Aa
Consequences of substrate scarring following rf ablation
Thanks for taking my question, doctor.
I'm a 62 year old male with atrial fibrillation that has been reasonably well controlled with Rythmol (225 mg/3X daily)for the last two years (still experience self-converting episodes every month or so). I had previously suffered from chronic/continuous afib prior to treatment. I'm considering having an rf ablation but am concerned about the unavoidable scarring that takes place during rf ablation as a by-product. In my case, with an enlarged left atrium (5.2 cm dia.), rf ablation would likely involve PVI as well as extensive substrate modification. I've read, for example, that scarring as a result of the PVI will sometimes lead to pulmonary stenosis.
1. Have there been reports of negative consequences due to the extensive scarring that takes place following substrate modification?
2. Would you expect any long term negative consequences from such scars?
3. Does rf ablative scarring have a different character than say that resulting from a myocardial infarct?
4. I've read that surgical scars on the ventricles will sometimes act as rentrant circuits, causing PVCs and VT. Would atrial substrate scarring be less likely to cause further arrhythmia than rf ablative scarring on the ventricles?
5. What of the more usual focal point ablation without substrate modification? Could that scar ultimately form a troublesome reentrant circuit?
6. Would scarring using other procedures, for example crygenic ablative therapy, lead to less scarring?
Thanks again to CCF for providing this wonderful service!
I'm a 62 year old male with atrial fibrillation that has been reasonably well controlled with Rythmol (225 mg/3X daily)for the last two years (still experience self-converting episodes every month or so). I had previously suffered from chronic/continuous afib prior to treatment. I'm considering having an rf ablation but am concerned about the unavoidable scarring that takes place during rf ablation as a by-product. In my case, with an enlarged left atrium (5.2 cm dia.), rf ablation would likely involve PVI as well as extensive substrate modification. I've read, for example, that scarring as a result of the PVI will sometimes lead to pulmonary stenosis.
1. Have there been reports of negative consequences due to the extensive scarring that takes place following substrate modification?
2. Would you expect any long term negative consequences from such scars?
3. Does rf ablative scarring have a different character than say that resulting from a myocardial infarct?
4. I've read that surgical scars on the ventricles will sometimes act as rentrant circuits, causing PVCs and VT. Would atrial substrate scarring be less likely to cause further arrhythmia than rf ablative scarring on the ventricles?
5. What of the more usual focal point ablation without substrate modification? Could that scar ultimately form a troublesome reentrant circuit?
6. Would scarring using other procedures, for example crygenic ablative therapy, lead to less scarring?
Thanks again to CCF for providing this wonderful service!
Now that I am using a Timex HRM with an accessory data recorder I can see that I have experiences similar to Tony/JCB. Walking at 4mph, at around 20-25 mts the bpm varies +- 10bpm whereas before that it is much less. The PAC's seem to begin then. A couple of times I've seen drops to 70 from 120 and then a recovery. After I get off the treadmill I have seen very low readings for a few minutes and then recovery. But yesterday was perfectly normal so it is inconsistent. I have an ECG event monitor now so I am recording at the same time and I will be looking forward to the doc's reading later this month. BTW Tony mentioned taking Rythmol, I quit after a week because it gave me some pretty bad palpitations at rest, and I couldn't do any exercise without getting dizzy. Did you have any problems? Cardizem did not help or hurt. Toprol was OK at rest but caused problems during exercise. Did not take any of them more than a week. The circumferential ablation technique is described on the Cleveland web page. The EP that I went to told me that it would be best to wait a few years for ablation techniques to improve. He was sure that my focus was the PV. Tony- Yes you are right about my prob. calc- see my other post. Thanks all.
Hi,
I recall you telling me about your ablation six months ago. You were happy back then with the results and apparently still are. That's great. I love hearing success stories!
Thanks for the info about ablating a large circle away from the pulmonary vein opening rather than the usual PVI. That's very interesting and makes a lot of sense. Evidently, they know what they are doing at the Mayo.
It is strange about your increased heart rate. Have you taken into account that you are now probably taking less meds? I'm sure it's not an important issue.
It's also great that you are able to get back to running. Keep it up.
Stay well,
Tony
I recall you telling me about your ablation six months ago. You were happy back then with the results and apparently still are. That's great. I love hearing success stories!
Thanks for the info about ablating a large circle away from the pulmonary vein opening rather than the usual PVI. That's very interesting and makes a lot of sense. Evidently, they know what they are doing at the Mayo.
It is strange about your increased heart rate. Have you taken into account that you are now probably taking less meds? I'm sure it's not an important issue.
It's also great that you are able to get back to running. Keep it up.
Stay well,
Tony
When feeling my pulse in afib, I can detect that it is very irregular and missing beats (even when I have no other symptoms). So, if I hook up a Polar heart rate monitor, I see 15-20 second averages that show a (typical) variation of 75, 102, 87, 112, 95, 70, etc. The rate is bouncing all over the place minute to minute. When in NSR, it's very steady, not varying more than 10% unless I get up and move around. The other thing I notice is that when I am in NSR, I can see the pulse at my wrist throb with each beat. When I'm in afib, the pulse is much weaker and I can't see an throbing (no atrial kick). Of course, if I then try to exercise, I find that I don't have the stamina that I normally do (but can otherwise function well even going for long walks).
My understanding is that the clots like to form in a small outcropping that lies on the left atrium (called the left atrial appendage). When in fibrillation, an eddy forms that traps particles and a clot can form around them - - much like an eddy in a running stream can trap a leaf, etc. When normal sinus rhythm is restored, this mini-clot (assuming one is there) is washed away. As to how long it takes to form such a clot varies from person to person. Generally, the rule of thumb is 2-3 days. However, it can form very quickly (I think) in some people. Your previous TIA indicates, I think, that you are susceptible to clot formation.
Besides the CHADS data, which I think is pretty convincing, the following site (http://www.affacts.org/Questions/af_and_strokes.html) states:
"Not all patients with atrial fibrillation are equally at risk of blood clot formation in the atrium. It has been shown that a previous history of a stroke or a transient stroke (called a transient ischemic attack), high blood pressure, diabetes, congestive heart failure, or certain other structural heart diseases increases the risk of stroke markedly."
You'll notice they specifically mention TIAs.
By the way, the probability of having a stroke (assuming the yearly probability is 2.8%) over 28 years is 55%. See my reply to your probability calculation in the coumadin thread.
Best wishes,
Tony
My understanding is that the clots like to form in a small outcropping that lies on the left atrium (called the left atrial appendage). When in fibrillation, an eddy forms that traps particles and a clot can form around them - - much like an eddy in a running stream can trap a leaf, etc. When normal sinus rhythm is restored, this mini-clot (assuming one is there) is washed away. As to how long it takes to form such a clot varies from person to person. Generally, the rule of thumb is 2-3 days. However, it can form very quickly (I think) in some people. Your previous TIA indicates, I think, that you are susceptible to clot formation.
Besides the CHADS data, which I think is pretty convincing, the following site (http://www.affacts.org/Questions/af_and_strokes.html) states:
"Not all patients with atrial fibrillation are equally at risk of blood clot formation in the atrium. It has been shown that a previous history of a stroke or a transient stroke (called a transient ischemic attack), high blood pressure, diabetes, congestive heart failure, or certain other structural heart diseases increases the risk of stroke markedly."
You'll notice they specifically mention TIAs.
By the way, the probability of having a stroke (assuming the yearly probability is 2.8%) over 28 years is 55%. See my reply to your probability calculation in the coumadin thread.
Best wishes,
Tony
As I read my description of how clots form, it occurs to me that is a point I didn't mention. It's my understanding that clots can form in the left atrial appendage (LAA) even when you are not in afib. For example, if you have an enlarged LAA (and/or atrium) or if you have mitral valve stenosis. Basically, any defect which slows blood movement past the LAA could cause clots.
Tony
Tony
I had a PVI ablation at Mayo 2/20/2004. They explained to me that there are two approaches to a PVI ablation. One is to ablate where the vein meets the atrium, and the other is to make a large circle around the area without getting near the openings. I had the latter because Mayo felt that it would be less likely to have a stenosis and also because it was just as effective. It worked.
I also suffered from atrial flutter and numerous PAC's. They were able to ablate those areas as well, and the PAC's have diminished immensely, and to my knowledge I have not had any flutter.
I didn't run for about 3 months after my ablation, and now I'm back to continuous running for 24 minutes and then intermittant running/walking for the next 16 minutes. Goal is continuous running at an easy pace for 40 minutes at least 3 times a week.
I am still on 50 mg of atenolol as a precaution and since I feel fine on atenolol they figure why mess with success.
One thing that did occur after my ablation is that my resting heart rate went up about an average of 10 beats per minute. It has continued higher than in the past. Not quite sure why this occured, although they say it is common.
I also suffered from atrial flutter and numerous PAC's. They were able to ablate those areas as well, and the PAC's have diminished immensely, and to my knowledge I have not had any flutter.
I didn't run for about 3 months after my ablation, and now I'm back to continuous running for 24 minutes and then intermittant running/walking for the next 16 minutes. Goal is continuous running at an easy pace for 40 minutes at least 3 times a week.
I am still on 50 mg of atenolol as a precaution and since I feel fine on atenolol they figure why mess with success.
One thing that did occur after my ablation is that my resting heart rate went up about an average of 10 beats per minute. It has continued higher than in the past. Not quite sure why this occured, although they say it is common.
Hello axg9504,
I saw this thread and the comments made by va_tony concerning his detection of Afib by measuring pulse rate and using a Polar HRM. His experience matches mine when I have had an Afib event except that I also feel the variable beats as a "rumbling" sensation in my chest.
The variation that he reports that he observes with his HRM also matches what I see during an event. Although the number of values he reported are limited, the variation (+/- 20 bpm) are very similar to what I detect with my Polar HRM during Afib. I have a Polar Accurex Plus with which I store and download rates to my computer so I have hundreds of data points from which my averages are calculated depending upon the length of the event.
It also sounds like we are all similar in age and have suffered with Afib about the same length of time. I am not symptomatic to the extent that I need medicines. (Played two hours of hard tennis this evening.)
Good luck.
I saw this thread and the comments made by va_tony concerning his detection of Afib by measuring pulse rate and using a Polar HRM. His experience matches mine when I have had an Afib event except that I also feel the variable beats as a "rumbling" sensation in my chest.
The variation that he reports that he observes with his HRM also matches what I see during an event. Although the number of values he reported are limited, the variation (+/- 20 bpm) are very similar to what I detect with my Polar HRM during Afib. I have a Polar Accurex Plus with which I store and download rates to my computer so I have hundreds of data points from which my averages are calculated depending upon the length of the event.
It also sounds like we are all similar in age and have suffered with Afib about the same length of time. I am not symptomatic to the extent that I need medicines. (Played two hours of hard tennis this evening.)
Good luck.
A couple more q's to you. You said "My symptoms with afib vary from not noticeable(except by taking my pulse)". What do you find when you take your pulse? Since you've been doing scouring the web, have you read anything about what happens to the blood that pools in the atrium. Can it stay there a long time without getting vented. Do you have to be in Afib for x amount of time before it collects. etc. Thanks!
Good to get your comments and see someone in a very similar situation. I ran 20-30 miles a week in my late 30's (started then). Then almost quit and in 50's tried to get back,noticed there were limits I couldn't break and then at 58 started getting light headed. I can now walk without getting light headed at 4mph for at least 2 miles. If I mixed in some running (at 6mph) with walking I'll get dizzy around 1.5mi. I can walk to recovery and then run/walk some more but I don't try to push it. I'm now taking an HRM and an event monitor to the gym and trying to correlate my monitor results (which I don't have yet) with my HRM. I do have PAC's/PVA's - they start like clockwork at 20 mts - my HRM tells me at this time that my bpm is varying 10 bpm's. I am hoping that the event monitoring will tell me more about when I break. The last time I did this I had 2 out of 4 readings showing limited periods of Afib. My ECG on 3 separate doc visits was stable. I probably will wind up taking C. but hey, think of your case, you went 28 years without an event. Using a prob of 2.8% a year (your case) the chances of having one in 28 years would be 35% using some very general assumptions (See my note to you on the Coumadin thread). Thanks again. I wish I could work out as much as you do. (mostly I'm slack)
Thanks!
That's useful info. It's a royal pain taking Rythmol three times a day at 8 hour intervals. I usually take mine on or about 6 am, 2 pm and 10 pm. It's so easy to forget the afternoon dose. But with twice a day, one can take a pill at breakfast and dinner time. Very convenient. I'll have to ask my cardio to write a prescription for Rythmol SR325. Cost shouldn't be a problem. I'm already paying the maximum co-pay my insurance requires for the regular Rythmol ($80/3 month supply), so the cost to me should stay the same.
Best wishes,
Tony
That's useful info. It's a royal pain taking Rythmol three times a day at 8 hour intervals. I usually take mine on or about 6 am, 2 pm and 10 pm. It's so easy to forget the afternoon dose. But with twice a day, one can take a pill at breakfast and dinner time. Very convenient. I'll have to ask my cardio to write a prescription for Rythmol SR325. Cost shouldn't be a problem. I'm already paying the maximum co-pay my insurance requires for the regular Rythmol ($80/3 month supply), so the cost to me should stay the same.
Best wishes,
Tony
Good question that has enlightened (me at least) with the answer from the doc. Mind if I ask: (1) Did you have any side effects from Rythmol? (2) If you exercise regularly did Rythmol cause problems? (3)Have you been on anticoagulation therapy these last 2 years? (4)What symptoms do you have when you are in Afib? Thanks for the info..
Hi,
I've been lucky I guess. I have almost no side-effects from either Rythmol, coumadin, altace and cardizem. The cardizem (calcium channel blocker) did seem to make my ankles swell at times, so my doc prescribed HCTZ, a diuretic, and I don't have that problem anymore.
I've been on anti-couagulation therapy for about two years. No real problems with that. I pretty much eat what I want (the so-call seafood diet - "see food, eat it") and don't see large fluctuations in my PT/INR. I do eat the same foods from week to week, though, and the "dose adjusted" nature of coumadin, allows for stabilization. It is a royal pain to have to be PT/INR tested every month. But I don't see any excessive bleeding because of the coumadin. I've had a number of hand cuts, etc. and saw no problem. During the summer I was ocean kyaking about the time there were hurricanes far to the south and the waves were pretty rough. Coming into shore I totally wiped out one time, the boat bouncing off me a couple of times and getting all scraped up rubbing along the bottom. But I didn't see any excess bleeding or bruising.
My symptoms with afib vary from not noticeable(except by taking my pulse) to experiencing severe palps. I believe I've had afib on and off for 30 years or so. In my early 30's, I used to run 5 miles a day and work out in martial arts in the evenings. I started getting severe runs of palps then, went to a cardiologist, but only saw occasional PACs on Holter monitor (the Holter missed the afib events, I believe). The cardiologist convinced me that these extra beats were harmless, so I tended to down play what I felt. I would get palps a few times a year and then it would disappear for several years and then repeat the cycle. I would complain to doctors about it, but they never caught it on the ekg. Finally about 2 1/2 years ago during a routine medical exam I complained again about it. The ekg showed that I was in continuous afib and, apparently, had been for several months. During that time I was in very good shape, working out at a gym nearly every day, jogging and participating in cardio-kickboxing. But I did notice that there were times that I felt that I was about to faint when I pushed too hard. Now that I take Rythmol, I only have an event once every month or two, generally triggered by exercise. This has really affected my ability to exercise because I'm afraid of triggering an episode. I still work out at a gym 3 times a week, lifting weights and slow jogging 2 miles (10 min/mile pace) on a treadmill. If I maintain a set routine, I seem to be OK. If I feel real good on a given day and accidently push too hard, I have an event that evening.
To answer your question, absense of symptoms doesn't insure that you don't have afib. In fact my cardio tells me that it's common to have short lived events especially when sleeping.
Frankly, if I were you, with a prior TIA and afib, I would take coumadin. If you already had one TIA, why risk another (or worse)? Sure taking coumadin is a pain but think of the alternative.
Good luck on your decision,
Tony
I've been lucky I guess. I have almost no side-effects from either Rythmol, coumadin, altace and cardizem. The cardizem (calcium channel blocker) did seem to make my ankles swell at times, so my doc prescribed HCTZ, a diuretic, and I don't have that problem anymore.
I've been on anti-couagulation therapy for about two years. No real problems with that. I pretty much eat what I want (the so-call seafood diet - "see food, eat it") and don't see large fluctuations in my PT/INR. I do eat the same foods from week to week, though, and the "dose adjusted" nature of coumadin, allows for stabilization. It is a royal pain to have to be PT/INR tested every month. But I don't see any excessive bleeding because of the coumadin. I've had a number of hand cuts, etc. and saw no problem. During the summer I was ocean kyaking about the time there were hurricanes far to the south and the waves were pretty rough. Coming into shore I totally wiped out one time, the boat bouncing off me a couple of times and getting all scraped up rubbing along the bottom. But I didn't see any excess bleeding or bruising.
My symptoms with afib vary from not noticeable(except by taking my pulse) to experiencing severe palps. I believe I've had afib on and off for 30 years or so. In my early 30's, I used to run 5 miles a day and work out in martial arts in the evenings. I started getting severe runs of palps then, went to a cardiologist, but only saw occasional PACs on Holter monitor (the Holter missed the afib events, I believe). The cardiologist convinced me that these extra beats were harmless, so I tended to down play what I felt. I would get palps a few times a year and then it would disappear for several years and then repeat the cycle. I would complain to doctors about it, but they never caught it on the ekg. Finally about 2 1/2 years ago during a routine medical exam I complained again about it. The ekg showed that I was in continuous afib and, apparently, had been for several months. During that time I was in very good shape, working out at a gym nearly every day, jogging and participating in cardio-kickboxing. But I did notice that there were times that I felt that I was about to faint when I pushed too hard. Now that I take Rythmol, I only have an event once every month or two, generally triggered by exercise. This has really affected my ability to exercise because I'm afraid of triggering an episode. I still work out at a gym 3 times a week, lifting weights and slow jogging 2 miles (10 min/mile pace) on a treadmill. If I maintain a set routine, I seem to be OK. If I feel real good on a given day and accidently push too hard, I have an event that evening.
To answer your question, absense of symptoms doesn't insure that you don't have afib. In fact my cardio tells me that it's common to have short lived events especially when sleeping.
Frankly, if I were you, with a prior TIA and afib, I would take coumadin. If you already had one TIA, why risk another (or worse)? Sure taking coumadin is a pain but think of the alternative.
Good luck on your decision,
Tony
I just read your response on Coumadin on the other thread. I am wavering on this. My situation is that I had a TIA 11 years ago. I was very fit at the time, much more than I am now, did not have any rhythm problems. I had a full cardio workup and MRI after that and they found nothing. My BP was normal(still is). Now apparently I have Afib only when I exercise and only when I go over a certain threshold (I am doing another round of event monitoring to determine if that is true). As far as Iknow I have not had Afib at rest (unless you can have it with no symptoms-hence my Q to you). According to the stats, I was supposed to have another TIA within 3 years after my first one with fairly high probability. I understand the stroke risk comes from blood pooling in the atrium during Afib, but if I don't have Afib, or only have Afib for a few minutes a week, is my risk really that high? For the present I'm taking an aspirin..
You might like to know that Rythmol has recently come to the market in sustained release form. Instead of three times a day, you would take it only twice a day. In your case, you would use Rythmol SR 325mg every twelve hours. The dose has to be slightly higher in the sustained form. I've been on Rythmol for three years for a-fib and SVT. It has helped me greatly, even with PVCs. I recently switched to the SR form, which I think is even better. The only problem is the cost, which is prohibitive if you do not have a pharmacy service.
I would expect that 2-3 years from now may find the success rates getting close to your objective. With good control on the Rythmol and no side effects, you are no doubt making the best decision. I have always been an impulsive person acting before thinking and not taking the time to reflect on repercussions. I have gotten a lot better though the last few years. I wanted an ablation after getting one four hour episode of A-Fib just because I never wanted to feel that dreaded arrhythmia again. I give you a lot of credit for being able to handle your sitaution with courage and level-headedness. You seem to be of strong character.
Talk to you again!
Erik
Talk to you again!
Erik
Thanks Eric for the encouraging words!
I'm not quite ready to go for it yet. I'm the kind of guy that drives car salesmen nuts, trying to get the best deal possible. The quoted odds for a successful ablation on a first try are like 70-80% (actually less for someone with enlarged atria like me) and a major complication rate of 1-3%. I'm holding out for technical improvements leading to success rates approaching 95%. The field is so new, I expect that EPs will achieve better numbers with time. Given that my afib is fairly well controlled by Rythmol at present and with no side-effects, I'm willing to wait.
But if my situation changes (e.g., meds start to lose effectiveness), I'll quickly make a decision.
Best wishes,
Tony
I'm not quite ready to go for it yet. I'm the kind of guy that drives car salesmen nuts, trying to get the best deal possible. The quoted odds for a successful ablation on a first try are like 70-80% (actually less for someone with enlarged atria like me) and a major complication rate of 1-3%. I'm holding out for technical improvements leading to success rates approaching 95%. The field is so new, I expect that EPs will achieve better numbers with time. Given that my afib is fairly well controlled by Rythmol at present and with no side-effects, I'm willing to wait.
But if my situation changes (e.g., meds start to lose effectiveness), I'll quickly make a decision.
Best wishes,
Tony
I think you should go for it. The numbers sound good as far as success rate. I wish you the best of luck! I know when/if I ever have episodes as often as you I will definitely be having a PVI. Heck, I would be willing to have a Maze procedure done right now through a small incision in my chest using that new robotic technique. Good luck Tony!
Erik
Erik
Hi mmfd,
You're right, of course. I'm fairly satisfied with the current ability of my meds to control my afib. So, I'm not in any hurry to have an ablation, considering the complications of the enlarged atria. However, from everything I've read, the antiarrhythmic meds lose their effectiveness with time. So at some point in the future, I'll probably be faced with a decision between opting for an ablation or accepting permanent afib with rate control management (I'm already on coumadin in any event). Hopefully, at that time, Centers like CCF and Johns Hopkins, closest to me, will have made procedural improvements in curing afib via ablation and that will present me with a tempting option. In the meantime, I'm just trying to get as much info as I can.
Best wishes,
Tony
You're right, of course. I'm fairly satisfied with the current ability of my meds to control my afib. So, I'm not in any hurry to have an ablation, considering the complications of the enlarged atria. However, from everything I've read, the antiarrhythmic meds lose their effectiveness with time. So at some point in the future, I'll probably be faced with a decision between opting for an ablation or accepting permanent afib with rate control management (I'm already on coumadin in any event). Hopefully, at that time, Centers like CCF and Johns Hopkins, closest to me, will have made procedural improvements in curing afib via ablation and that will present me with a tempting option. In the meantime, I'm just trying to get as much info as I can.
Best wishes,
Tony
Hey Tony, with all the negative info you have, I think it would be a no-brainer to have any procedure, providing you tolerate your Rythmol with minimal side effects! Since your AF is self-correcting, but I do understand how you want as much information as possible before you make any decisions. Good luck.
Thank you so much for answering my questions which I found helpful!
I probably wasn't as clear as I should have been when I asked the first part of my question. By "substrate modification", I was referring to a relatively new procedure by that name which seeks to electrically isolate various portions of the atria from each other and thus prevent multiple reentrant wavelets from establishing a fibrillation. This would be desirable in the case of patients with enlarged atria, like myself. As I understand it, the procedure would be similar to a Maze procedure, except involving rf ablation, and would be performed in addition to the PVI. Obviously, such a procedure would involve a greater amount of scarring than usual.
However, you answered all my other "scarring" questions which were of a more general nature and I am reassured that ablative scarring is not clinically significant and associated complications are generally rare. This helps to put my mind at ease about having an ablation in the future.
Thanks for taking time out of your busy schedule to reassure and educate folks like me. I really appreciate it.
Regards,
Tony
I probably wasn't as clear as I should have been when I asked the first part of my question. By "substrate modification", I was referring to a relatively new procedure by that name which seeks to electrically isolate various portions of the atria from each other and thus prevent multiple reentrant wavelets from establishing a fibrillation. This would be desirable in the case of patients with enlarged atria, like myself. As I understand it, the procedure would be similar to a Maze procedure, except involving rf ablation, and would be performed in addition to the PVI. Obviously, such a procedure would involve a greater amount of scarring than usual.
However, you answered all my other "scarring" questions which were of a more general nature and I am reassured that ablative scarring is not clinically significant and associated complications are generally rare. This helps to put my mind at ease about having an ablation in the future.
Thanks for taking time out of your busy schedule to reassure and educate folks like me. I really appreciate it.
Regards,
Tony
Hi Tony,
radiofrequency ablation as used for pulmonary vein isolation to treat atrial fibrillation is a successful procedure. The first procedures result in 70-80% cure of atrial fibrillation and a second procedure for failed first procedures hit 90% success.
1. Have there been reports of negative consequences due to the extensive scarring that takes place following substrate modification?
The scarring is localized to around the pulmonary veins. The most common significant complication is pulmonary vein stenosis, albeit we have not seen many significant cases of the that here. There have been about 20 cases reported of left atrial esophogeal fistulas. This is a dangerous complication, but fortunately is very rare.
2. Would you expect any long term negative consequences from such scars?
I don't expect it. It is a relatively new procedure and only time will tell what complications will surface.
3. Does rf ablative scarring have a different character than say that resulting from a myocardial infarct?
In the sense that a scar is dead myocardial tissue, yes it is the same. But this is a localized scar of the atrium and not thought ot be of clinical significance.
4. I've read that surgical scars on the ventricles will sometimes act as rentrant circuits, causing PVCs and VT. Would atrial substrate scarring be less likely to cause further arrhythmia than rf ablative scarring on the ventricles?
We have not seen complications of reentry from PVIs.
5. What of the more usual focal point ablation without substrate modification? Could that scar ultimately form a troublesome reentrant circuit?
same as answer as 4. We have not seen this.
6. Would scarring using other procedures, for example crygenic ablative therapy, lead to less scarring?
Not sure about this one, but I am not sure that this is a clinically relevant point. The scar created are small and localized and do not appear to have the same clinical impact as scars from heart attacks.
I hope this helps and good luck with the PVI if you choose to go forward.
radiofrequency ablation as used for pulmonary vein isolation to treat atrial fibrillation is a successful procedure. The first procedures result in 70-80% cure of atrial fibrillation and a second procedure for failed first procedures hit 90% success.
1. Have there been reports of negative consequences due to the extensive scarring that takes place following substrate modification?
The scarring is localized to around the pulmonary veins. The most common significant complication is pulmonary vein stenosis, albeit we have not seen many significant cases of the that here. There have been about 20 cases reported of left atrial esophogeal fistulas. This is a dangerous complication, but fortunately is very rare.
2. Would you expect any long term negative consequences from such scars?
I don't expect it. It is a relatively new procedure and only time will tell what complications will surface.
3. Does rf ablative scarring have a different character than say that resulting from a myocardial infarct?
In the sense that a scar is dead myocardial tissue, yes it is the same. But this is a localized scar of the atrium and not thought ot be of clinical significance.
4. I've read that surgical scars on the ventricles will sometimes act as rentrant circuits, causing PVCs and VT. Would atrial substrate scarring be less likely to cause further arrhythmia than rf ablative scarring on the ventricles?
We have not seen complications of reentry from PVIs.
5. What of the more usual focal point ablation without substrate modification? Could that scar ultimately form a troublesome reentrant circuit?
same as answer as 4. We have not seen this.
6. Would scarring using other procedures, for example crygenic ablative therapy, lead to less scarring?
Not sure about this one, but I am not sure that this is a clinically relevant point. The scar created are small and localized and do not appear to have the same clinical impact as scars from heart attacks.
I hope this helps and good luck with the PVI if you choose to go forward.
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