Bambi I replied to your last post but there are 162 relies hence repeat here
The mini maze isolates the pulmonary veins from the outside and catheter ablation does it from the inside. Some maze procedures do both. It’s not news! A F doesn’t appear outside the heart as you say it’s the procedure that comes from the outside sometimes it’s not enough to isolate the PVs and then ablation to other structures inside is needed. Important to get facts right when people are considering their treatment
Did you watch the video she posted Rosy?
Just part of it’s seemed to be about wolf mini maze which I’m aware of. Also aware of other maze procedures. I might ask our MD who does ablation to talk about maze procedures again in the autumn as seems to be of interest to a lot of people
That sounds like a good idea.
Error there RosyG.. "Since research has shown that almost all A-Fib signals come from the openings (ostia) of the four pulmonary veins in the left atrium, one technique is to make circular radiofrequency (RF) Ablation lines around each pulmonary vein opening (called “Circumferential” or “Empirical Ablation”). This isolates the pulmonary veins from the rest of the heart and prevents any pulses from these veins from getting INTO the heart. However, it’s difficult to make circular RF lesions and they aren’t always successful.
In a Wolf Mini Maze, Dr. Wolf, uses a special “bi-polar” RF clamp to ablate and electrically isolate the pulmonary veins, where the triggers are located that activate AF. This ablation procedure is performed through two small “non-rib-spreading” mini-incisions, one on each side of the chest. The word “ablation” simply means to destroy tissue by burning it. This is done in a specific pattern. The chaotic electrical activity of the heart is halted because the electrical impulses cannot cross the burn scars that separate the areas of the atria. The “bi-polar” RF clamp is so efficient that he can perform an ablation in 8 seconds. An ablation would normally take up 3 minutes with a conventional unipolar RF head."
forgot the source,,,wolfminimaze.com/what-is-at...
In addition: It is now believed that networks of nerve cells, called glanglonic plexi, may contribute to or initiate these irregular electronic impulses, and current treatments now include ablation of glanglonic plexi to eliminate atrial fibrillation. To watch a video that discusses recent research into the relationship of sleep apnea and these ganglionic plexi (“the third fat pad”), see Noted Electrophysiologist and Ablation Pioneer Discusses New Findings About Atrial Fibrillation and Obstructive Sleep Apnea.
source:stopafib.org/learn-about-af...
The plot thickens, you don’t have to be brain of Britain to work out that this reply was not written by Bambi. Over the past 2 days, Bambi has made around 31 replies to her previous post and this reply bears absolutely no resemblance in style, delivery or content to any of the others. Although I’m not able or willing to comment on any of the content, in my opinion regardless of it’s content, it has been written by someone with medical experience.
Hey Flap, really???? I was replying to RosyG here. I did not realize RosyG started a new thread, until I was looking for something else and saw this an hour or so ago. (Ive been busy with other things besides this) and wanted to finish editing, but as usual, you beat me to it. Her comment was not made in the original posting which is why I commented here, DIRECTLY to RosyG (im assuming Rosy is a female.)
I have include the sources for her and this was taken directly from them.
Yes,as a teacher and later university lecturer,one gets the ' feel' for a writing style from students. Something not quite right in all this.
At least Bambi has acknowledged that her reply was in fact, extracted directly from literature produced by the Wolf set up in Houston. However, it was only when challenged, she decided to edit her reply to include references to the source of the information. One wonders if she had not been challenged, whether or not she would not have edited the reply and perhaps been happy for it to appear as though it was her direct reply. All very disappointing and unnecessary……
Flap, anyone that knows me, which you obviously do not, know I dont speak medical jargon. And no I didnt think I needed to since the readers would know that. But Since you find it necessary to point out flaws, I promptly as possible, added the source, and another statement from a different source; (stopafib).
Yes indeed. I agree.
Very disappointing comment FlapJack.So, now the AFA forum has become the "thought police" ?
Learned people address "inaccuracies" with learned replies.
All the evidence (and it was widely circulated here to anyone really interested) shows that a single CA is just 45% successful in eliminating AFib, after five years, for persistent sufferers.
If you know better, prove it !
Bambi, do keep on posting. I was made aware of the Wolf Mini Maze and the thoracoscopic approach to ablation by your comment here on the AFA forum a year ago.
Saul
Possible nowhere near as disappointing as what Bambi has done to be critical of the treatment therapy which is currently available to the vast majority of folk suffering with AF. This forum and its members actively do everything they can to make people aware of any and all developments and treatments which are available to improve the wellbeing of anyone with AF. To put that into perspective, there are efforts underway to have a talk about the MiniMaze treatment at one of our Zoom support group meeting which are now open to members of this forum.
However, this forum is self monitored and every member is encouraged to make admin aware if there is activity which they think, might not be in the best interests of the forum. Whether or not admin react is entirely up to them. I rarely use the report function but unfortunately, there were concerns about what was being said to promote interest in the Wolf MiniMaze procedure. Making people aware is one thing, but doing it in a way which openly criticises treatment currently available to folk with AF is effectively advertising and that is against the rules of the forum. What was disappointing was that several attempts were made to discourage what was being said because some members were clearly concerned about treatment they had received or were due to have. Eventually, at one stage the message did seem to get through but unfortunately it didn’t stop the comments which gave the impression that the whole purpose of the post was to promote a procedure.
I see that admin did decide to delete a video which was posted a couple of days ago with an advisory request so it was quite extraordinary to see that another video was posted yesterday which again was designed to advertise the Wolf MiniMaze procedure.
I think we need to understand that the USA and the UK have two very different healthcare systems and what might work in the USA might not in the UK. In simple terms, the way things are at the moment, the Wolf MiniMaze treatment is not going to be available through the NHS in my lifetime (I’m 75) which why attempting to criticise Catheter Ablation (which is available) is an unacceptable method promoting the Wolf MiniMaze procedure.
Personally, I am not connected in anyway with the AF Association or HealthUnlocked who run this forum but I have a huge respect for the work they do for people with AF. What I say or do is entirely down to me and whilst I believe I only have the best interests of AF sufferers (excuse the pun) at heart, I am also mindful that others will disagree with me and respect that you might be one such person……..
Well said. Exactly my thoughts on this subject.
As Wilsond says “exactly my thoughts on this subject”
I find the OPs complete dismissal of anything other than the talked about procedure quite disturbing and likely to cause deep concern for anyone who has been through or going for an ablation.
I didn't see the OP that's being referred to here but I'd definitely agree that posting a video promoting the procedure ought not to be allowed. People can always find these things themselves. If the AFA are able to ethically endorse the procedure that's another matter.
The video that I saw was of a cardiac surgeon (Dr Wolf) explaining the medical issues and the reasons that most single CAs fail for persistent AFib, because they scar the inside of the heart, attempting to reach (via transmural lesions) nerve bundles that are located at the back (outside) of the heart.
The video displayed electrical mappings of two case studies where several prior catheter ablations totally scarred the inside of the pulmonary veins inside the heart (a complete circle), yet failed to isolate the nerves outside the heart, and the patient thus remained in AFib.
Using a thoracoscopic (mini maze) approach, this was corrected and comparative EKGs were presented to illustrate the complete isolation henceforth, and freedom from AFib.
Nothing in your reply justifies your referring Bambi's comment to a moderator.
"Being critical" is the basis of all science and progress.
That is how propositions and habits get reappraised and modified.
The fact of the matter is that during a catheter ablation the inside of your heart is scarred (burned or frozen forever) to get through (transmural lesions) to the nerve bundles which are in the ganglionated plexi on the outside (back) of the heart.
The mini maze and thoracoscopic procedures directly deal with these nerve centres and can isolate them as completely as possible (95% of the time for paroxysmal patients) first time, rather than the three or four catheter ablations to get to 85% success after five years !
If this is not worth knowing and espousing, I don't know what is.
The video that I saw was of a Dr (Dr Wolf) explaining the medical problems and the reasons for some failings to scar the inside of the heart, to attempt to reach (transmural lesions) nerve bundles that are located at the back (outside) of the heart.
The video displayed electrical mappings of two case studies where several prior catheter ablations totally scarred the inside of the pulmonary veins inside the heart (a complete circle), yet failed to isolate the nerves outside the heart, and the patient thus remained in AFib.
Using a thoracoscopic (mini maze) approach, this was corrected and EKGs were presented to illustrate the complete isolation henceforth, and freedom from AFib.
I TOTALLY AGREE it is not every one who can afford the mini maze and have to have what is offered to them
What folk seem to have overlooked is the title of the original post which started this debate. It just referred to the Wolf MiniMaze procedure and said ablations don’t work. It has since been edited and the video removed. Is it really that surprising this caused those of us who care about how ordinary AF patients, who haven’t got a chance of ever having a Wolf MiniMaze procedure, reacted in the way that we have. Particularly as another video with similar content has been added to this post…..
Saul, I too, found Dr Wolf and the mini maze from Bambis post a year ago and am forever grateful to her for it. Keep on keepin on Bambi!!!
Thank you. I copied your message to Bambi on the WMM FB forum.Bambi is single-minded and blunt, but her message is sincere and unbiased.
I hope that you are well and your AFib is in the past. All the best. Saul
Actually Saul my procedure is coming up on June 27. I am so looking forward to it and relief from the AFib monster and AFib meds! Thanks!
"The plot thickens, you don’t have to be brain of Britain to work out that this reply was not written by Bambi. "
But, surely, the source of the information is not what is important *provided it is accurate*? In this case , I don't see any reason to doubt that it is; however, if it is not, then by all means point out any error(s). I think that some of the commentary on this thread-I'm not referring to your post specifically -has become rather ad hominem.
Hear, hear, I agree. Please permit people to air their preferences. We are living in a democracy.
Meanwhile, some guy posted conspiracy theories around the Covid vaccine recently, and he got much less abuse.
I think Bambi is just trying to make people aware of another option that appears to have a great success rate at quelling this insidious condition called AFib. I'm from the US and I've had no procedures yet. Financial and Insurance issues are definitely a concern as I would not have the means to pay privately either. I don't believe there's an ulterior motive on her end, especially where she was a member here for years, in the same dire straits as many others. I think she's just trying to help and spread the word of her success. IMHO...
You are correct, and Thank you, Ive addressed your reply in detail on my original posting
Exactly, BobsBeat.
Bambi has had the procedure as her 80+ year old mother and they are both in NSR, first time and only time with no further medication and no anti-coagulants with some 97% reduction in stroke risk due to AFib (due to LAA clamping).
If that's not a result worth touting, I give up !
I disagree,the whole tone is WMM or nothing! Essentially every other treatment is waste of time. There is also a feeling that it is only ignorance of the research and aims of WMM that prevents all AFib club members being able to a) choose to have it or b) afford it.
Information on any treatment options is always welcome of course but not at the expense of trashing the options available to the majority of people.
It is perfectly valid to highlight the success rate (and failings) of various procedures and to refer to the science why this is so. This is not "trashing."
The cost of the procedure, its availability, and the affordability for most are questions to raise with the medical professionals, which is what Bambi kept saying.
I agree with you Bob, but for the reasons you outline, let’s hope she finally gets the message and realises the MiniMaze procedure, for many years to come, will only be available to the fortunate few. There is nothing wrong with making people aware of treatments, that’s what forums like this are for, but when it’s done in a way which attempts to rubbish the primary alternatives which ARE more easily available, then that’s just plain wrong.
For me, this is not personal, I’ve met and like Bambi with her zany attitude to life but when it makes people apprehensive about having treatments which are within range, to me, that’s not helpful…..
"I agree with you Bob, but for the reasons you outline, let’s hope she finally gets the message and realises the MiniMaze procedure, for many years to come, will only be available to the fortunate few."
I don't think that can be known for sure. The current cost of the procedure at a private hospital wouldn't necessarily be that to the NHS as it is a large buyer of drugs etc., and can negotiate prices down substantially. Further, nobody has stated what component(s) of the procedure are intrinsically expensive. And even if a treatment is expensive, it might still be cost effective.
"There is nothing wrong with making people aware of treatments, that’s what forums like this are for, but when it’s done in a way which attempts to rubbish the primary alternatives which ARE more easily available, then that’s just plain wrong."
I don't ageee that just comparing the success rate of ablation with maze is unreasonable or amounts to rubbishing the former. It's simply dealing with facts.
It gets a bit complicated dealing with all the different types of maze and MiniMaze procedures but my comments related to the Wolf MiniMaze. Personally, I haven’t a clue what it costs but someone here who seems quite knowledgeable I think has mentioned a figure of $150,000 for a procedure in the States. If you are from the UK, you will appreciate the current state of the finances here which are likely to get a lot worse before they get better so to be honest, I don’t think my comment was that inaccurate.
As far as the second point, perhaps you didn’t see the original title of the post which has prompted this debate. I think it has been “softened” now but again, “rubbished” wasn’t wholly inaccurate. I believe you also referred to it as controversial but I bow to your better judgement……
I think the key consideration is what is it about the procedure which makes it expensive? Part of the cost may be because it's being conducted by a sought-after surgeon or EP or because of its limited availability. But if there is nothing intrinsically expensive about it, it could be rolled out more widely, Another question might be: how would the cost compare to two or three ablations which might be required otherwise? And as the procedure is nit generally advised for people with PAF it might be perfectly viable.
Time will tell, thanks for your reply….
If they are stating facts about the efficacy of the current treatment, it isn't "rubbishing" anything. It's stating facts.
Your argument is like saying, when someone hears about a new treatment study where they cured 95% of previously incurable ovarian cancer, one of the hardest cancers to cure - that no one should talk about it because it isn't "approved for widespread use yet" and/or "isn't an option for most people who need treatment right now".
It's ridiculous. There's nothing wrong with talking about it.
My money hungry EP would've had me believe that an ablation was A-OK for me too, despite the fact that it is completely unnecessary for me considering my current case.
Absolutely right, the whole purpose of this forum is to share accurate information from reliable sources but the title of the original post which started this debate actually said that ablations don’t work. It made no reference to any statistics, it was just a bold statement which implied that nobody in their right mind should have an ablation now that the Wolf MiniMaze is available. It has since been edited.
RosyG, regrettably, your statement is inaccurate and is not a "correction".
The errant signals do begin from outside the heart, in nerve bundles located in the ganglionated plexia, which are located round the pulmonary veins on the back (outside) of the heart.
"It is now believed that networks of nerve cells, called glanglonic plexi, may contribute to or initiate these irregular electronic impulses, and current treatments now include ablation of glanglonic plexi to eliminate atrial fibrillation."
stopafib.org/learn-about-af...
The Cox maze isolation (gold standard) and the mini maze isolations are the most effective and the scarring is carried out outside the heart and NOT inside the heart.
100% more effective than CA (all the stats were in the answers in Bambi's earlier post).
The original Cox procedure required the stopping of the heart and this is not necessary with the mini maze keyhole procedures.
It isn't news, as you say, and Dr Wolf pioneered the mini maze procedure in 2004.
But, it is news to lots of AFA forum members.
Let us stick to facts and be helpful to each other, regardless of personal preference.
Thank you. Saul
I am all for scientific advancements,after all it's what humans arguably do best.
My concern with the whole focus of this post is that there is an emphasis that any other intervention is basically wasting your time.
I'm sure the WMM is a very effective treatment , especially for certain patients such as Mummyluv .
However in the UK and , obviously,other parts of the world, we have a national health service that is under the greatest strain financially and in terms of staffing levels since it's inception in the immediate post war era.
Given that ANY treatment for AFib is for quality of life ( could be a moot point ,as it seems logical that a heart going off on one regularly will only benefit from calmer waters) it is hard for Trusts to justify allocation of funding,when there are alternatives that do work .( Medication or Catheter ablations)
Success rates very ,and I was told that Cryo ablation of the four veins has a success rate first time of between 60-80 % After the blanking period,I may need a touch up if the scars haven't quite formed a good ' bracelet ' effect. This would be much quicker than original and would give even more protection.
As far as my right sided atypical Atrial Flutter was concerned,success rate of 90-98%,and as that affected my life far more than Fib,I'm delighted with that .
I feel better than for years and years, everyone is commenting on how well I look,skin is glowing and I feel great. I am aware that in the future this can change.
Nothing is guaranteed in this game. WMM may ' solve' AFib effectively, but as Bob D found, sometimes we develop other arrthymia over time. Our crazy hearts being prone to these things...🙄
Now,what has irritated me is the whole tone of this OP, mainly the extremely negative view of other treatments. The effect on some members that they are basically being told in the original post that they have little hope of effective treatment has been seen already in the comments and is to be regretted.
Comments urging us to challenge our consultants as to why they are not getting on with more WMM are frankly specious and demonstrates a lack of appreciation of other health systems. Of course ,we can ask questions about techniques but it is difficult for many people to get even clinic appointments at present!
Also if research is being referred to it is standard to cite whose and where, always.
Information is always interesting to receive and will be read with an open mind by me ,but I think for myself.
Hi Wilsond, thank you for commenting on my procedure 
I actually didn’t have the WMM, the Wolf mini maze isn’t technically a maze procedure as it’s doesn’t perform maze lesions.
I had a mini maze procedure here in the U.K. by a surgeon based here and who has only done a handful of Private procedures the majority of his procedures are NHS. It is a postcode lottery at the moment in the U.K., some trusts do provide, others don’t.
I do believe that mini maze procedures will become more common in the U.K. as part of a hybrid offering for those who are persistent or who have other medical reasons why catheter ablation is not appropriate for them. Our guidelines are the moment are built around open heart maze.
There is not a surgeon in Scotland where I live who does keyhole mini maze (only open heart maze) but my local cardiac surgeons are currently training on the surgical side of hybrid (mini maze) in order to provide this.
Mini maze surgery (usually as part of hybrid) is done in greater volume in the Netherlands and our cardiac team have partnered with a hospital there. I am hopeful this will be the case in time across the many U.K. hospitals who don’t currently offer this treatment for certain circumstances.
Catheter ablation as many have said has very good results in the earlier stages of afib and I’m not aware in the research I did before my procedure of any of the U.K. surgeons offering a maze style procedure for earlier stages of afib.
Aha! It's all these Mazes.. 🙂🙂 Hopefully if the NHS recovers one day ,options will be more widely available if appropriate. Keep up the good work Mrs! Xx
I really do believe that will be the case, in time we will have more surgeons here doing mini maze.
Dr Wolf’s procedure differs from mini maze in that he believes that the maze part is unnecessary and he believes that the ganglionic plexi are vital. Most mini maze do some but not all of the ganglionic plexi. From what I have read the ganglionic plexi are indeed important in the earlier stages of afib. Research in the last 5 years has found that they are less of the driver in persistent which is the reason the other surgeons I consulted with gave for not ablating all the ganglionic plexi.
There are indeed a lot of variations of maze procedures. The newer convergent procedure being another one (where the entire back wall of the heart is ablated).
I find it so sad when these threads get so heated. There is a place for each of these procedures and this forum serves to help make us all aware of the different options and help us ask the right questions and if we are in the U.K. understand from each other where each is currently available. Then it’s a personal decision for each of us.
Thank you. Do your surgeons perhaps have a website or place of info where members can read about this type of Maze Procedure?
Hi Singwell. Here is the link to the surgeon who did mine. Scroll down to the video with Steven Hunter, there is not much about the actual procedure on here but there will be soon. They recorded my actual surgery and will produce a video which will be available on this website along with more on the procedure.
thekeyholeheartclinic.com/k...
In the meantime there is a very good video of the mini maze procedure like mine on Prof Salzberg’s Swiss Ablation clinic website. I also consulted with Prof Salzberg. If you go to the tabs on his website he also has a page on hybrid too which is good. Prof Salzberg operates with a leading surgeon from the Netherlands. As I mentioned in a previous post, in Europe, the Netherlands are the most advanced.
swiss-ablation.com/en/cardi...
Finally if you want to watch the actual procedure then here is a video from the US which I think I wore out before I went in for mine. For me knowledge is comforting and so I watched this loads. I imagine that may not be the best route for everyone!
I have loads more info, links, research for anyone who wants to know more.
Hope helpful x
"Given that ANY treatment for AFib is for quality of life ( could be a moot point ,as it seems logical that a heart going off on one regularly will only benefit from calmer waters) it is hard for Trusts to justify allocation of funding,when there are alternatives that do work .( Medication or Catheter ablations)"
Key questions here might be: what is the cost of a single maze procedure when compared with (likely) repeated ablations? What additional risks, if any, are entailed by maze procedures? And what component(s) of maze procedures makes them expensive? If there was better uptake for maze procedures -because they are more effective- this might result in a net gain if the result was fewer days lost from work, fewer GP visits fewer strokes etc..
It is difficult to provide a comparison, although I have come across some figures when Googling. As you say, multiple CAs, expensive anti-coagulants and the cost of monitoring adds up.
"Results: The cost of catheter ablation ranged from $16,278 to $21,294, with an annual cost of $1,597 to $2,132. The annual cost of medical therapy ranged from $4,176 to $5,060."
pubmed.ncbi.nlm.nih.gov/176....
ncbi.nlm.nih.gov/pmc/articl...
Mini maze procedures are more effective as demonstrated by the FAST study from 2012:
"Minimally invasive surgical ablation was shown to be more effective than catheter ablation at stopping atrial fibrillation. Specifically, 65.6% of patients in the surgery group were free of atrial fibrillation, flutter, and antiarrhythmic drugs at 12 months compared to only 36.5% of patients in the catheter ablation group."
stopafib.org/afib-news-even....
The success rates are even higher today, and a good datum is the fact that (most) insurance companies in the US are prepared to fork out for mini maze procedures.
This was the point of the post that started all this going: "should we not ask the medical professionals why the mini maze is not a first-line procedure in 2022 ?"
I accept that there will be , hopefully, better treatments and interventions for AFib,Flutter etc and obviously welcome them.I have a very open mind as a recently higher level educator.
My objection to this poster and apparent disciples, is the tone. The tone being that everything but WMM is a waste of time.
Well...great! Since that is not yet a universal option ( cost/availability/ appropriateness?)and the rest of us then are clutching at straws??
Cheers.
I don't think that those having ablations are clutching at straws, since the figures are averages. In practice the probability of a successful ablation will depend on a host of *individual* factors including (but not confined to): age, whether you are in permanent AF, kidney function, left atrium more than 4.3 cm, ejection fraction. So it's very much an individual matter. Also, the added risk of some maze procedures will rule out the procedure for some. See the link in the thread: "The Cox-Maze & Mini-Maze Surgeries and the Hybrid Surgery/Ablation" for a detailed discussion of the pros and cons.
Just to be clear, right atypical flutter is best suited to catheter ablation and Dr Wolf is also of that mind set. When people develop right atrial flutter after WMM ( most notably due to previous ablations) and it doesn’t resolve with cardioversion, Dr Wolf recommends a catheter ablation as it is very successful.
Just one thing I noticed if it's helpful - in Bambi's response I did see use of the quotation marks so read it as quoting from other material. Perhaps a citation might have adequate clearer? One question I had for Bambi and others who've had the Wolf Mini Maze procedure - it's all very well to deal with the pulmonary veins whether from 'outside' or 'inside' but how does this procedure stop AF from breaking out via other venous pathways? Which we all know can happen. So, surely it cannot be the 'permanent fix' as apparently billed.
yes, that is the point I made too,that as Bob D found,sometimes new arrthymias break out after time. x
I mentioned in the previous posting on this subject that the WMM cannot address AFlutter. WMM patients usually must follow up with CA in right atrium to address flutter. One of the reasons I chose not to pursue the WMM as my first step. Since I have both persistent AFib and flutter. My persistent is a new thing, however, and my echocardiogram picture perfect. Therefore, my EP stated I had an excellent chance of success.
Of course. The WMM has its limitations and does not deal with AFlutter and is not suitable for patients with enlarged atria >55mm, I believe, and for patients with specific prior valve repair surgeries.
The information is available on the WMM FB Forum: Live AFib Free.
Well there we are. I had both AFib ( cryo of the PVs) and Flutter last week. Surgeon very happy,and he is highly regarded . He said 98%certain he had nailed it and very pleased with Afib side.I do not disregard WMM but I do object to the assertion that all else is inferior. Arrthymias are such random beasts I fear we are fighting a long battle Saulger.
First off, I wish you 100% success, as I do for all of us on this forum.
Secondly, I have no affiliation or loyalty to the WMM; I am equally interested in all thoracoscopic procedures such as Cox III, Cox IV, and others, that directly ablate the nerve bundles outside the heart - just like the mini maze that MummyLuv had in London five weeks ago.
I have not had any procedures but, if and when, I will choose NOT to have a CA for the reasons enumerated in my earlier posts.
Your preference and mine are immaterial to science.
The affordability and availability do not skew the science.
The evidence is the determinant and shows that CA are 50% successful first time over five years of monitoring, for patients in persistent AFib, whereas thoracoscopic procedures are 90% successful first time over the same period, with no further medications.
You called for accuracy yet touted BobD as an example of a long standing success story for a single CA, which was patently invented because BobD admitted four catheter ablations since 2008, and he is on daily medication that also helps to stave off AFib episodes, as per the links that I posted in reply.
A single CA is traumatic enough and I shall forgo the pleasure of "top ups", as marketing jargon will refer to additional CAs to rectify prior failed procedures.
Kindness and understanding to genuine, caring, and well-meaning posters such as Bambi will also help !
Typical aflutter is addressed by the WMM because it is in the left atria. Atypical flutter is in the right atria and therefore is not addressed by the WMM.
The original thread on this topic was a long and rather controversial one. Regarding the merits of the maze procedure versus ablation, it might be as well to get some really up to date peer-reviewed information on the topic. I have read that whilst the success rate for the maze procedure is higher than for an ordinary ablation, the maze procedure (in some of its variants at least) can be more risky. I also don't know whether-as some here have claimed- it is too expensive for the NHS to consider. The NHS has certainly adopted other expensive treatments. Also, even if the procedure is expensive, it might still be cost effective if it means fewer strokes, follow-up hospital visits etc.. I don't know of any component of the procedure which would make it intrinsically expensive (more expensive, say, than other forms of surgery). Finally, even if it's not widely available in Europe at the moment, it might well be in the near future, and some people might find the cost manageable. So I think it was quite reasonable to introduce the topic and to promote it.
Yes. Peer review is important if we're going to understand best practice, limitations and advantages. Always hard yo break new ground so hopefully it will come.
What I failed to understand is why it is controversial to question why the scarring (CA) is done inside the heart to reach the nerve bundles responsible for AFib, which are located on the outside of the heart.
In the video, referred to in the original post, Dr Wolf demonstrated complete scarring (full circle) by several prior CAs inside the heart around the pulmonary veins which yet failed to create scarring through the heart wall (transmural lesions) and therefore failed to isolate the PVs.
A mini maze corrected it, as illustrated by electrical mapping diagram and EKGs.
Isn't this what this forum is for? (even if the poster is seen by some as over-zealous).
This article discusses the issue you raise:
a-fib.com/treatments-for-at...
"To be effective the ablations (lesions, burns) have to be transmural; i.e., they have to penetrate all the way from the outside of the heart to the inside. But the inside of the heart varies in thickness, has ridges, etc. And epicardial (outside the heart) fat can also prevent transmurality. Even bipolar RF burns cannot guarantee transmural lesions. Transmurality of a lesion set cannot be guaranteed with current ablation catheters on the beating heart. Also, proving or confirming bidirectional block from outside the heart can be challenging."
Thank you. Lots of good info.
Very interesting and applies equally to scarring inside or outside the heart, hence the hybrid procedure that addresses both facets of the heart, either at once or at a later time.
Near future!? For a quality of life elective procedure? We will see
Hi Rosy. Just to add my tenpenneth about the rogue signals, rather than the Dr Wolf fan club, I will be having a Cox IV Maze whilst undergoing valve repair surgery.Both the surgeon and my EP have advised that rogue signals do come from outside the heart. The common place is the PVs, which is why they try PVI first but some do originate from outside, which is why they ablate the exterior when in a position to do so.
How are you now? Do you have a date? Been thinking about you
Hello there. Thankfully, still in NSR so have been doing really well, until I had a fall on Monday and my left lower leg is a sight to behold. Have been x-rayed and nothing broken but the pain is being caused by the swollen tissue, which was caused by the bruising, which was caused by the Apixaban doing its job in a sterling fashion. Rest, elevation and painkillers at the moment.
No date for the op yet (no rush 😁) as I need to have an angiogram first. I've only just had my appointment for that come through for next month so that's the latest.
Hope that you are continuing to go from strength to strength. 😊.
yes I know it's possible to get this when you are down for other surgery I haven't troubled to get too much into the discussion but I view the entrance to the PVs as part of the heart!I think some of the discussion has been at cross purposes but didn't want to be drawn into arguments!! I was offered ablation of the GPs as have vagal AF so had looked into this some time ago and again, whilst the main GPs are outside it is the case that some of the tissue is not I will ask ourMD to talk to our support group about this and will post if we manage this in September so everyone can join! Hope your bruising goe saway soon Take care
You "didn't want to be drawn into arguments" but you made a new post to argue.
pulsed field ablation
update / nurse
LA slightly enlarged
STS Guidelines Wrong to Call for More Surgical AF Ablation by John Mandrola
I’d like to hear from any “younger” AF sufferers
