One week post Pulsed Field Ablation

Hi everyone. I had my pulsed field ablation a week ago in Austin with Dr. Natale and his stellar team and facility, as part of a Medtronics trial study of their PFA catheter. The procedure went as smoothly as I had hoped, and this is my one week update.

The procedure time was somewhat shorter than an RF Ablation, and "lesions” were done at each of the pulmonary veins, as well as some on the posterior wall. Those of you who know about PFA know that one of the benefits is that there is no burning, so less inflammation (in addition to it being safer, and – seemingly more effective (100% for paroxysmal afibbers) based on the previous small study).

I had zero chest pain after the procedure. I had ectopics ( roughly 1 to 5 every minute or two) for the first day and evening. They lessened somewhat by morning and then basically ended when I started flecainide 50mg BID in the morning. They haven’t returned to date. Only issues thus far are 1) groin site bruising, 2) throat soreness from intubation which resolved in a couple of days, 3) fatigue from anesthesia which also resolved after a few days.

At this juncture I am very happy with my decision to fly to Austin for a PFA, and for that matter my decision to work with reducing and tolerating my afib symptoms for the past 10 years rather than using meds (until recently) or getting an ablation (I learned and grew a lot from facing the beast, and my lack of prior ablations got me in this study). Afib frequency crossed my threshold of what I was willing to tolerate in February of this year.

This study is open to both paroxysmal and persistent afibbers with no previous ablations, but I found out that Dr. Natale (I’m guessing others in the study as well) has used the PFA catheter with a Compassionate Care exemption (it hasn’t been approved for general use) for some people who have had prior ablations.

As part of the study I was given a monitor that I have to use for 1 minute each week to record and send my heart readings. I have to follow up on video conference at 1 month, 3 months, 6 months and 1 year – they initially told me I’d have to go back to Austin, but that wasn’t what I was being told last week.

That’s about it. Time will tell/confirm if this fully worked and whether it is at least as durable as an RFA – there doesn’t seem to be a reason to think it won’t be. Thanks to Shannon and Carey and the rest of you (let’s not forget Hans) for making it possible to find out about best practices and practitioners! Ralph

Great news....Nice to see you came through this prob. easier then having a couple of teeth pulled.
When i 1st saw this procedure it looked very promising for the lets just say not too complex Afibber and your report looks like that's the case.... seems great but its all about long term so lets wait but for PV ablations this at very least appears to lessen sym. short term....as for me 36 hours after my RF ablation in 2018 it felt like an elephant was sitting on my chest for about 8 hours then within about 8 more hours it was pretty much gone but that was an incred. painful + stressful situation so if stuff like that + other problems can be avoided short term that is wonderful.

GL + keep us updated you lucky guinea pig.



Edited 1 time(s). Last edit at 05/05/2021 04:17PM by vanlith.

Good to hear Ralph.
I hope you will periodically update us on your recovery, as many of us will be interested in this new technology.
Jeff

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Jeff W
Good to hear Ralph.
I hope you will periodically update us on your recovery, as many of us will be interested in this new technology.
Jeff

+1.

I will update in a few months (after blanking period, etc) and after the trial time ends at 1 year. And if something goes sideways before that I'll let you know

Interesting.

Great Report Ralph!

And thanks for being the first Afibber that I know of from our forum and website that has volunteered as a pioneer for recent your index ABL using PAF ablation!. The great news so far from a growing list of very robust trials on Microburst Electroporation (Pulse Field Ablation) across the EU, US, Canada, and other countries now, has been super promising indeed!

And yet, while we still have to allow the science of PFA to fully come to us and not get too far ahead of our skis .... we truly are now entering a more mature phase of the PFA technology vetting process in which its increasingly clear how powerful, effective and safe PFA will be once the last bits of longer-term vetting are finally complete in the not too distant future, thus opening the flood gates for iota almost certain wide spread adoption as the new gold standard for most cardiac ablation procedures.

And we are already well ahead in the actual field use by independent highly-experienced ablation EPs, in terms of our real-world understanding of PFA technology and its application ... especially in performing PVI/PVAI ablation procedures ... and we are definitely further ahead now in the key Efficacy plus improved Safety metrics with our growing real-world PFA experience than we ever were with some of the Rotor-based concepts starting around 2012 that, at first blush, seeming set the EP world on fire, temporarily, with the breathless excitement and promise these fledgling rotor concepts.

aim the beginning the hype was so flush it seemed sure to sweep away all other ABL tech before it ... but, alas, in what turned out to mostly be driven by premature marketing hype in hindsight.

Thankfully, the field of EP/Cardio has learned a thing or two from some of those past experiences. Plus, the very nature of PFA tech in using a fundamentally improved energy source ... Electroporation ... which confers a uniquely low threshold of PFA electroporation within cardiac endothelial myocyte tissue, and thus serendipitously creates a consistent Non-Thermal ablative effect via tiny micro-pores created in key cardiac tissues in order to achieve durable ablations with essentially no thermal injury effect at all!

The success of using electroporation for cardiac ablation is created through these rapid micro-pluses of DC (Direct current energy) that spares all of the surrounding cardiac endothelium. It almost seems like magic, but it is really just one of those random positive flukes of nature that certainly looks like it will soon usher in a new generation of cardiac ablation therapy.

Cheers!
Shannon

Thank You Shannon for your encouraging post about the bright future of this new technology. How long should we wait until it becomes available for every afib patient?
Kind regards,

Ben

Shannon
I am interested to sign up for the PFA , could you assist and provide the contact details of Dr Natalie
Thk you
Tim

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Tim
Shannon
I am interested to sign up for the PFA , could you assist and provide the contact details of Dr Natalie

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