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conference
Posted by bettylou4488
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conference October 14, 2020 12:55PM |
Registered: 6 years ago Posts: 524 |
does this look like it could be good? $47 is not a lot.. but I also don't want to spend $ on stupid. Thoughts? (It came up on an ad on FB LOL.!)
[getinrhythm.com]
[getinrhythm.com]
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Re: conference October 14, 2020 02:57PM |
Registered: 10 years ago Posts: 2,520 |
Thanks Betty!
I read the schedule. I would had been interested if some of the topics would include supplements to tame AF, triggers, tests to take (ie EXA,), left side sleeping vs right, vagal etc.
Dr Natale will speak I think. Is this an AF 101 conference to educate newly diagnosed patients or will the discussion include new info that has not already been discussed here on the forum?
I read the endorsements. Mellanie True Hills, founder of StopAfib.org simply had her LAA surgically removed and she is af free? No ablation? No RF of AF pathways she developed? Same with the skydiver testimonial. I never read here on this forum that one can skip an ablation and go straight to a maze and become AF free. If that is the case, then why do EPs recommend an ablation? I don’t get it.
I’m Mellanie True Hills, an afib patient and survivor who has been afib free for more than 14 years after undergoing a surgical procedure. In September 2005, I underwent a mini maze surgery and removal of my left atrial appendage, and I became afib free.
Edited 4 time(s). Last edit at 10/14/2020 04:23PM by susan.d.
I read the schedule. I would had been interested if some of the topics would include supplements to tame AF, triggers, tests to take (ie EXA,), left side sleeping vs right, vagal etc.
Dr Natale will speak I think. Is this an AF 101 conference to educate newly diagnosed patients or will the discussion include new info that has not already been discussed here on the forum?
I read the endorsements. Mellanie True Hills, founder of StopAfib.org simply had her LAA surgically removed and she is af free? No ablation? No RF of AF pathways she developed? Same with the skydiver testimonial. I never read here on this forum that one can skip an ablation and go straight to a maze and become AF free. If that is the case, then why do EPs recommend an ablation? I don’t get it.
I’m Mellanie True Hills, an afib patient and survivor who has been afib free for more than 14 years after undergoing a surgical procedure. In September 2005, I underwent a mini maze surgery and removal of my left atrial appendage, and I became afib free.
Edited 4 time(s). Last edit at 10/14/2020 04:23PM by susan.d.
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Re: conference October 14, 2020 04:20PM |
Admin Registered: 6 years ago Posts: 5,358 |
That's a conference put on by the folks at stopafib.com. It's a reputable organization and their conferences get good reviews.
Yes, Mellanie True Hills had a Maze procedure back in the early 2000s, but don't take her results as typical. Maze procedures are heart surgery and come with all the risks and recovery time that involves. Even the minimally invasive mini-Maze procedure means weeks of recovery and significant pain. And then when it comes to success, one of the most common complications of Maze procedures is atrial flutter (AFL). And how do they treat AFL? With an ablation, of course. So if you go right to a Maze as first choice, there's a good chance you'll spend 6 weeks in discomfort recovering and then need an ablation anyway. That's why EPs don't go right to Maze. Personally, I looked into Maze very carefully for myself at one time and I'm no fan. It's an overrated procedure.
Yes, Mellanie True Hills had a Maze procedure back in the early 2000s, but don't take her results as typical. Maze procedures are heart surgery and come with all the risks and recovery time that involves. Even the minimally invasive mini-Maze procedure means weeks of recovery and significant pain. And then when it comes to success, one of the most common complications of Maze procedures is atrial flutter (AFL). And how do they treat AFL? With an ablation, of course. So if you go right to a Maze as first choice, there's a good chance you'll spend 6 weeks in discomfort recovering and then need an ablation anyway. That's why EPs don't go right to Maze. Personally, I looked into Maze very carefully for myself at one time and I'm no fan. It's an overrated procedure.
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Re: conference October 14, 2020 04:28PM |
Registered: 10 years ago Posts: 2,520 |
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Re: conference October 14, 2020 05:00PM |
Registered: 11 years ago Posts: 4,228 |
Quote
susan.d
Carey- how can a maze “ AF cure” have a higher success rate than a RF ablation? Or does it? Was she just lucky?? One still has pathways after a maze that continues to fire AF signals. Right? Am I wrong?
Here is Shannon's comment on the maze/mini maze topic in 2017 [www.afibbers.org]
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Re: conference October 14, 2020 06:39PM |
Admin Registered: 6 years ago Posts: 5,358 |
Quote
susan.d
Carey- how can a maze “ AF cure” have a higher success rate than a RF ablation? Or does it? Was she just lucky?? One still has pathways after a maze that continues to fire AF signals. Right? Am I wrong?
I don't know who's claiming Maze has a higher success rate than ablation. I've never seen any stats comparing them. I wouldn't say she's lucky, that's putting too strong a negative spin on it. A Maze procedure essentially does the same thing as an ablation, but it uses a scalpel to make the scars instead of a catheter. So in both methods you still have tissue firing away with chaotic AF signals, but they're fenced in by scar tissue so those signals go nowhere. I've been in NSR for three years now but I'm sure if you put a mapping catheter into one of my pulmonary veins, you'd find the ECG display completely lit up with AF.
It would be hard to provide more details than Shannon did in the post George linked, so go read that and it should answer anything you don't understand.
BTW, there are videos of Maze procedures on youtube. For example.
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Re: conference October 14, 2020 09:39PM |
Registered: 10 years ago Posts: 1,748 |
Carey:
You said; So in both methods you still have tissue firing away with chaotic AF signals, but they're fenced in by scar tissue so those signals go nowhere. I've been in NSR for three years now but I'm sure if you put a mapping catheter into one of my pulmonary veins, you'd find the ECG display.
Are you saying that even after an ablation you still have "chaotic AF signals" but they just can't reach the ventricals? i did not know that, i guess I thought after an ablation you were clear of those AF signals.
You said; So in both methods you still have tissue firing away with chaotic AF signals, but they're fenced in by scar tissue so those signals go nowhere. I've been in NSR for three years now but I'm sure if you put a mapping catheter into one of my pulmonary veins, you'd find the ECG display.
Are you saying that even after an ablation you still have "chaotic AF signals" but they just can't reach the ventricals? i did not know that, i guess I thought after an ablation you were clear of those AF signals.
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Re: conference October 14, 2020 11:29PM |
Registered: 10 years ago Posts: 2,520 |
Elizabeth, me too. I thought an ablation created a scar barrier for new pathways. I thought one would not have potential mapping firing while in nsr. Carey- this is educational- can you elaborate on how in your case, you speculate you have af firing pathways yet you have a steady nsr heart without symptomatic af arrhythmia? Thanks.
Because if that is the case, any EP can perform an ablation and see firing and ablate. Only once an ablation is completed and they drug you to induce AF, a nsr heart with no visible mapping means the ablation is over.
Because if that is the case, any EP can perform an ablation and see firing and ablate. Only once an ablation is completed and they drug you to induce AF, a nsr heart with no visible mapping means the ablation is over.
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Re: conference October 14, 2020 11:40PM |
Registered: 10 years ago Posts: 2,520 |
Quote
GeorgeN
Carey- how can a maze “ AF cure” have a higher success rate than a RF ablation? Or does it? Was she just lucky?? One still has pathways after a maze that continues to fire AF signals. Right? Am I wrong?
Here is Shannon's comment on the maze/mini maze topic in 2017 [www.afibbers.org]
Thanks George. What does CA stand for?
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Re: conference October 15, 2020 12:13AM |
Registered: 6 years ago Posts: 524 |
Quote
susan.d
Thanks Betty!
I read the schedule. I would had been interested if some of the topics would include supplements to tame AF, triggers, tests to take (ie EXA,), left side sleeping vs right, vagal etc.
Dr Natale will speak I think. Is this an AF 101 conference to educate newly diagnosed patients or will the discussion include new info that has not already been discussed here on the forum?
I read the endorsements. Mellanie True Hills, founder of StopAfib.org simply had her LAA surgically removed and she is af free? No ablation? No RF of AF pathways she developed? Same with the skydiver testimonial. I never read here on this forum that one can skip an ablation and go straight to a maze and become AF free. If that is the case, then why do EPs recommend an ablation? I don’t get it.
I’m Mellanie True Hills, an afib patient and survivor who has been afib free for more than 14 years after undergoing a surgical procedure. In September 2005, I underwent a mini maze surgery and removal of my left atrial appendage, and I became afib free.
yea I really don't know.. started reading the comments in the thread on FB regarding it and I'm not so sure if it is a good looking conference or not really. always on the search though right??
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Re: conference October 15, 2020 12:41AM |
Admin Registered: 6 years ago Posts: 5,358 |
Quote
Elizabeth
Are you saying that even after an ablation you still have "chaotic AF signals" but they just can't reach the ventricals? i did not know that, i guess I thought after an ablation you were clear of those AF signals.
Yes, you still have chaotic AF signals after an ablation. The cells generating those signals are still firing away, but they're electrically isolated from the rest of the heart by the scar tissue of ablation lines surrounding them. The signals can fire all they want but they go nowhere.
And that's explained by an interesting historical bit about ablations. Back around 1998, they did actually ablate the cells producing the chaotic signals and eliminate them. Dr. Haissaguerre in Bordeaux France discovered that the chaotic signals almost always originated in the pulmonary veins, so he went in and ablated the offending cells. This worked fairly well, but they discovered that ablating the insides of those veins often caused a narrowing of the vein (stenosis), which can cause difficulty breathing. So in 2001 Haissaguerre decided instead to leave the veins alone and just ablate a circle around where they entered the heart. And with that, the Pulmonary Vein Isolation (PVI) procedure was born. Probably 100% of the people here who've had an ablation have had a PVI.
So that's how we ended up with ablations leaving the offending cells still firing but stopping the AF anyway.
Oh, and Maze procedures work the same way. They don't stop the chaotic signals either, they just surround them with a fence of scar tissue.
Edited 1 time(s). Last edit at 10/15/2020 12:45AM by Carey.
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Re: conference October 15, 2020 01:37AM |
Registered: 10 years ago Posts: 2,520 |
Quote
Carey
Yes, you still have chaotic AF signals after an ablation. The cells generating those signals are still firing away, but they're electrically isolated from the rest of the heart by the scar tissue of ablation lines surrounding them. The signals can fire all they want but they go nowhere. So in 2001 Haissaguerre decided instead to leave the veins alone and just ablate a circle around where they entered the heart. And with that, the Pulmonary Vein Isolation (PVI) procedure was born. Probably 100% of the people here who've had an ablation have had a PVI.
So that's how we ended up with ablations leaving the offending cells still firing but stopping the AF anyway.
Which brings me to a nagging question I’ve had since my overdose/ICU. An EP walked into my icu room and drew a drawing of a heart on the blackboard and then drew donut circles around his PV drawing. He explained if he did a PVI cryo ablation then the firing signals won’t penetrate and my AF would stop. He went on to say only those who had af afterwards were caused by a gaps in scar tissue formation and a second ablation would be needed to touch up the PVI’s scar barrier.
So why do folks who had a skilled EP perform a successful PVI isolation and AF returns? Many then go and get a LAA (or two) , CS, left atrial septum, superior vena cava, posterior wall, LA roof line, floor and inferior posterior lines etc. isolated if all that Haissaguerre did (and you explained above) was a PVI to isolate the wall from AF returning?
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Re: conference October 15, 2020 04:16AM |
Registered: 5 years ago Posts: 146 |
Quote
susan.d
Yes, you still have chaotic AF signals after an ablation. The cells generating those signals are still firing away, but they're electrically isolated from the rest of the heart by the scar tissue of ablation lines surrounding them. The signals can fire all they want but they go nowhere. So in 2001 Haissaguerre decided instead to leave the veins alone and just ablate a circle around where they entered the heart. And with that, the Pulmonary Vein Isolation (PVI) procedure was born. Probably 100% of the people here who've had an ablation have had a PVI.
So that's how we ended up with ablations leaving the offending cells still firing but stopping the AF anyway.
Which brings me to a nagging question I’ve had since my overdose/ICU. An EP walked into my icu room and drew a drawing of a heart on the blackboard and then drew donut circles around his PV drawing. He explained if he did a PVI cryo ablation then the firing signals won’t penetrate and my AF would stop. He went on to say only those who had af afterwards were caused by a gaps in scar tissue formation and a second ablation would be needed to touch up the PVI’s scar barrier.
So why do folks who had a skilled EP perform a successful PVI isolation and AF returns? Many then go and get a LAA (or two) , CS, left atrial septum, superior vena cava, posterior wall, LA roof line, floor and inferior posterior lines etc. isolated if all that Haissaguerre did (and you explained above) was a PVI to isolate the wall from AF returning?
I haven’t been reading this forum for too long and it’s kinda scary when you read a post and actually think you have some idea what their talking about. It’s a great question. I can’t wait to read the answer but I bet it’s not as simple as the question. Or is it?
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Re: conference October 15, 2020 08:35AM |
Registered: 11 years ago Posts: 4,228 |
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Re: conference October 15, 2020 09:52AM |
Registered: 10 years ago Posts: 2,520 |
Quote
GeorgeN
What does CA stand for?
Catheter ablation.
So why do folks who had a skilled EP perform a successful PVI isolation and AF returns?
Because the PV's aren't the only source of afib in some people.
I asked that icu EP to elaborate. I wasn’t in great shape at the time so perhaps I didn’t fully understand him, but he said the PV’s are the first line of defense from brain to heart, and if one’s PV was successfully isolated then it’s like a bank vault and no af signals can get through.
I’m interested in your comment George that the Pv’s aren’t the only source of AF in some people. How can these signals get through to the LAA, CS, etc if they don’t need to breach the PV’s?
Edited 1 time(s). Last edit at 10/15/2020 09:53AM by susan.d.
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Re: conference October 15, 2020 10:05AM |
Admin Registered: 6 years ago Posts: 5,358 |
Quote
susan.d
I’m interested in your comment George that the Pv’s aren’t the only source of AF in some people. How can these signals get through to the LAA, CS, etc if they don’t need to breach the PV’s?
It's not that the signals get through the barrier and travel to the LAA, CS, etc. It's that the signals can originate from those locations too. So if you've got AF emanating from the PVs and the CS, doing only a PVI isn't going to stop your AF because you'll still have AF signals coming from the CS.
The PVs are simply the most common source of AF, but they're not the only possible source. You can have AF sources almost anywhere within the atria.
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Re: conference October 15, 2020 01:58PM |
Registered: 11 years ago Posts: 4,228 |
Quote
susan.d
I’m interested in your comment George that the Pv’s aren’t the only source of AF in some people. How can these signals get through to the LAA, CS, etc if they don’t need to breach the PV’s?
What Carey said.
Spontaneous Initiation of Atrial Fibrillation by Ectopic Beats Originating in the Pulmonary Veins, September 3, 1998, N Engl J Med 1998; 339:659-666, Michel Haïssaguerre, M.D., Pierre Jaïs, M.D., Dipen C. Shah, M.D., Atsushi Takahashi, M.D., Mélèze Hocini, M.D., Gilles Quiniou, M.D., Stéphane Garrigue, M.D., Alain Le Mouroux, M.D., Philippe Le Métayer, M.D., and Jacques Clémenty, M.D.
"A single point of origin of atrial ectopic beats was identified in 29 patients, two points of origin were identified in 9 patients, and three or four points of origin were identified in 7 patients, for a total of 69 ectopic foci. Three foci were in the right atrium, 1 in the posterior left atrium, and 65 (94 percent) in the pulmonary veins (31 in the left superior, 17 in the right superior, 11 in the left inferior, and 6 in the right inferior pulmonary vein). The earliest activation was found to have occurred 2 to 4 cm inside the veins, marked by a local depolarization preceding the atrial ectopic beats on the surface electrocardiogram by 106±24 msec. Atrial fibrillation was initiated by a sudden burst of rapid depolarizations (340 per minute). A local depolarization could also be recognized during sinus rhythm and abolished by radio-frequency ablation. During a follow-up period of 8±6 months after ablation, 28 patients (62 percent) had no recurrence of atrial fibrillation."
[www.nejm.org]
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Re: conference October 15, 2020 03:29PM |
Registered: 10 years ago Posts: 2,520 |
Thank you! Got it. I’m so blessed to find an artist skilled in LAA CS etc because most Ep,s are not and only do the PV’s...which can lead to af in the future if the source is elsewhere.
Quote
Carey
I’m interested in your comment George that the Pv’s aren’t the only source of AF in some people. How can these signals get through to the LAA, CS, etc if they don’t need to breach the PV’s?
It's not that the signals get through the barrier and travel to the LAA, CS, etc. It's that the signals can originate from those locations too. So if you've got AF emanating from the PVs and the CS, doing only a PVI isn't going to stop your AF because you'll still have AF signals coming from the CS.
The PVs are simply the most common source of AF, but they're not the only possible source. You can have AF sources almost anywhere within the atria.
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Re: conference October 15, 2020 03:31PM |
Registered: 10 years ago Posts: 2,520 |
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Re: conference October 15, 2020 03:53PM |
Registered: 11 years ago Posts: 4,228 |
[afibbers.org] (from Pat Chambers article {PC, MD})
"P is for pole cells and they are the pacemaker cells of the heart. These have traditionally been described only in nodal tissue (SA node and AV node). However, in August of 2003 the Cleveland Clinic group was the first to describe P cells in human pulmonary veins (PVs) near their entry into the left atrium. They were found at autopsy in 4/4 AF patients and in 0/6 controls (one without history of tachyarrhythmia and five heart transplant donors). To date they have not been described anywhere else in the heart outside of nodal tissue"
In the small 2003 Cleveland Clinic autopsy study all the afib patients had P cells in the pulmonary veins and none of the controls did. Doesn't mean there aren't other sources for afib, just that this is a common one. This is why a simple PVAI ablation will work a fair amount of the time. But because there are other foci, it is why they don't work all the time.
A speculation of mine is that most afibbers start with this as their genetic predisposition to afib. However, repeated afib episodes may change tissue elsewhere and create other foci. This may also be why an afibber doesn't want to wait too long to get an ablation as "afib begets afib" and may create more of these foci making ablation success more difficult.
"P is for pole cells and they are the pacemaker cells of the heart. These have traditionally been described only in nodal tissue (SA node and AV node). However, in August of 2003 the Cleveland Clinic group was the first to describe P cells in human pulmonary veins (PVs) near their entry into the left atrium. They were found at autopsy in 4/4 AF patients and in 0/6 controls (one without history of tachyarrhythmia and five heart transplant donors). To date they have not been described anywhere else in the heart outside of nodal tissue"
In the small 2003 Cleveland Clinic autopsy study all the afib patients had P cells in the pulmonary veins and none of the controls did. Doesn't mean there aren't other sources for afib, just that this is a common one. This is why a simple PVAI ablation will work a fair amount of the time. But because there are other foci, it is why they don't work all the time.
A speculation of mine is that most afibbers start with this as their genetic predisposition to afib. However, repeated afib episodes may change tissue elsewhere and create other foci. This may also be why an afibber doesn't want to wait too long to get an ablation as "afib begets afib" and may create more of these foci making ablation success more difficult.
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Re: conference October 17, 2020 01:16PM |
Registered: 6 years ago Posts: 524 |
Quote
susan.d
=
So that's how we ended up with ablations leaving the offending cells still firing but stopping the AF anyway.
Which brings me to a nagging question I’ve had since my overdose/ICU. An EP walked into my icu room and drew a drawing of a heart on the blackboard and then drew donut circles around his PV drawing. He explained if he did a PVI cryo ablation then the firing signals won’t penetrate and my AF would stop. He went on to say only those who had af afterwards were caused by a gaps in scar tissue formation and a second ablation would be needed to touch up the PVI’s scar barrier.
So why do folks who had a skilled EP perform a successful PVI isolation and AF returns? Many then go and get a LAA (or two) , CS, left atrial septum, superior vena cava, posterior wall, LA roof line, floor and inferior posterior lines etc. isolated if all that Haissaguerre did (and you explained above) was a PVI to isolate the wall from AF returning?
I am not new to heart stuff and have had AF episodes over the last 5-10 years. Reading up more because I had two in the last month both ECV within a couple days. I am figuring out most of the acronyms but can someone point me to the different types of ablations? I feel like a total newbie here on this one. thanks ..LAA.. PVI.. I know this is like asking on a gluten free list.. "what's gluten". lol. hopefully some of you will have patience with me
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Re: conference October 17, 2020 03:43PM |
Registered: 11 years ago Posts: 4,228 |
Quote
bettylou4488
..LAA.. PVI..
LAA= Left atrial appendage (a common source of triggers in some afibbers, especially with longstanding persistent afib). Only top flight ablationists will work here. The downside is there is a 60% chance of needing lifetime anticoagulation after an LAA ablation, or a screen device to keep clots from escaping (like the Watchman). The issue is the work on the LAA can slow the emptying velocity from LAA, making clots more likely & therefore increasing stroke probability.
PVI= Pulmonary vein ablation
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