Wait for Pulsed Field Ablation ?

I have had 2 previous ablations {last ablation in Dec 22} but still suffer from tachycardia/flutter. Sotalol and Multaq stopped working and I started dofetilide in the beginng of June. I have not experienced any episodes and so far I have tolerated the drug very well.
I have another ablation scheduled in November of this year to hopefully address tachycardia/flutter. With PFA hopefully approved next summer, I am debating if I should take the risk of waiting until PFA is available? Does anyone have experience with being on dofetilide for a year or more?

I only spent a few months on it, but I found that the longer you take it, the more effective it becomes. And that's exactly what others who'd been on it told me to expect. I think it's a pretty good bet it will continue to work for you until next summer.

The current PFA instrument is best suited just to ablate the pulmonary veins. Might have some use elsewhere in the left atrium, but too blunt for a typical right-sided aflutter ablation. So, unless they are going to be working on the pulmonary veins for your flutter/tachy, no reason to wait for PFA, because they probably won't use it and will just use RF or perhaps RF and focal Cryo in some circumstances, such as working near the AV Node.

Jim



Edited 2 time(s). Last edit at 08/04/2023 06:05PM by mjamesone.

Agree with Jim. At least, as far as I have seen on YouTube, the 'wand' is a six-loop 'sink stopper' that must be rotated and applied repeatedly for a few seconds, but the shape is best suited for the PV ostia. Maybe there's another series of loop applicator....?

Quote
gloaming
Agree with Jim. At least, as far as I have seen on YouTube, the 'wand' is a six-loop 'sink stopper' that must be rotated and applied repeatedly for a few seconds, but the shape is best suited for the PV ostia. Maybe there's another series of loop applicator....?

Not yet, at least according to the ep I was in contact with, but hopefully in the future. Both in and out of trial, they are combining RF with PFA for most areas outside the PV and definitely not using PFA to ablate the flutter line.



Edited 1 time(s). Last edit at 08/05/2023 09:04AM by mjamesone.

I started dofetilide on 5/10/21 for persistent afib. I went into normal sinus rhythm after 2 doses. I remained in sinus rhythm for about a year and then started having breakthrough episodes of afib. I had an ablation on 6/28/22. The breakthrough episodes of afib stopped, but when my EP tried stopping the dofetilide after the blanking period, I went into afib after holding 2 doses. So now I remain on dofetilide. I have not been having any afib, but I would like to stop the medications (dofetilide and diltiazem), because they make me feel "weird". So, I am scheduled for an ablation in November to try again. However, my EP mentioned that he would be doing Pulse Field ablations next year, so I might wait. Don't know if this helps you or not. Good luck.

Fibber, did you suspend any heart medications, whether rate or rhythm, for about 10 days prior to the Holter monitor? Did you have a Holter assessment a couple of weeks past the blanking period?

Stopped the dofetilide after 90 days. Went into afib after holding 2 doses of dofetilide. My kardia said i was in afib and I could definitely tell I was in afib. Never had a holter monitor assessment.

Okay, so your history is fairly straightforward...no Holter because all indications were that you were still in AF. It must have been bitterly disappointing.

I am not in afib as long as I take the dofetilide. I went back into afib after trying to stop the dofetilide. Went back into NSR after resuming the dofetilide. Sorry if I was not clear.

I am unclear, yes...sorry. I guess I assumed that at some point an ECG was done and they found that you had intermittent AF or PACs and that you could either revert or take something, and that has worked. For some reason I had it in my mind that you had had a procedure, and I thought a Holter would have been assigned to you later.