Interesting new take on pared down ablations

[dmac4646]

news-medical.net/news/20190...

[Hidden]

Thanks dmac .. .yes, this is interesting.

[dmac4646 in reply to Hidden]

"Catheter ablation started in 1998. There has been little improvement in clinical outcomes in the last ten years despite costlier technologies and a more complicated procedure requiring highly skilled staff. In this trial, we stripped the procedure back to the bare essentials to see if it achieved the same outcomes."

That para will be controversial - but if the research stands up and more can be positively treated and time given to complicated cases it may well help.

[CDreamer in reply to dmac4646]

Which I guess is what I am saying in my answer below but how would they know who has complications and who has not? None of my complications were picked up prior to the ablations.

[rosyG]

thank you- very useful

[Peddling]

Thanks very much - most helpful.

[Buffafly]

Interesting!

[CDreamer]

I’m not sure what to think of that. I can see it is less costly and requires less staff and equipment but surely that would still require a cath lab? The bottle neck in our area is that the cath lab is used for a variety of procedures, AF ablation being only one and the use of the cath lab is shared out between a number of Cardiologists. I can see they may be able to get a bigger throughput which may help but it would be interesting to see by how much.

They seem to have only used cryoablation which wasn’t an option for me as I have an unusual atria shape and 3 rather than 4 pulmonary veins so surely some mapping procedure would have to be done to determine who is and is not suitable?

I can see the benefits but not sure it could be as easy as is suggested - but maybe it is! Speaking as someone who woke up having resuscitation in the cath lab - I’m all for the monitoring and mapping.

[dmac4646]

the connection is cost and rising need in the UK

[Hidden in reply to dmac4646]

Deleted my post.

[MarkS]

Very interesting! Results have only gradually improved. In the early days, ablations were only done by real experts whereas now ablations are done by every EP or registrar regardless of how skilled. I think skill still really makes a difference - hence the relatively small increase in success rates over the last 20 years.

I guess they just whack the pulmonary veins in this cut-down procedure. That would work in most cases but my ablation would have failed as erratic signals were also coming from the ligament of marshall.

[dmack4646 in reply to MarkS]

Evidence would support the skill of the operator being key .

[Melchet]

I share the view of MarkS that PVI Cryoablations are already ‘paired down’. Certainly in my case, there was no evidence of 16 channel oscilloscopes and catheters sniffing out rogue electrical signals and accessory pathways elsewhere. My EP made it clear that first stage treatment for my PAF would be PVI and depending on the outcome, RF ablation with mapping might be required later to clear up any remaining problems. The article does not seem to be particularly newsworthy since the practice of pairing down already exists, but maybe someone could persuade me otherwise?

[dmack4646]

Possibly , as many people need more than one seems like a kind of “triage” system where they try thus first and presumably try a more advanced procedure if it doesn’t work... would like to hear Pro Schillings view on this .

[cuore]

The AVATAR-AF trial appears, like the Cabana trial, to say that ablation is superior to drug therapy and should be considered as the first line of treatment:

" "The findings also question the value of drug therapy, and whether catheter ablation should be the first line treatment for atrial fibrillation patients with symptoms.""

At one year the results were spectacularly better with the conventional ablation group than the drug group; furthermore, the conventional ablation group also did better than the AVATAR -AF group:

"At one year, 21% of patients in the AVATAR group needed hospital treatment to relieve symptoms. This was significantly lower than in the drug therapy group, of whom 76% needed therapy (p<0.0001), and not significantly different to the conventional ablation group, of whom 18% required treatment (p=0.6)."

For me, ablation with mapping is still the winner, and there appears to be a guarantee that less ablation is done. I believe it was the STARR-AF II trial that concluded less was better.