Thanks for taking my question. I posted several years ago. I am a 26 year old male with Idiopathic RVOT VT. Perfect heart otherwise. I have been through 4 previous ablations. In total I have had 23 lesions placed in my RVOT. I am having a fifth ablation at Mayo this month using cryoablation. My question which I can never seem to get an answer to, is "How many lesions is too much in the ventricles?" I can't find any research, and every doctor I ask has an indirect answer. I know the atrium can get many, many lesions during an abaltion for AF. Other doctors will say there is no number for too many. If this is so, then I would like to know the higher numbers of lesions some of the doctors have placed int he ventricles.
So I would like to know if possible how many lesions can "safely" be placed in the ventricles, and I'd also really like to know what some of the higher numbers of lesions Cleveland Clinic doctors have placed in the Ventricles during ablations on healthy hearts.
What is the repercussions of having too many lesions?
Q1:"How many lesions is too much in the ventricles? I can't find any research, and every doctor I ask has an indirect answer."
You are going to get another indirect answer for me. Some questions in life just don't have the prefect answer, or even a good answer. "Is she the right one for me?" or "Would a mustang or camaro be a better car?" are similar questions.
Ablation procedures are new procedures, only around about 10 years. RVOT VT is a relatively rare disorder, and so the world's experience with the ablation of this disease is limited. The answer to your question will likely eventually be available -- in another 5 to 10 years.
Q2:"If this is so, then I would like to know the higher numbers of lesions some of the doctors have placed in the ventricles"
One of the higher numbers I have seen is 64. If echocardiograms performed after the previous ablation attempts have not shown a change in function, that is probably (that's right, probably) a reliable indicator that "too many" lesions were not performed.
Q3:"What is the repercussions of having too many lesions?"
In general, most lesions are approximately 2-4 mm in diameter from standard techniques. The cumulative effects are not really as much of an issue as having one lesion placed in a particularly wrong spot, like near a coronary artery. Having said that, the more lesions are placed, the higher the likelihood that one is placed in a bad spot.
The electrophysiologists at the Mayo are first rate. You are going to have to let them use their judgement in deciding when enough is enough.
Interesting question...I have had two ablations and I know the second one (Left-side) resulted in 10-12 burns. I'm not sure about the first (RVOT). I'm going to try and remember to ask my doctor this question next month. Also, I will get a copy of the notes from the first procedure.
I presume you are still symptomatic. What type of arrythmia do you have that requires a 5th ablation?
I still have RVOT VT. I get small non sustained runs of VT and tons of PVC's. VT isn't much of a problem, but the PVC's are. My first ablation was for SVT. The next two were for RVOT VT but were in a small hospital. For my fourth I went to Mayo and got a lot of relief from the ablation, but they were unable to burn the foci because of a good chance of right bundle branch block. This time I am going in for an abaltion using cryomapping and cryo energy, which is more accurate and can cause deeper lesions. I'm getting it burned no matter what even if it causes right bundle branch block. Did you have both RVOT VT and LVOT VT?
WOW!! That's a lot of ablations. I know that prior to my first ablation, my EP said they were going to ablate very conservatively, so it might "more than 1 or 2". So far, two seem to be the magic number.
First ablation was RVOT (EP said I did not "technically" have VT, better described as NSVT). Not sure how many burns on the first one...I'm going to ask for the report when I go for followup next month. Although I had a lot of relief, the pvcs were still acting up (6,000/24 hour) and a second ablation was performed 3 months later.
Second ablation report: four morphologies of pvcs were noted, none appeared to originate form the previous ablation site. Predominant pvc was mapped to the lateral left ventricle (activation was late in the right ventricle). Morphology of predominant pvc was RBB with inferior axis. Ablation was performed for the earliest site of ventricular activation (-80 sec lateral left ventricle) and a line was drawn toward the mitral valve....didn't feel a thing : )
First ablation was RVOT, and the second was LVOT...Hope this makes sense to you. Curious -- Is the cryoablation performed in the same manner? How does it differ from RFA? Thanks!
My mother had the ablation around 10 years ago.I think she had 7 lesions done. It slowed her heart as was needed. She had to get a pacemaker a couple years ago because her heart was beating too slow.... because of the ablation. Be careful!
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