"regular" vs. pulsed etc..

I need a 101 here. Can someone send me to a link re what the different type of ablations are? I have a cardiac history (from birth) and in persistent afib at moment (have had on and off with ECV for maybe 5 years.). I might need to think of ablation. (Am on dofetildie.. not working I guess.). I. know about Natale and pursing that but I honestly don't really understand ablations and how the pulsed ablation differs. I can of course google and am doing that. It is funny my kid has all sorts of issues and I know those inside and outside... but for me I hate googling. I have an appointment now in mid Sept with a cardiologist here that does the pulsed ablations but when I searched they group it seems they are super new. This EP came recommended by Dr. Kahn who I see for my functional cardiology needs (and I have a congenital cardioglost also). I do have a regular EP already but honestly I only ever talk to the PA-C and she is new to the field. It bothers me to no end that I can't ever talk to the doctor . On the rare occasions that I do, the EPs answers are sometimes different than the PA-C. Thanks for any links here and elsewhere. I am continuing to search the group. Like I said I have been in and out of afib for quite a few years but the last week have rate controlled and ...boooo!!!!! I don't like it!!! LOL. (Ps I am taking cardizem to rate control. Beta Blockers make it so I can not MOVE.. and they upped my BNP numbers when I took them in the past.)



Edited 1 time(s). Last edit at 07/21/2021 09:23AM by bettylou4488.

Quote
bettylou4488
I need a 101 here. Can someone send me to a link re what the different type of ablations are?

The big difference is what is used to create the lesion sets.

Cryoablations use cold or freeze the tissue
RF or radio frequency use heat (most common)
The new kid on the block is pulsed field (PFA) also called 'Electroporation', here is a 2019 thread on the topic: [www.afibbers.org]
A post from Shannon in April 2021 [www.afibbers.org] {edit addition} Ralph's 2 month PFA report.

If I was in the market for an ablation and I qualified for the study, I'd choose PFA by Natale. Otherwise, I'd choose RF by Natale.



Edited 1 time(s). Last edit at 07/22/2021 04:00PM by GeorgeN.

A "basic" ablation is a Pulmonary Vein Isolation Ablation or PVIA. This is pretty much standard for every procedure. Then the EP may go "hunting" for other "hot spots" to ablate. At the upper end of this is isolation of the left atrial appendage or LAA. Many EP's are not trained to do this. It is only done if necessary. For those who get the LAA isolated, they have a 60% chance of needing either lifetime anticoagulation or the placement of a device such as the Watchman. This is because after this isolation, the flow through the LAA can slow to a level creating an ongoing clot formation risk.

At the end of the ablation, the EP may administer a med, isoproterenol, which will accelerate the heart and potentially induce afib allowing the discovery of other "hot spots" to be ablated.

This is a VERY condensed explanation, and someone may want to enhance it.

thanks for the info George

Well explained George. Thanks its helps many of us especially me as i have a date in Austin 9/14
T