Pappone (CPVA)

[nbpa1234]

Hello,

I was diagnosed with afib at 38 this past May. Was working nights for 13 years and was around 300 pounds and wasn't eating or sleeping well at all. I have had PAC’s and some PVC’s in the past with OCD and anxiety. The worst of all of this is I feel everything even PAC’s. I know the moment I have afib. It is the worst. I have been cardioverted once and I am now on propafenone for the past 4 months and my dosages have been changed 3 times since I am having breakthroughs of afib, I am now at 425 mg extended release 2x a day. I have been finally scheduled for a pappone ablation in January and right side ablation for atrial flutter. Has anyone ever had a pappone ablation and what were your results.

Thanks

[CDreamer]

I am not sure what a Pappone ablation is? Do you mean a procedure where the EP is remotely controlling it?

[BobD Volunteer]

OK Carlo Pappone was the bloke who started doing pulmonary vein isolation for AF but I have never heard of an ablation referred to this way. Here in UK we normally speak of "an ablation" or a "Pulmonary Vein Isolation Procedure." There are very many methods of doing this from using heat to extreme cold and if you go to AF Association main website there is a booklet you can down load which explains them all.

Effective in about 75% of cases but may need repeating. I had three before my AF was stopped.

It is worth commenting that life style changes are important and that failure is almost guaranteed if these are not implemented as part of your treatment. Weight loss is one of the most important factors here and a body mass index (BMI) of less than 25 highly desirable . Obesity is a major contributory factor in AF and many EPs (here in UK) will not proceed unless weight loss is implemented in advance.

[nbpa1234]

Lolol, “bloke”. Yeah, I should of put that in my post that since being diagnosed with afib I went from 300 to 265 and am now working days and eating right. I did everything u can think of to turn afib around but it is still here. My cardiologist says if I didn’t do all those things it would be 100% worse. My EP calls it a pappone and he said it’s just easier to call it that then the full name. I believe bob, correct me if I’m wrong that they ablate in a circular motion and they make a 3D map your heartland like cdreamer said thy use remote controls.

[CDreamer in reply to nbpa1234]

Well I was referring to the procedure in which the Pappone was in US whilst the patient in a Cath lab 4,000 miles away in Italy it was a procedure for atria tachycardia.

PVI or cryogenic loop or balloon at the top of catheter inserted into vein in the leg are all guided by GPS. Very complicated and requires a highly skilled team, the lab looks more like a scene from a SCI FI set than a hospital. Ensure the EP performs them very frequently - success rates have been linked to EPs who perform multiple procedures every day, some only perform them very occasionally so do ask how many procedures a year he does.

Go to YouTube and search PVI ablation and you too can watch exactly what happens. It is a fairly common procedure - I’ve had 2 - partially successful but as Bob says you wouldn’t get a chance of one here until your BMI was considered reasonable,

This one is from the Cleveland, one of the best clinics in the US

youtu.be/SZ_uIfj-hIQ(Not working as expected?)

[nbpa1234 in reply to CDreamer]

Thank you so much for that information. Yeah I know what your saying with the bmi. I’m working hard on that. Lost 35 pounds since August. Hoping to lose another 10 before ablation at end of January. I’m 6’1 so I would be real happy with that. I live in New York and my EP is top notch one of the best around. He has done over 4,000 ablations and over 20,000 other heart surgeries. He does between 8-10 ablations a week. Would you know if this type of ablation would help my PAC’s/PVC’s? I have had them for a long time now before I was diagnosed with afib. They have gotten so much better but I was hoping that maybe this type of ablation would stop the errant beat from reaching.

[CDreamer in reply to nbpa1234]

I wouldn’t know but one can hope. Good luck & let us know how you get on. Read the posts on here regarding recovery- takes longer than you are led to believe.

[Polski in reply to nbpa1234]

I think some people have found that taking magnesium supplements can decrease ectopics.

[CDreamer]

PS - I would say that modern ablations can be about 1 hour - so we were told at a recent talk - dependant upon the complexity encountered.

[Jong1945 in reply to CDreamer]

The Cleveland video above says around 4-5 hours. 1 hour sounds pretty darned quick to me! I think some of the more minor ablations (accessory pathway etc) can be 1-hour-quick, but if an EP said to me that my AF PVI ablation could be done in 1 hour I would be quite concerned.

[CDreamer in reply to Jong1945]

Depends upon which type RF or Cryo. Using a balloon or ring which covers the area in one go = 1 hour but not everyone is suitable. I wouldn’t be concerned as this seems to be the norm nowadays.

I wasn’t suitable as I have 3 and not veins as one is conjoined and much larger than normal so the ring wouldn’t cover the area hence it would need individual burns from a tip. Both mine therefore took 7+ hours but that was 2013 & 2014 and the technology has moved quite a bit since then! Our local hospital seems up to scratch and 1 hour was what they told us at our support meeting in Exeter on Friday,

[Jong1945 in reply to CDreamer]

Ah, ok understand. But that also means the prep and mapping etc is all very quick too.

[Jong1945]

Pappone was certainly in there near the beginning of AF PVI ablations, but Michel Haissaguerre at Bordeaux was, I thought, generally credited with "inventing" the PVI for AF, or at least identifying the PV foci triggering AF. Pappone's CV is perhaps the longest CV I think I have ever seen - at 157 pages I leave it to you to work out when he started AF ablations.... af-ablation.org/uploads/cv-...

Haissaguerre did linear AF ablations in 1994, (PubMed ID 7697206) and the PV foci were identified in 1997 (PMID 9725923).