Hi Mellanie, Medtronic has both irrigated and non-irrigated RF probes of various shapes and sizes under the Cardioablate brand name. What's your views towards the two? Seems to me that an irrigated tool would provide safety benefits such as preventing tissue adhesion to the probe during the ablation process. The non-irrigated versions are similar between Atricure and Medtronic and theyby researcher - AFIBBERS FORUM
Thanks Mellanie, I understand, that is why I used "like" because Atricure devices have been around longer and I think people are probably more familiar with those tools. Medtronic devices work the same way and are very similar to Atricure's. The high variability in success rates is the nugget out the study..by researcher - AFIBBERS FORUM
This is about using RF devices like Atricure (mini-maze tool sets) to do a Cox maze lesion set during open heart surgery to fix other problems such as valves and bypass.by researcher - AFIBBERS FORUM
EB, According to the stats on their web site, OSU does over a dozen AF ablation cases per week and that represents about one fifth of all their electrophysiology procedures. A very busy clinic.by researcher - AFIBBERS FORUM
EB, It would be interesting to see how OSU, where Sirak is, manage AF cases and decide on the best approach. They are one of the top 3 centers in the USA based on CA procedure volume and they appear to have everything listed on the AF site including drugs, catheter ablation and surgery . I think surgery would be the way to go if you were to have open heart surgery anyway.by researcher - AFIBBERS FORUM
Interesting research out of U. of Penn comparing 3 different popular approaches of ablation.by researcher - AFIBBERS FORUM
Karen, Linked below are some articles regarding PV stenosis cases and how the doctors tried to solve the problem using balloons, stents and surgery.by researcher - AFIBBERS FORUM
Erling, I am not against supplements or meds, so try those first. I take potassium daily via 2 bananas and fish oil, exercise daily and eat healthy. However, if you are on supplements and failed AAD's. What Erling would you tell some one like GH. I could easily call your research rubbish but I refrain because I know a lot less than there is to know. If there is a silver bullet solutiby researcher - AFIBBERS FORUM
GH, Seems like your EP has it backwards as for long term efficacy of drugs compared to ablation. When done at experienced centers and monitored for 5 years, it is not even close. Ablation is far better. CABANA trial results are continually being release and that will be the definitive study comparing the two approaches, that one is being coordinated by Mayo Clinic. Biosense Webster (Johnson aby researcher - AFIBBERS FORUM
Hi Lou, Some further clarification - All AF ablation procedures now are designed to be done outside the PV in the antrum. PV stenosis is caused by burning inside the PV instead of the antrum which is very avoidable by having an accurate anatomical map and knowing where the catheter tip is located. Karen's problem could have been caused by either one, or both issues. Things that shouldby researcher - AFIBBERS FORUM
Hi Karen, So sorry to hear of your PV stenosis complications. Below is a link to an article describing your complication, registration is required and free. With the modern mapping systems and sufficient experience, stenosis complication is around 0.3%. Based on your description, something went wrong starting with femoral vein access and that mapping was not sufficiently accurate if done. Yoby researcher - AFIBBERS FORUM
Far better to be admitted during the week.by researcher - AFIBBERS FORUM
Sorry, didn't mean that. I didn't realize the normal heart has such a wide range so congrats on success.by researcher - AFIBBERS FORUM
That is dramatic and a good result I guess. However, I wonder if there is a lower limit on LA diameter where navigation of conventional catheters becomes too risky, if AF remains and ablation needs to be an option..by researcher - AFIBBERS FORUM
Hi Dick, Thanks for doing your periodic reviews. Lots of moving parts out there. The Heatwire (heart.org) site has a nice section on the trial and tribulations of AF management from the AAD perspective under their "Advances in AF" tab on the right side of the page. I still remember the great promises to be delivered by Multaq and Pradaxa pre-FDA clearance and then reality hits withby researcher - AFIBBERS FORUM
Unfortunately, the odds don't favor your cousin for long lasting success with CV and drugs. Whenever I see or hear " technology and methods are constantly improving over time", I wonder when if ever that was not the case in all technologies that we live with. Some are slower changing than others. Ablation technology seems to move at about the same rate as TVs. Every few years tby researcher - AFIBBERS FORUM
Phyllis, While I am sure India has some good ablation expertise, left sided VT ablation is really cutting edge and a whole different ball of wax compared to AF. Even the very top experts in the world have manual complication rates around 10% and high mortality rates (2-4%) in papers I reviewed. The procedure requires high density electrogram mapping unlike AF which is anatomical mapping. Thby researcher - AFIBBERS FORUM
McHale, My arrhythmia was niacin induced. I was prescribed large does of niacin by a young doctor when I found out I had familial hypercholesterolemia. This was in the early days of statins and the doctor didn't know what he was doing in retrospect.. Had my first attack during a business meeting where I had flown out to. That was within a week of starting the niacin. I had no idea whatby researcher - AFIBBERS FORUM
Josiah, You may want to listen to the panel discussion I posted in the thread just above this one. Like Shannon said, acute reversibility (if you have an accident or nose bleed) is an important attribute to consider in these type of drugs. The panel talks about that. My 91 year old father in law is on Warfarin and staying on it.by researcher - AFIBBERS FORUM
tobherd, the top guns all use RF for AF ablation. Hans, got it. Thanks for the clarification.by researcher - AFIBBERS FORUM
Hans, Not to be diagreeable but I think the Natale figures need some checking. I was told the number ablations at CCF has been around 2500 per year when he was there and continues at that level now. 80% would be 2000. If he doesn't take any vacation or time off to give seminars and travel to other places to train other EPs, then that would mean he would do 4 ablations every weekday for tby researcher - AFIBBERS FORUM
I just noticed that Dr. Jais was the expert providing answers to patient questions (open to all - registration required) on the Journal of Afib site. Many of the questions are very similar to questions asked here so you may find his comments helpful. I don't know if he is still the answerer, I don't think so. There are also a number of interesting articles with one a comprehensive reby researcher - AFIBBERS FORUM
Sorry to hear of your PVC. I did not realize that there was a connection between AF and PVC, for some. I thought PVCs were precursors to VT/VF only. I hope you find the answer you need. I am pretty sure that Natale's group do PVC ablations if you get to that decision point.by researcher - AFIBBERS FORUM
The first 5 minutes were introduction that most here are familiar with. The meat starts after that.by researcher - AFIBBERS FORUM
The updated expert consensus guidelines issued this month by the USA and European heart rhythm societies puts ablation as first line therapy for paroxysmal AF, if you can get it done at an experienced center. I think the only reason to delay, if you are have paroxysmal AF, would be that you do not have access to experienced ablation centers. Otherwise, the docs keeping you on AADs are really noby researcher - AFIBBERS FORUM
Fox, that's inspiring. Thanks and best wishes for continued NSR.by researcher - AFIBBERS FORUM
Hi Shannon, with respect to your questions you raised regarding the robotic system(s). " I think they may use the robot for initial catheter insertion and placement in many cases? " The access to the femoral vein and transeptal puncture are all done manually as is the initial placement of sheath and catheters into the left atria. The sheath that is used to guide the rranseptal pby researcher - AFIBBERS FORUM
Jackie, Definitely, the systems don't replace human intelligence. It does the navigational part precisely without mechanical trauma. The rest like intelligently setting catheter power and temperature and picking the right places to ablate are still the domain of human intelligence. I feel bad for your friend. He really got the short end of the stick. A trainee without appropriate pericby researcher - AFIBBERS FORUM
Zach, I am glad Dr. Su was able to treat your AF. Sounds like you took part in the trial. The US/European expert (for folks interested in a list of "masters" - check the author listing) consensus on AF just came out and it is available online now. You will find a nice long discussion on the various energy sources and cryo balloon. The meta analysis they did on 22 centers that publisby researcher - AFIBBERS FORUM
Almost all the top centers have installed Stereotaxis but I think Many old masters like Natale and Jais are still doing AF manually because they are still faster than the computer-magnets. Natale's group primarily use their system for VT/VF ablations which are very demanding and where the system is actually better than manual. Jais has stated in presentations (a couple of years ago) that tby researcher - AFIBBERS FORUM