My guess is that this is about market share in paroxysmal cases where the popularity of cryo-balloon has grown. EP Lab digest latest issue has an article regarding Kuck's group in Hamburg (one of the highest volume groups in western EU) using the Artic Front in 30% of their cases. That would be most of the paroxysmal cases using average statistics for high volume centers. The selling poinby researcher - AFIBBERS FORUM
I think you have to look at the whole time series and not just the earliest patients. I get a few things from Winkle's presentation. His group is pretty good. I wish more EP labs would publish similar data, however, it will be difficult especially at the smaller labs because EPs move around so only the high volume labs have the continuity to publish valid long term data. It took them 5 yby researcher - AFIBBERS FORUM
It is rare and dangerous as it can clog circulation to the lungs. Stroke causing clogs has to circulate through the left side.by researcher - AFIBBERS FORUM
See video at bottom of page. There will be some limited early results release next month but the bulk of the results will not be released until after 2017. As a group, the AF patients in Cabana trial are further in AF progression and have more comorbidities than the people that come to this forum.by researcher - AFIBBERS FORUM
No. The pediatric EP at CHLA that does ablation is probably skilled and experienced, as far as simple procedures like WPW. The EP that is the subject of this thread had one case where he failed procedures on a kid with WPW. FIVE times! The mother was set straight by the screener after it was explained to her that should not be happening. Poor kid and mother. The EP supposedly has great bedby researcher - AFIBBERS FORUM
Jackie, I remember Pam's experience well. It is ironic that Dr. Calkins has been a leading voice on procedural complications and yet had Pam's case happen under his nose. That is an example of avoiding fellows and rookies in doing the procedure. In Pam's case, handling the Lasso properly is not suppose to be difficult and the fellow still did what he was not suppose to do. Hereby researcher - AFIBBERS FORUM
Ted, His group does complex VT and there seems to be a division in sub-specialties. For complex VT (which is arguably more complicated than AF ablation), Dr. Burkhardt is the man. He has done thousands of them and those patients are typically very very sick. So the answer is yes, his group can take care of that in Austin (La Jolla may not have the equipment) and Burkhardt is the top gun. Beloby researcher - AFIBBERS FORUM
Could have been.by researcher - AFIBBERS FORUM
Following on recent postings about selection of ablation specialists for yourselves and love ones - I share the following. I apologize for being so agitated. Details are edited out until I get permission from parents to release more details. A tennis friend of mine does arrhythmia screening for young atheletes. She has done tens of thousands full time. We played last Friday and got on the sby researcher - AFIBBERS FORUM
Bill, if you do a search on Mayo, there was recent feedback about results obtained from there and also some comments regarding a couple of their top EPs.by researcher - AFIBBERS FORUM
If recollection serves, "multielectrode phased RF pulmonary vein ablation catheter " was the Ablation Frontier experimental device. The study was done to evaluate the catheter for FDA clearance. It never gained clearance for obvious reasons demonstrated above.. All of that happened after Medtronic bought them. After the trials, Medtronic bought out cryocath. Now Medtronic is out tby researcher - AFIBBERS FORUM
Shannon, They really have an outstanding group there and gaining a lot of knowledge by tracking their SLC area arrhythmia patients over the long haul. Analogous to the Framingham tracking.on heart disease. If they started out thinking about that when they came out of Stanford, that is pretty awesome. They are excellent ablationists first and foremost. RE: stereotaxis shines in VT/VF/PVCs.by researcher - AFIBBERS FORUM
There were 16 references to "asymptomatic" in total. Ten of that were in the discussion sections that are relevent to treatment and management. The remaining 6 were in the footnotes referencing literature that contained "asymptomatic" in the papers' subject-title. I downloaded the PDF and did the search in Adobe. There is also no black and white definition of asympby researcher - AFIBBERS FORUM
TAA- Yes. I read all ten references on asymptomatic patients. None of those exclude ablation as an option.by researcher - AFIBBERS FORUM
TAF - In the 2014 guidelines, there were 10 references to asymptomatic patients, none of that explicitly state whether it was a good idea or a bad idea to ablate. What they do show is that asymptomatic patients are a huge concern because of stroke risk and EPs seek to ferret those patients out to put them on anticoagulants. In the patient management flow chart, whether someone is symptomatic orby researcher - AFIBBERS FORUM
Just noticed it at HRS website.by researcher - AFIBBERS FORUM
safib - RE "This study suggests to me a large downside to ablation: starting with only asymptomatic cases 36% had AFIB recur and became symptomatic, presumably worsening the risk of ischemia as well." Being symptomatic vs asymptomatic is strictly a QOL issue and doesn't impact the ischemia risk. You will still need to be on continuous anticoagulation therapy in either case.by researcher - AFIBBERS FORUM
The 60 minute video is no longer available after much digging. Below is the transcript of the episode. The discussion on dementia and alzheimer's starts in part 2 but the whole thing is worth reviewing.by researcher - AFIBBERS FORUM
Shannon, I don't know if you have seen the 60 minutes segment on the Laguna Woods (also known as Leisure World before they converted to a city) that was put together by Leslie Stall. They talked about dementia, alzheimer's and show brain cross sections post mortem of the subjects that died with various stages of dementia and it was entirely consistent with your post. It was really eyeby researcher - AFIBBERS FORUM
I am really falling behind, my answer before the article below (I just saw this today while looking for something else) would have been WHY bother? My father in law is in this cohort, if current knowledge and technology was available 15 years ago, I would say go for it as he was a very active fellow until his recent incidents. Research below from St. David's on long term persistent AF patiby researcher - AFIBBERS FORUM
I posted one earlier this year from Intermountain center in Utah. It covers a typical paroxysmal case that was performed using a magnetic guidance system. If recollection serves, Weiss (the EP) talks about the procedure from both the manual perspective as well as magnetic assisted perspective. Patient was the father of a good doctor friend.by researcher - AFIBBERS FORUM
I was searching for something else and stumbled upon the following regarding GP ablation (using Botox) as an adjunct to open heart CABG. It is germane to Les with regards to what his EP tried to accomplish. Japanese researchers did a similar study in heart failure patients undergoing open heart surgery, using cryo and not Botox.by researcher - AFIBBERS FORUM
Thanks Shannon - "half life of Multaq is around 13 to 18 hours" That is a big advantage. It should be used in lieu of Amio unless a patient knows that ablation will not happen for a long while. Very small differences in the other measures, efficacy and toxicity.by researcher - AFIBBERS FORUM
Apache - glad to hear that your HCV problem has been solved. I think you are the first person that posted on the subject. A couple of months ago or so, there was a warning from the FDA about the incompatibility of Harvoni (and I am sure other HCV drugs) with Amiodarone. It was a dangerous mix for some so you did the right thing by tackling HCV first. Best wishes in your conquest of AF.by researcher - AFIBBERS FORUM
Same problem with Multaq too. Long half life and only a slight improvement in toxicity.by researcher - AFIBBERS FORUM
TAF - Success rate in the cited presentations and papers ALWAYS refers to off AAD's. If you still need AAD 6 months after an ablation, it's a fail, even if the symptoms are more tolerable and burden is reduced. You raise a good point though, it is important to ask an EP how he defines success if it is different than the definition in the HRS guidelines.by researcher - AFIBBERS FORUM
Les, I didn't realize you got recruited into the GP/DSPECT trial. I would be interested in seeing your full report if you are willing to share. I hope that it was a benefit for you but then trials are done to see if there is a benefit over standard of care. You were probably a more challenging case in the spectrum of cases given the unexpected size of your LA. The idea of GP ablation haby researcher - AFIBBERS FORUM
Les, Glad you had Ernst at the controls. I was looking back at your questions when you first came to the forum. Now I wonder if your very frequent "ectopics" were actually short duration AF causing enlargement of LA. You were definitely at the high end of the range on LA diameter. Best wishes for NSR.by researcher - AFIBBERS FORUM
Clay, No. What I have seen is the the top labs like to group themselves together and survey amongst themselves and then present the numbers at conferences, as talks rather than papers. So if you have the proceedings from meetings, you can get the numbers from the slides. There seems to be a reluctance to formally publish these as they make the average lab look bad. And they want to bring theby researcher - AFIBBERS FORUM
Both Topera (FIRM) and Ecvue (Cardio Insight) are FDA cleared. I believe the Germans have their own version and Kuck is testing it. Ernst in the UK is playing with it too. I don't know who is active in the US. Since it originated out of Cleveland Clinic research, I would think that is the more obvious place to start. With Medtronic owning the technology now, I expect it will spread quicby researcher - AFIBBERS FORUM