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Heart Disease (Expert Forum)
ablation techniques
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ablation techniques
by arthur, Sep 01, 2001 12:00AM
Two years ago I came down with a PAF condition (out of the blue) which resulted in about 6-7 incidences of self-converting AF within one year. I underwent a successful rf ablation of a PV focus (one of several causing premature atrial depolarizations, APDs) which cured me of PAF (Marchlinski, UPenn). Since that time I used tambocor (200 mg/day) to help reduce the number of APDs which are a continuing issue. With tambocor, the APDs are limited to about 0-3 per minute; without tambocor, they occur at about 1-6 per minute...including several "attacks" this last year occurring usually after workouts which last seconds to minutes and appear to include a huge number of these premature beats to the extent that they seem like AF (I believe they were not AF since I could still detect regular series of beats between the chaotic skips, and the "attacks" appeared to build up and go back down within the space of 10-20 minutes, as if responding to a surge of adrenaline).
I know that I have several active PV foci which cause the atrial "skips", and I know that rf ablations are used only when the benfits outweigh the risks. Marchlinksi feels that a second rf ablation should not be conducted unless (and until) AF rears its ugly head or the ectopy becomes unbearable.
(1) Do you think that rf ablation should be used to rid me of these annoying APDs, since they are occuring at an intensity that at least to me seems rather high? (I do not want to resume tambocor treatment)
(2) Are there other ablation techniques that are safer (like cryoablation)?
I know that I have several active PV foci which cause the atrial "skips", and I know that rf ablations are used only when the benfits outweigh the risks. Marchlinksi feels that a second rf ablation should not be conducted unless (and until) AF rears its ugly head or the ectopy becomes unbearable.
(1) Do you think that rf ablation should be used to rid me of these annoying APDs, since they are occuring at an intensity that at least to me seems rather high? (I do not want to resume tambocor treatment)
(2) Are there other ablation techniques that are safer (like cryoablation)?
Doctor's Answer
by CCF-M.D.-CRC, Sep 01, 2001 12:00AM
Dear arthur,
It sounds to me like the benefits of a second ablation in your case would outweigh the risks. The risk of pulmonary vein stenosis in our lab is less than 1% per vein ablated and I suspect that it is also low at UPenn. Cryoablation is on the horizon but is not being used for this in the US yet.
It sounds to me like the benefits of a second ablation in your case would outweigh the risks. The risk of pulmonary vein stenosis in our lab is less than 1% per vein ablated and I suspect that it is also low at UPenn. Cryoablation is on the horizon but is not being used for this in the US yet.
