ablation question

I've been trying to find some info on ablation for a pulmonary vein ectopic focus resulting in a tach and lots of PACs.

I was feeling pretty confident about having my upcoming EP study and ablation ( and I'll ask the doc lots of questions, when the time comes) but now I've read some confusing things.

Questions:

1.I understand the pulmonary focus can be more difficult to ablate. Is this always the case?

2.Do they always have to do a transesophageal ultrasound or other extra procedures for the pulmonary focus?

3. Is it true the EP doc has to PUNCTURE the pericardium to get to the pulmonary vein for the ablation?

4. Does a pulmonary vein ablation always take many hours?

This is making me very nervous.

Thanks for any info!

Lynn

[Cleveland Clinic]

Lynn,

I can certainly tell your getting nervous about this.  

Im assuming your having a pulmonary vein isolation. If this is the case, there isnt a specific focus, they will try to isolate the electical activity of the pulmonary veins from the rest of the heart.

Some people use a transesophageal ultrasound to guide the therapy. Here it is routine and the results are quite good.

The puncture the atrial septum to perform the procedure. Not the pericardium, which is the lining of the heart.

The ablation time varies, there is no too long or too short time.

I think you should calm down and not get too bogged down in the details of the case. This procedure is complex even for basic cardiologist, I think you could do more harm then good by trying to understand the minutia.

good luck

[LynnSB]

Thanks. I didn't remember you had a pulmonary focus.

thanks again for the info!

[Dotcom]

I have A-Fib and it has gotten much worse lately. Dr's. say very close to stroke. I am on Coumadin now and they want to perform Pulmonary Vein Isolation, if tests say ok to do so. I am 66 years old and was told that 65 is about the cut off age for this procedure. Should I be concerned? Is their anyone my age or close who has had this procedure done? Would like to hear from you. Going for test Monday the 15th to see if I can have surgery. All responses appreciated.        Thanks
                                          Very nervous, Dotcom

[arthur]

A few years ago, Dr. Francis Marchlinski (UPenn) published a paper which reviewed ablations done on folks of various age groups and found no increased risk due to any age, even for folks in their 60's and 70's.  These ablations were for a variety of supraventricular arrythmias.  So, as far as I can tell, the procedure does not carry an increased risk for age.  Good Luck!
-Arthur

[arthur]

Below is the abstract from the paper re. age and ablations...
I stand corrected...it's safe for folks in their 80's as well.
-Arthur


Efficacy and safety of catheter ablation in octogenarians.

Zado ES, Callans DJ, Gottlieb CD, Kutalek SP, Wilbur SL, Samuels FL, Hessen SE, Movsowitz CM, ontaine JM, Kimmel SE, Marchlinski FE.

                       Hospital of the University of Pennsylvania, Philadelphia 19104, USA.

                       OBJECTIVES: To determine whether catheter ablation is safe and effective in patients over the age of 80.
                       BACKGROUND: There is a tendency to withhold invasive therapy in the elderly until it has been proven safe and
                       effective. METHODS: Over a two-year period from February 1, 1996 to February 1, 1998, 695 consecutive patients
                       underwent 744 catheter ablation procedures of supraventricular and ventricular arrhythmias. These patients were
                       divided into three groups based on age: > or =80 years, 60 to 79 years and <60 years. Acute ablation success, using
                       standard criteria and complication rates for these three groups were determined. RESULTS: There were 37 patients
                       > or =80 years, 275 patients 60 to 79 years and 383 patients <60 years old. The overall acute ablation success rate for
                       the entire group was 95% with no difference in rates among the three groups (97%, > or =80 years; 94%, 60-79
                       years; 95%, <60 years). The percentage of patients undergoing His bundle ablation was greatest in the > or
                       =80-year-old group (43% vs. 19% vs. 2%, p < 0.01), and the percentage of patients undergoing accessory pathway
                       ablation was greatest in the <60-year-old patients (0% vs. 4% vs. 25%, p < 0.01). The overall complication rate for
                       the entire group was 2.6%, and there was only one major/life-threatening complication. There was no difference in
                       complication rates among the groups (0%, > or =80 years; 2.2%, 60 to 79 years; 3.1%, <60 years). Based on the
                       sample size, the 95% confidence interval is 0% to 7.8% for an adverse event in the octogenarian. CONCLUSIONS:
                       Catheter ablative therapy for the arrhythmias attempted in the very elderly appears to be effective with low risk.
                       Ablation results appear to be comparable with those noted in younger patients.