesions are made in both the left and right atria does not impact the mechanical function/pumping of the heart!

In my view, this short tweet by Dr. Walid to Dr Natale simply reflects the lack of even modest 'collateral' impact to adjacent cellular structures surrounding the desired cellular zapping achieved by PFA electroporation.

And this twitter discussion was simply to highlight the main advantage of electroporation, even though both RF and CRYO are impressively safe and effective modalities, as it is, especially in experienced hands.

I have no doubt that if either Dr Natale or Dr Walid knew that their very minimal comments to each other on Sunday might cause such concern on an AFIB forum, they would have more fully explained the larger context of their brief and relatively benign Twitter comments. :-).

If you run across any such potentially confusing comments or statements on social media that seems to run counter to what you have learned about AFIB ablation, just drop
me or Carey a PM and we'll try to put it in all in a real-world context.

Alas, it is late here and now I'm falling asleep while typing, which is my clue to dive into dreamland. I'll return to this thread tomorrow and hopefully this post will help clear up any confusion others too may have had over this one small tweet.

Back at you in the morning with more ... sweet dreams all ... zzzzzz

Best wishes
Shannon



Edited 2 time(s). Last edit at 07/27/2020 11:13AM by Shannon.

Thanks Shannon - I knew there was some kind of nuance to this and I tried to use
Ask Jeeves to find out more about "the convergent" but really didn't find any solid leads.



Thanks Susan - I've heard about this 'googling thing' but haven't looked into it yet. Sounds interesting.

Still undecided if I should get on the Face Book or the My Space. I'll see what Ask Jeeves thinks.

Feel free to write me directly at dumbazz87@aol.com

I will take my Results from my two Catheter Ablations with Dr. Natale to draw my conclusion. As of July 28,2020 I am doing great. I do realize one day I could have another “jumper”. If that happens, I will consult TAC in Austin and make a plan with there guidance.
Honestly, I am thankful for Life. Life is Good.