A doctor friend has been drinking a bitter melon juice mix (homemade) every morning for his type II diabetes and it has been working since his diagnosis. I don't know if it has any age extending side effects to it. I believe he takes one whole melon (size of bell pepper) per day. I will ask to make sure and re-post.by researcher - AFIBBERS FORUM
Same to you Shannon. All the best.by researcher - AFIBBERS FORUM
Ted, Beyond what is available in the public domain (see references in write up below), I don't have any insights into what the cardiologist that you talked to sees in his experience. The studies are pretty dated and observational.by researcher - AFIBBERS FORUM
I am more curious than optimistic or pessimistic at this stage. There are 2 technologies currently offered for mapping rotors, both have issues. With the Topera, mapping is limited by blind spots (40% in total currently) and basket size. With the CardioInsight (external EKG vest), heart motion with systolic cycle and respiration cycle would cause accuracy and rotor stability mapping issues (upby researcher - AFIBBERS FORUM
Thanks for the link George too. I had no idea the test are so affordable now. Shannon - RE fibrosis, some interesting work is being done on heart failure pathology now, specifically HIF/PHD (see link)by researcher - AFIBBERS FORUM
Well done Shannon!by researcher - AFIBBERS FORUM
Good to hear from you Les. Best wishes for continued improvements.by researcher - AFIBBERS FORUM
2 year results are starting to come in. The one below from Tomassoni's group in Kentucky. Authors conclude that results warrant randomized trials from Abbott, the owner of Topera.by researcher - AFIBBERS FORUM
Thanks George and I would surmise (and glad) that most of the posts here regarding ectopics relate to PACs . That's important because the recently released UCSF 15 year holter study has really changed the perception on PVCs. Current rule-of-thumb is not to do any intervention until PVCa hit 20% burden or around 20,000 PVCs per day. UCSF data shows that is way too late for developing heartby researcher - AFIBBERS FORUM
Do PACs and PVCs run together usually? I think they are completely different (upper vs lower chambers) and unrelated. Although I would be a lot more concerned with PVCs in relation to PACs as it relates to potential acute medical issues. We always seem to group them together in discussions implying that they run together. Is this true?by researcher - AFIBBERS FORUM
The more recent AF mapping research on scarred areas and electrical activity have changed the picture regarding CFAE. As originally interpreted by Nademanee, CFAE areas were thought to be scarred regions driving AF. The DEMRI results and electrogram mapping results show that CFAE areas are in fact where healthy heart muscles exist. The scarred areas are low voltage areas with little activityby researcher - AFIBBERS FORUM
Shannon, here is a nice literature review from late last year about acute AF termination during ablation. Conclusions are squishy as you discussed. Authors aren't sure why there is a correlation between lower recurrence and higher success with AF termination in most studies. They believe it could just be an indication that the patients that achieve acute AF termination may not have progrby researcher - AFIBBERS FORUM
60% EF is decent so I would not stress about that.by researcher - AFIBBERS FORUM
Hi Shannon, there are many aspects of pay-to-play in medical device R&D and clinical trials to dislike (HIFU as an example and now laser balloons). As for mapping tools and systems, at least they do no harm and useless at worst, at best, they are useful and do no harm. Hopefully, cardio insight vest belongs to the latter category after more trials. If all the money are in bank accounts aby researcher - AFIBBERS FORUM
Shannon and George, Yes what you say is consistent with what the authors are also saying and also the editorial. The difficulty of identifying subclinical AF is a big issue that requires more work. For practical purposes, the study reflect the difficulty faced by patients and EPs in how to deal with runs of PACs and whether they mean anything in terms of heart function and circulation. Readinby researcher - AFIBBERS FORUM
The cohorts in this study were healthy volunteers with no apparent heart disease at the start. They were tracked over the long term to understand the relationship between PACs development, AF development and stroke risks. The results show that strokes are often the first presentation of PACs before the onset of AF. Study raises a lot of questions and more work needs to be done to understand thby researcher - AFIBBERS FORUM
Apache and Shannon, I don't know who the panelists were other than Jais that introduced Haissaguerre. The Medtronic purchase of cardioinsight must have been a nice payout for the original doctors that put up money to fund development. I expect Medtronic to make a big push on commercialization just like they did on cryo balloons. Biosense is finally getting some decent competition in ablaby researcher - AFIBBERS FORUM
Looks like a useful tool for LAA occlusion.by researcher - AFIBBERS FORUM
I edited the first post to the referral site.by researcher - AFIBBERS FORUM
(video link at top of article) Haissaguerre's preferred term for "rotors" is re-entry circuits. In the video he talks about the AFACART trial that used the EKG vest to map drivers in persistent patients. The first step of the ablation procedure is to go after the drivers, followed by PVI and other areas as needed. Really interesting results in that driver ablation alone wasby researcher - AFIBBERS FORUM
Mount Sinai interventional cardiologists group discussion of devices and anticoagulants.by researcher - AFIBBERS FORUM
There will be an article published in Circulation that is related to this topic and it addresses the role of contact-force measurement to either improve contact or to maintain a certain range within what the manufacturers recommend for optimal lesions. It is difficult to remain in range because of systolic motion and respiration motion. Looks like the effects are half and half and I am not sureby researcher - AFIBBERS FORUM
The reason I am bringing this up is that I had no idea how much the heart moved because of respiration. This is important for imaging the heart as the devices have to compensate for movement. Today, one of the mapping/ablation companies announced a new way to compensate for respiration so that an EP can be more precise with the catheter tip locations during mapping and ablation. The movement (by researcher - AFIBBERS FORUM
The "gliding" technique of RF ablation has been around a while and talked about by different operators. If memory serves, at least 5 years when I first heard it described for PVI. It is a heuristic process so difficult to quantify for a publishable study. So in answer to "trade secret" - no others use it and it has been done for at least a few years now.by researcher - AFIBBERS FORUM
I believe it was the live web transmission from Mount Sinai at the ISLAA that I watched. It is available on the web but I don't recall the site. Lots of curiosity about how it is done by Dr. Reddy and the only one to raise concerns about potential small blood vessel damage was Doug Packer. If it works, and it looks like it does, then Dr. Natale and others would not have to worry about draby researcher - AFIBBERS FORUM
Vivek Reddy is the only one I am aware of that is doing something similar with their own contraption. There is a video of how they do it but I don't recall the site. I believe the practice will spread once there are enough cases to show that the esophagus is not injured by deflection. One concern expressed by Doug Packer was that there are a lot of small blood vessels supplying the esophaby researcher - AFIBBERS FORUM
What Shannon described at St. David's doesn't sound inconsistent with what is being done at Duke. ICE catheter gets sterilized and repackaged in sterile package. Pacing catheters also get the same treatment. Sheaths and ablation catheters do not. The Olympus endoscope are huge things in comparison and with lots of nooks and crannies.by researcher - AFIBBERS FORUM
In addition to the TEE probe deflection method in the Brazilian paper below. The Japanese are developing a cooling balloon that worked very well in human trials. Also, Vivek Reddy's group is also doing deflection with a tube like structure. So far all the results have been positive. This will allow for improved ablation of the LA posterior wall without causing dreaded AEF complications.by researcher - AFIBBERS FORUM
His thoughts on modifiable AF risk factors, accidental China project and trends in AF ablation.by researcher - AFIBBERS FORUM