More recent article talks about EP catheter reprocessing. The procedure for dismantling, sterilization and reassembly have to be cleared by the FDA. I don't believe all catheters can be reprocessed, especially ablation catheters. The article talks about ICE and mapping catheters. No mention of sheaths. Duke EP has high reputation and I assume they have done this without issues. There iby researcher - AFIBBERS FORUM
I think the article is only disconcerting to the extent that Dr. John is still too inexperienced to treat LSPAF patients, the toughest class of AF ablation patients. The success rate presented in the BELIEF trial is outstanding. Probably the best that has ever been published. It is a little silly to argue facts (BELIEF results) with feelings (Dr. John). That's my take coming from a physiby researcher - AFIBBERS FORUM
Just to make things more equitable, Andrea's last name was also mis-spelled. Congrats to both as treasured resources for AF patients worldwide. Well deserved and a toast to Shannon for his dedication.by researcher - AFIBBERS FORUM
I believe the research into LAA firing adds to the understanding of AF development so it is an important piece of the puzzle just as PV firing is of principal importance. My sister in law in her early 60's just had two right sided accessory pathways ablated. She lived with WPW ever since she remembered. I suspect she has a genetic predisposition to having those two circuits. Her episodesby researcher - AFIBBERS FORUM
Thanks for mssg and replies. Have a nice time in KC.by researcher - AFIBBERS FORUM
Shannon, looking at the Circulation article referenced above, the following are the LSPAF stats and LAA firing prevalence. The total patient population for that study was N=3966 Out of that total, LSPAF population was N=1145 (100%) Out of the LSPAF population, redo was N=503 (44%) In those redos, LAA firing was N=149 (13% of original LSPAF population, and 30% of LSPAF redos) Firstby researcher - AFIBBERS FORUM
That is exciting news Shannon. Thanks for the mssg the other day. You can probably help me with a few questions regarding LAA ablation that I have always wondered about and this looks like a good time to ask given the nice results out of BELIEF. The appendage is probably the most delicate structure in the LA, ie the thinness factor, how does Natale go about deciding whether to go in and do a fby researcher - AFIBBERS FORUM
Following on Doreen's questions with regard to DECAAF. I looked at the more recent articles and found an interesting tidbit with regards to PVI results obtained as a matter of research into scaring pre and post-ablation. Only 7.3% of the PVs were completely isolated as measured by DE-MRI. Fortunately, the PVs don't have to be completely isolated to achieve NSR. These are top hands dby researcher - AFIBBERS FORUM
Fellows from same group had earlier published a study of their single center experience in SVT, AF and VT ablations. When analysed by the AF subgroup, CF catheters were safer in fellow hands. I imagine the fellows were mostly observing the higher complexity VT procedures. Link below -by researcher - AFIBBERS FORUM
See first post ... edited.by researcher - AFIBBERS FORUM
A while back, I promised Shannon I would put something together comparing major complications from the different classes of centers. Cappato et al did a world wide survey of tertiary referral centers (even amongst them, many would only do paroxysmal AF). Deshmukh et al did a analysis of a wide variety of private pay and medicare centers. Lastly, Winkle just looked at the medicare data only.by researcher - AFIBBERS FORUM
George, you may have seen the TED talk from research cardiologist/runner below regarding exercise and heart health.by researcher - AFIBBERS FORUM
Paehua, Sorry to hear about your botched surgery. The last time i checked (that was 2-3 years ago), there were only a few hundred cases of Cox Maze done in the entire USA for the year. That means that there are very few specialists left from the old school that still do these type of surgeries which are done at the same time as other open heart procedures such as your aortic repair, CABG or soby researcher - AFIBBERS FORUM
Doreen, In the video below Prof Jais talks about the latest thinking with respect to fibrosis and AF ablation. It's the top video on the list.by researcher - AFIBBERS FORUM
John - your description sounds similar to the runner in the video below (his narrative starts at 52:30, chapter 6). The video is from the HRS website on patient education.by researcher - AFIBBERS FORUM
Like George wrote, Mandrola was using Santageli and Marchlinski as examples for skill level required to do VT/PVC ablations, and did not in anyway imply their skills are superior to other VT ablation elites. I have not read the referred article yet but it looks like an important article about a shift in the thinking the PVC's as non-benign symptoms of potential cardiomyopathy and potentialby researcher - AFIBBERS FORUM
It is hard to tell from the abstract what happened in terms of complications so here is a detailed breakdown from Table 3 (sorry couldn't cut and paste, I have paper copy). Major complications differ significantly between CF, MAN and RMN. Respectively, they are 10%, 2.7% and 1.2%. Major acute complications are 2.4%, 0% and 0% respectively. Major catheter ablation related are 2.4by researcher - AFIBBERS FORUM
The results are surprising. I would have expected CF catheters to be safer and better but no, not for VT ablation anyway at a top center in Europe. Left ventricle heart wall thickness is around 11 mm +/- 2mm. Atrium wall thickness is anywhere from 0.5 mm to 3.5 mm averaging less than 2mm. So I am not sure if the results mean anything for AF ablation. LVT ablation is more complex than AF ablaby researcher - AFIBBERS FORUM
From looking at something else today, my understanding is that it is logistically impossible to switch from manual to Stereotaxis once a procedure starts. So that would be another reason for him to slug it out. If he knew going in how difficult it was to cross a GoreTex patch, I think he may well have done it retrograde. The other possibility is that John had a lot of calcification around hisby researcher - AFIBBERS FORUM
I am not sure what is meant by research. If it is basic research on animal models and clinical studies done on animals, then off the top of my head is Oklahoma U., Mayo, Cleveland Clinic. Recent examples of their research are contact forces and steam pops in canine hearts, OU. Tissue and organ temperatures in canine during cryoballoon ablations at Mayo. CCF does company sponsored studies on aby researcher - AFIBBERS FORUM
That's an informative site. Thanks for sharing. You can do a search based upon the company paying fees too. Some of the payments are hidden, for example money paid to practice groups or hospitals for "research" that includes clinical trials of devices. Those are pretty big chunks of money beyond consulting fees and meals that don't appear on an individual doctor's filby researcher - AFIBBERS FORUM
Vivek Reddy gave a nice presentation on force sensing catheters at St Jude sponsored symposium. See link below. There is concern expressed by the panel that fellows are not learning important manual skills and critical thinking when CF catheters are used. V. Reddy isn't so concerned and says it improves results for the less skilled operators and also his own. The second video downby researcher - AFIBBERS FORUM
Added Jais presentation video regarding mapping and ablation of persistent AF to first post here. Covers the latest thinking in Bordeaux. Great Q&A interaction at the end with Marchlinski and Pappone.by researcher - AFIBBERS FORUM
As Shannon wrote, the elites stay with RF because it offers more flexibility in terms of where they can go and also power titration. If you saw Natale's persistent AF ablation video, then you would have heard him tell the audience what his thinking was with regards to going after everything in the index ablation vs waiting to see how a less aggressive approach (that still terminated the AF)by researcher - AFIBBERS FORUM
Cryo balloon has definitely taken off in the past couple of years. For labs that have average skills, the success rate are about the same for RF and Cryo for PAROXYSMAL AF or around 70% successful rate at the 12 month mark. Cryo balloon is not appropriate for persistent AF as it is designed for PVI only. The big advantage is that cryo procedures saves time and there is lower risk of perforationby researcher - AFIBBERS FORUM
Shannon, I was wondering if you were sitting in on these. Lots of questions and feedback from other top experts too like Packer, Mansour, Tomassoni, etc in addition to fellows in the audience and a couple assisting the procedures. I added a cryo balloon video to the first post.by researcher - AFIBBERS FORUM
Direct from the master. It is technically heavy but this will be a good reference for those asking about how he thinks and how he does it.. The video below from Peter Weiss of Utah Intermountain on stereotaxis magnetically navigated paroxysmal AF Cryo balloon ablation of paroxysmal AF from Javier Sanchez of TCAI (great comments from Doug Packer of Mayo) Pierre Jais presentby researcher - AFIBBERS FORUM
Here is a video directly from the source, Natale/Burkhardt live case webcast at 2014 ablation symposium. The one above is more of an overview of standard of care. This patient here had a heart attack followed by more heart attacks as he would not quit smoking, so the ventricular scar grew and they are chasing the scar with recurrent procedures. The video is heavy into technical jargon so probaby researcher - AFIBBERS FORUM
Something like that happened to McHale when Natale visited a NYC clinic and he took the offer. He made the right decision and has been happy with the results ever since. He still post here occasionally. I think that was a couple years back. Before the ablation, he was really agonizing over whether an ablation is a good idea or not. Look his posts up.by researcher - AFIBBERS FORUM
Shannon, That is quite a story about the Gortex repaired PFO and trying to do a transeptal puncture through it. I wonder what the reason was that he didn't even consider going retrograde and avoiding all of that trouble since it sounds like he had to reach the LV anyway. Perhaps the Stereotaxis system was already tied up in a long VT procedure.by researcher - AFIBBERS FORUM