Cleveland Clinic Procedures

[Lightcutter]

This question has a few parts.  Please bear with me.  From reading the literature, my understanding is that there are essentially approaches to ablating Atrial Fibrillation.  One is called circumfrential Pulmonary something something and consists of laying down scar tissue around the four (?) pulmonary veins, with the assumption that most rogue electrical signals originate in the pulmonary veins.  The other approach, approach Y, locates the rogue signals and then isolates them specifically - a sort of seek and destroy approach.   I further understand that the Cleveland Clinic endorses the first approach, the Circumfrential Pulmonary something something.  The first part of my question is:  is this correct, in particular, does the Cleveland Clinic endorse the Circumfrential Pulmonary something something?  

I have A-fib and was ablated earlier this year.  It doesn't seem to have worked and at my follow-up I asked my doctor about this.  He said that he did approach Y, and that, as far as he knew, every doctor at Cleveland Clinic did Y.  I thought about this for a while and it occurred to me that while my doctor might not know what the other doctors do, his staff must also work with other doctors and must know what other doctors do and know if my doctor was, in fact, the only doctor to do approach Y.  It seems unlikely that the staff wouldn't have made that fact known to him over the course of working with him.  So, question two is:  is this correct.  Is it extremely unlikely that this is anything but a misunderstanding, Is it possible that my doctor is the only one - or one of the few - who does approach Y and doesn't know it?  My last question - and the bottom line - is:  how concerned should I be about all of this?

[Smitty150]

I had a PVI+ other abaltions at the CCF three weeks ago.

It sounds as if I had what MJM describes. That is, the PVI plus various other burns in selected areas.

So far so good for me but I have been cautioned to keep the champagne on ice for 3 months before beginning the celebration.

I obsessed a bit on preparing for the procedure and even dropped a scheduled PVI with my local (and very good) EP in favor of waiting several months to have it done by Dr. Saliba at the CCF.

Speaking for myself, the whole scenario at CCF gave me confidence that I was at a prime center for this procedure. It appears that the interplay among Dr. Natale and his colleagues constitute an
"all-pro" team with an active program of intellectual and practical development.

I think it also wise to consider the support staff at a place such as CCF. These people do nothing but catheter ablations day-after-day. Other hospitals may see them only sporadically.

Best of luck.

[Michael J. McWilliams, M.D.]

Very good question but difficult to answer.

does the Cleveland Clinic endorse the Circumfrential Pulmonary something something?  

Every center seems to do atrial fibrillation ablations a little bit differently.  I cannot comment on what the other doctor did and how he placed his/her lesions because I am not sure what their technique is.  They may have a very organized approach to "seek and destroy" and in infact in may be close to what Dr. Natale does and teaches.  There is no way for me to know unless I saw it performed.

Dr. Natale does a PVAI (pulmonary vein antral isolation) -- this is a technique that stays outside the pulmonary veins.  It covers a wide area that includes careful ablation outside the PVs and includes regions of the posterior wall and in selected individuals may extend to include the coronary sinus, mitral valve annulus, roof, some of the anterior wall, the superior vena cava and sometimes the crista terminalis.  It is complicated to explain and takes a long time to learn.

Roughly 25% of people will need a redo procedure to achieve the success rates quoted in the literature, and some patients need even more than that.

If you are truly unsatisfied with your last procedure, consider getting a second opinion.  There are many very qualified centers around the country.  I would be happy to recommend one close to you.

I hope this helps.