Here is a prior thread on this topic, including some comments by Shannon.by GeorgeN - AFIBBERS FORUM
Great--- looks like it worked for this man that had it done---I never liked the idea of burning holes in the heart. I wonder if this procedure will be once and done. Lby Elizabeth - AFIBBERS FORUM
New ablation technique -- no burning or freezing. /Lby LarryG - AFIBBERS FORUM
Hi Shannon, Thanks for the further input. When I asked Prof Jais whether or not one could have PFA after a RFA I was thinking mainly conceptually (I’d only had my ablation the previous day) but also for any later possible - albeit (hopefully) unlikely - reconnection of the PVs as it’s clear that - for now at least - PV isolation is ‘all’ PFA can do. Cheers, Mikeby mwcf - AFIBBERS FORUM
The question I have Mike, is what if your recurrence is from a focal trigger such as an atypical left flutter ... or even a CTI flutter source within the right atria far away from the PVs?? It would be very hard to tell beforehand just where your recurrence is originating from, but I suppose he could always just switch back to RF in that case since the only PFA catheter, so far, offered by Faby Shannon - AFIBBERS FORUM
A bit more on Farapulse PFA: “FARAPULSE Receives FDA Breakthrough Designation for its Endocardial Pulsed Field Ablation System”by mwcf - AFIBBERS FORUM
Cheers Shannon. From the link you provided (and that I read very carefully this time): “PFA’s qualitative safety edge also has meaningful implications for the durability of electrical PV isolation—arguably the most meaningful endpoint in AF ablation procedures—given that the primary mechanism of recurrence following ablation is electrical PV reconnection. Because multiple PFA lesions couldby mwcf - AFIBBERS FORUM
Thanks for the clarifications !by Pompon - AFIBBERS FORUM
Yes Callydex, This preliminary approach to Pulse Field Ablation is limited to only doing a PVI ... so far. No doubt, as the technology matures, the developing companies will expand the catheter designs and overall supportive systems to allow more flexible ablation for more challenging cases of AFIB like so many of us on Afibbers forum have either required, or are waiting to have a more comprehby Shannon - AFIBBERS FORUM
Not sure if this is a stupid question: does the PFA ablation address sources of afib outside the pulmonary veins or just the PVs?by Callydex - AFIBBERS FORUM
Thanks Shannon and hoping the hands respond well soon. And yes that article was/is indeed very difficult to get to grips with and I still haven't! But that said, I do now increasingly appreciate that safety - and particularly in the hands of less experienced operators - is the main advance intrinsic to PFA. I'd very much still like to interpret the article whereby the first PFA proceby mwcf - AFIBBERS FORUM
The main benefit of PFA Mike is, indeed, the safety aspect. There is some degree of potential efficacy benefit for PVI. particularly with less experienced ablation EPs ... but not so much of an ‘efficacy’ advantage for highly experienced elite level operators. More this weekend. Shannonby Shannon - AFIBBERS FORUM
Mike and Anti-Fib l, I’ll write more tomorrow, Saturday, regarding PFA and Electroporation ... and yes, Dr Natale is very familiar with it all and has been actively investigating electroporation or some time now, via Medtronics design for PFA, as well as working with BioSense Webster and Abbott on their respective designs for PFA systems. Its a very exciting development long term and yet Iby Shannon - AFIBBERS FORUM
QuoteCarey Why did they use RFA for the second procedures? Because they have RF catheters that can do single burns with accuracy to close a small gap, but the PF catheters can't do that (yet). The paper isn't written well. It's rather confusing and leaves out some important details, but the take away is that once they settled on using the biphasic 3 waveform they achieved 1by mwcf - AFIBBERS FORUM
QuoteCarey The paper isn't written well. It's rather confusing and leaves out some important details, but the take away is that once they settled on using the biphasic 3 waveform they achieved 100% success. I don't believe any single patient received more than one type of waveform. That’s an understatement? I’m curious as to why they wrote this as they did. Or if this was justby rocketritch - AFIBBERS FORUM
Quotemwcf Why did they use RFA for the second procedures? Because they have RF catheters that can do single burns with accuracy to close a small gap, but the PF catheters can't do that (yet). The paper isn't written well. It's rather confusing and leaves out some important details, but the take away is that once they settled on using the biphasic 3 waveform they achieved 100%by Carey - AFIBBERS FORUM
Not as recent as the other links, but here is another Article with Webcast Videos from Heart Rhythm 2019 If Natale was doing this Shannon would have been talking about it. I asked my EP about this last month, and he thought it was a ways off from being available, unless I got in on a Study.by The Anti-Fib - AFIBBERS FORUM
Another article about it. "Safety is the biggest benefit of PFA and the "results of this first in human study are very impressive to say the least," commented John Day, MD, of Intermountain Medical Center Heart Institute in Salt Lake City, Utah. If further studies support these findings, PFA could "disrupt the Afib ablation market" as it shortens procedure times anby Brian_og - AFIBBERS FORUM
Thanks Carey and rocketritch for your input. I'm still a bitt confused and in some ways underwhelmed. And as someone who will more than likely require a touch-up procedure at some point, I really want to buy into this PFA stuff! From the full text: "With successive waveform refinement, durability at 3 months improved from 18% to 100% of patients with all PVs isolated."by mwcf - AFIBBERS FORUM
Why does it not require anesthesia?by Brian_og - AFIBBERS FORUM
Quoterocketritch So all participants had two complete procedures. The second consisting of remapping and PVI repair if needed. I didn’t see anywhere where they stated how many PVI isolations needed to be re-done during the follow up procedure. True. I wish they had broken out the number that needed RF touch up. I assumed some or even most didn't, but even if they all did, a 100% successby Carey - AFIBBERS FORUM
QuoteCarey That kind of success rate combined with the near total lack of complications (a single pericardial effusion in the whole study), the speed (avg. 92 minutes), the lack of need for general anesthesia, and the lack of risk to the esophagus and phrenic nerve makes this nothing short of huge. The afibbers out there who are considering ablation but haven't done it yet should seriouslyby Daisy - AFIBBERS FORUM
After reading the entire study it appears that the hundred percent comes after the second visit where any breaks in or incomplete PV isolations were isolated with standard RF frequency catheter. So all participants had two complete procedures. The second consisting of remapping and PVI repair if needed. I didn’t see anywhere where they stated how many PVI isolations needed to be re-done duriby rocketritch - AFIBBERS FORUM
Quotemwcf Please correct me but does the above mean that only 18% of patients had successful PV isolation 3 months after the index procedure?? If so, looks very much like 2 goes are required - and more so than is the case with RFA?. No, that section is really badly worded. I had to go find the full text and read it to understand what they meant. What they're talking about there is that theby Carey - AFIBBERS FORUM
Looks broadly promising - particularly from a safety profile viewpoint - overall, but not sure about this bit (from the full article): “Secondary endpoints Of 62 patients scheduled for remapping, 52 (84%) actually presented for this invasive PV reassessment at a median of 84 days following the index procedure. With successive refinements to the waveforms, the proportion of patients (and PVs) wiby mwcf - AFIBBERS FORUM
Not sure if you’re link is working for everyone but here’s a similar link.by johnnyS - AFIBBERS FORUM
by JoyWin - AFIBBERS FORUM
QuoteCarey Pulsed electrical field is interesting stuff. If it pans out it should greatly reduce complications like phrenic nerve injury. The dailymail article is rather incoherent and misses the important points, but here are some pretty good results from a small clinical trial. The 'pretty good results' from a small clinical trial link (a JACC article) you provided used the Faraby mwcf - AFIBBERS FORUM