What are peoples views on how developments in the treatment of AF might lead to an ultimate cure or indeed ablation becoming the first line of defence?
I am thinking about advances in mapping procedures and ablation technology. It seems a lot of investment is being made in these areas.
Whilst one might hope that progess will be made, so far most advances seem only to have made life easier for the EP not greatly improved outcomes for the patient as far as I can see . At a talk I gave in 2008 I compared such treatment with aviation citing the first ablation around 1994 as the Wright Bros first flight and suggested that we had reached a level between the two world wars. I hoped that we would soon invent the jet engine and exceed the speed of sound. I was disheartened to be told by a leading UK EP that things had plateaued and not to expect so much and thus it seems to be in last twelve years.
Success rates in ablation may only have risen ten or so percentage rate although more ablations are being done thanks to those advances in treatment.
There is also a feeling in some quarters that we are looking under the wrong tree for an answer and that AF may actually be a symptom not the condition. The Legacy trails in Australia showed that life style changes often reduce AF burden to a level where ablation was no longer necessary .
For sure if I needed ablation now I would not waste time holding back in the hope of better treatment in the future.
It is likely but they would have to train more EPs and set up more cath labs before everyone could have it. I feel sure that in time it will be seen to be very cost effective.
I had 3 ablations 10 or so years ago ... and my last ablation 2 months ago. Recent one was much better than the former ones.
Didn't have to lay flat-on-my-back for 10 hours. Was up and walking after 2 hours. Groin wounds were non-existent and quite minor compared to puncture wounds years ago.
EP and staff told me mapping software was much more advanced and even the catheters had more advanced functionality and could sense pressure, electrical activity, and temperature better.
I believe the new catheters allow the EP to ablate in areas not thought possible a few years ago. One important area that is a delicate area to ablate is the Left Atrial Appendage (LAA).
My EP ablated the LAA. His staff told me he is one of the few in the world who ablates that tissue-thin area. But it is a known AFIB and stroke producing area, so it is great if the doctor has the skill and equipment to ablate it.
I would presume taken together this would precipitate better outcomes for patients.
'Up and walking after 2 hours' sounds great. May I ask which hospital & EP. Presumably it was a local anaesthetic
General Anesthetic. Dr. Natale at Los Robles Hospital in Thousand Oaks, California. What enables you to be active so soon ... is new collagen plugs they place in the catheter vein to 'plug' it. They don't need to apply pressure or worry about wound healing anymore. The plug just dissolves within a couple of weeks. No more laying still ... no more patient discomfort ... no more catheter punctures that won't heal well. I found them quite an improvement over my old ablations.
Excellent improvement, best wishes.
Dr. Natale is the BEST, in my opinion, in the United States.
Yes! He is certainly one of the best. He is a 'teaching' EP and heads up a team of 14 EP's at his Texas Cardiac and Arrhythmia center. I'm sure his EP's are all top notch.
My 2nd and 3rd ablation were performed by Dr. Steven Hao, in San Francisco. Back then ... Dr. Hao was partnered with Dr. Natale. So Dr. Hao is also a high-level AFIB EP.
If the NHS in the UK is going to last, they will have to focus more on lifestyle prevention and that includes AF treatment. On ablations, I have always considered the 'burning' procedure frankly verging on the barbaric and with rapidly rising numbers of AFers and cost (probably around £20K now) I think improvements will come but the time scale???
It seems to be cryo ablation these days? I was up and out after 2 hours. Brighton.
There are no lifestyle changes I could have made, except dropping my glass of wine with dinner (which I did). Low BMI, blood pressure crept up a bit but still “normal”, non smoker, well supported, good diet, can’t exercise as much as I would like due to orthopaedic issues.
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