Pulsed Field Ablation

Well, a sustained uptick in afib frequency starting in February finally tipped the scales and led me to pursue an ablation. I found out that Dr. Natale is participating in the Medtronic Pulsed Field Ablation trial. I had a video interview with him and I signed up! (I don't fit into any of the exclusion categories). I’m flying to Austin for the procedure.

Dr. Natale assured me it was a good decision and that I wasn't just being a guinea pig. I believe he has done a few dozen of them at this point. I will meet with him in person the day before the procedure.

In addition to the relative safety and simplicity of the procedure, Dr. Natale said I won’t feel the pain in my chest the following day that many or most people feel because it isn’t a burn. Apparently the blanking period is likely to be easier as well. He did say that in the unlikely event that LAA needed to be ablated he would have to send in a traditional RFA catheter for that. I am really hoping that is not necessary.

Not sure this will post, but here is the link to the trial which is happening at several locations around the world [clinicaltrials.gov]

Thanks to all of you who post so generously and intelligently on this site - I wouldn't have known about PFA, Dr. Natale, or a hundred other things without you.

Wish me well. Any first ablation advice (PFA specific or not) is welcome (I did see the recent posts about shaving). I’ll report back. Ralph

You are very lucky with your timing that Dr Natale is doing it. I was told by my local ep to call up his colleague at Mt Sinai hospital in NY back in 2019 because they were doing the trials. Personally I wouldn’t feel comfortable unless Dr Natale was the operator but last year he wasn’t doing them. I called up Mt Sinai to humor my local ep and found they only ablate the four pulmonary veins with this new technology. Dr Natale does more than the four pulmonary veins to achieve better success.

He is an artist at his skill and experience and you are in good hands. I just had a Natale ablation last Thursday. Safety is his concern. I wish this new technology can be used for the sa/av nodes in the near future. Gives me hope Natale is on board. Thanks for posting.

Please keep us up to date with your ablation. Best of luck!

Do they perform different kinds of ablation with this technology, or is it PVI-only ?

Pompon- last year at Mt. Sinai Hospital in New York Dr. Reddy was only doing the PVI. Things could had changed but at that time the trial was only for the PVI.
[www.eplabdigest.com]

Update link of more centers doing it:
[cardiacrhythmnews.com]



Edited 1 time(s). Last edit at 04/21/2021 03:33PM by susan.d.

Thanks Susan. I appreciate the encouragement and well wishes.

Pompon, my understanding is that Dr. Natale would do a little more than the PVI if needed. His nurse said something about the back or posterior wall I think. How that could be done with this catheter is not something I currently understand. He is definitely mapping with a catheter through the opposite femoral vein. There are some places he can't do with this catheter like the LAA, but he would send a traditional catheter in if that was necessary. Not sure what any of the other EP's in the study are doing, but the study definitely includes Persistent afibbers so I would think that more than PVI would be necessary for some people in the study.

Maybe Shannon or Carey or someone else has some better understanding?

Ralph, he uses three insert areas- both groin and one neck. You are extremely lucky he started doing the pulse AND you are using his custom high tech Cath lab in Austin. I had mine at los Robles in CA. Smaller community hospital, but his CA team are great-Greg, Jose and Ralph plus his excellent NP.

My experience 100% will never occur in anyone else. So don’t discount I had 3 ablations with his expert abilities or my slower recovery. My next I have to go to Austin. I have to wait and see how this one is doing. I’m extremely frail and sensitive so my 52 burn recovery feels worst than ever and I feel like I have a bad asthma attack with gasping for air and coughing right now. I have junctional rhythm from multaq after the ablation (36-42HR) so it’s a wait and see process now.

Please post after your ablation the good news.

@ Susan & Ralph : thanks for your explanations.

Hi Ralph,

Thanks for the inquires and you'll be in the best possible hands with your PFA -based ablation in Austin as apart of the Medtronic trial on Pulse Field Ablation (the technology is also called 'Electroporation') and there are quite a few past posts from me and a good number of other posters as well over the last few years on this very exciting and very promising new tech that is rapidly making its way into main stream ablations over the next couple of years!

Dr Natale has already done a fair number of PFA procedures and there is nothing at all that is more challenging for him in the nature of the technology or the approach required. No surprise ... he has taken to it like a duck to water.!

Also, keep in mind that this trial is not a formal randomized control trial, but rather a prospective study that allows a bit more flexibility and discretion for each operator to make choices to best serve the needs of a given patient.

And this is a common practice within the protocols laid out for various studies that both Dr Natale and other top operators are very familiar with navigating such parameters. He will no-doubt be able to address your specific needs as well Ralph!

More later ... but I'm half way to Cottonwood for some errands from my home in Sedona and I had just pulled off the road to send you this brief update to your questions.

Cheers!
Shannon

Best of luck Ralph!