Fluoroscopy

I don't have an ax to grind here, just sharing what little I have learned.

As I began to consider an ablation, I found youtube videos by Dr. Kneller. In the end, I decided not to use him for my ablation, but his videos were informative for me, who knew nothing. One of his videos, which I did not watch prior to my procedure, cautioned about the radiation exposure of the fluoroscopy, and cautioned to find a doctor who kept the radiation time to a minimum.

I had Dr. Natale do mine. As I read his clinical notes, I saw he used fluoroscopy on me for 15.6 minutes.

Notes also said:

Radiation dose

Air Kerma(AK): 119mGy
Dose Area Product (DAP): 1421uGy*m^2

That didn't mean anything to me, so I asked my niece who was in nuclear medicine. She said that dose is equivalent to two Ct scans of the head back to back. Previously, when asking her opinions on letting oral surgeons do Ct scans on me, she said one per year of the head would be OK with her.

So in the case of a heart procedure, I can see why I would be expected to tolerate more time. The medical team certainly has incentive to keep the amount of time to a minimum for their own health risk, despite their protective clothing.

I will have to ask how much fluoroscopy time will be required for my ablation touch-up/watchman placement in two months. Just out of curiosity though. I don't know enough to negotiate on that.

A touch-up ablation and Watchman should be much shorter than your initial procedure. And there's really no way around fluoroscopy. They have to know exactly where they are in the heart and they also need to check the Watchman for leaks. So minimizing the time they use it is really all they can do.

What is the difference between a touch up ablation w/Watchman placement vs a Re-Do with Watchman placement? When appointment is made within 3 days after the initial ablation?

Important success or failure difference or insurance terminology or?

How would they know so fast after just the one night in the hospital with no further testing etc.?

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Qwackertoo
What is the difference between a touch up ablation w/Watchman placement vs a Re-Do with Watchman placement? When appointment is made within 3 days after the initial ablation?

A touch-up procedure is finding the spots where afib signals are getting past the previous ablation lines. It's usually one or two burns vs dozens for a full ablation. And the Watchman is no more than another 10-15 minutes. My Watchman procedure was a total of 20 minutes and that included the entire time needed to insert and position the catheters. If a touch-up is being done at the same time, inserting and positioning catheters has already happened.

The paperwork I received to educate me about two (2) MIBI treadmill stress tests with contrast said that each such encounter was equivalent two 500 chest x-rays. Then, I had other scans, an angiogram, and two ablations, each with fluoroscopy. Plus two chest x-rays as part of the pre-ablation workups. I may eventually die from a tumor caused by all that radiation, if not from the countless hours I have flown above 25K feet ASL. And lived at 15K ' in the Andes for four years. But for now, I'm doing just fine, thanks very much.

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Carey

What is the difference between a touch up ablation w/Watchman placement vs a Re-Do with Watchman placement? When appointment is made within 3 days after the initial ablation?

A touch-up procedure is finding the spots where afib signals are getting past the previous ablation lines. It's usually one or two burns vs dozens for a full ablation. And the Watchman is no more than another 10-15 minutes. My Watchman procedure was a total of 20 minutes and that included the entire time needed to insert and position the catheters. If a touch-up is being done at the same time, inserting and positioning catheters has already happened.

Thank you for the reply, Carey

Mine was classified as a Re-Do along with the planned Watchman placement 6 weeks after initial ablation which was more extensive than a PVI with 72 PF only no RF. It has been awhile but in re-reading and studying everything in my history, especially last week after my first visit in quite some time with my local Cardiologist caused me to wonder on the terminology. I believe it was 58 PF applications of energy and a little less than 1 minute for the RF plus the Watchman. The LAA was re-isolated and from what I've read it is thicker tissue and does tend to regain connections after initial isolation plus a few other re-connections during second go round.



Edited 1 time(s). Last edit at 04/27/2026 03:08PM by Qwackertoo.