Pulsed Field Ablation

[Chilbolton1]

I have a video consultation on Monday with my Consultant, (im in Uk).

Has anyone experienced this op please. I’m asking because I’m sure he will be putting me forward for this, we discussed a while ago but I hadn’t realised it was a newer version of ablation. I’m very sqeemish and I think he thought I was a nutter. Can’t help how you are. Thank you

[mjames1]

First, congratulations for being considered for Pulse Field Ablation (PFA). All reports show it to be as effective as RF and Cryo, but with a better safety profile. We are still waiting for it to be available in the US out of trial. I'm Jealous

I know in the UK that PFA is already out of trial, at least at Royal Papworth, but if this is a trial elsewhere, make sure you read the trial specifics before committing.

You will also want to ask who will be doing the procedure and at some point find out how many PFA's they have done and how many other types of PVI's they do annually. Four months ago, that number would have been around 20 for each of the ep's at Royal Papworth. And while not a large number, it's understandable since this is a new procedure, but keep in mind that each of the ep's had many other types of ablations under their belts. On the other hand, if I was told I would be number 1 or 2, I might give pause

You should also know that PFA, at least at Royal Papworth again, is done exclusively under General Anesthesia (GA) -- unlike RF and especially Cryo, where sedation is often used. This is a plus for some, a negative for others.

Lastly, if you have any other type of arrhythmia, such as flutter, make sure to ask if it will be treated at the same time. PFA uses a blunt instrument, so for example is not suitable for ablating the right-sided flutter line, nor ideal either for chasing down arrhythmia's outside of the pulmonary veins on the left atrial wall.

The ep will use RF for these areas during the same procedure, at least the ones I have been in contact with, but best to make sure that capability is there if needed.

Good luck. Feel excited. And let us know how the consultation goes.

Jim

[Lenlec]

PFA is an exciting advance. Hope it will be available uk wide soon. I’m due my 2nd ablation end of this year in Coventry.

[PCC62]

Hi Chilbolton

I had a PFA in Dublin three months ago under Dr Derek Crinion at the Blackrock Clinic. I don't know whether I was lucky or whether that's the norm with PFA but the whole procedure was very smooth. I had two in-person consultations (including a variety of tests), plus two follow-up phone calls (really to reassure me) pre the procedure, talking through all the risks as well as the benefits of PFA over the other two options. The one area that he couldn't really comment on was the longevity of the effectiveness of the PFA as he had only a two-year history of patients who had PFA i.e. he couldn't tell me whether it might correct my AF for a few years, several years or life! He had done over 200 PFA procedures to date, all successful and with 85% not needing a further ablation thus far, albeit in only a maximum 2-year window. My procedure was under GA and lasted 5 hours and I stayed in hospital overnight after it. In recovery I had no pain whatsoever, impressive bruising in the groin area but not painful at all. The would site took about four days to heal and the lump it left disappeared after about 3 weeks, gradually reducing over that time. I didn't need to have any pain medication whatsoever - he did say that was quite unusual but apparently I have a high pain threshold. I felt really good quite quickly, so good in fact that I went back to work after a week. I've remained in sinus throughout the last three months and feel really well. I'm still on meds to see me through the blanking period and next week I have another assessment & tests to review where I'm at and whether some meds can be eliminated. Based on my experience (and please note, I have no medical knowledge/training), I'd highly recommend PFA.

Good luck!

[mike1961]

Good morning,

I had PFA (my 2nd ablation - first in 2018 using RF) at Bordeaux on 03/01/23 as follows (from report):

AF at start of procedure.

Alcoholisation of Marshall Vein - converted AF to a roof-dependant AT.

PFA ablation to create posterior line in lower left atrium - converted AT to NSR.

PFA used to ablate a reconnection of the right superior PV.

Typical flutter line but this time using RF.

And no GA - just sedation. I never felt the PFA, but definitely felt the RF.

So very widespread use of PFA for me. But my EP Pierre Jaïs has done hundreds if not 1000s of PFA ablations - he has been developing PFA with Farapulse for a few years now.

Cheers,

Mike

[cuore in reply to mike1961]

I went to Bordeaux three times whereby two were done by Pierre Jais, the last one May, 2019 which is almost five years ago. Dr. Jais is the best especially since I was one of the most complicated cases he had had. At the time, PFA was not available for me, but he did make a comment about being confident about future technology. Now I am in AF most of the time, going into AF when stress or something intense triggers it. It does not last for more than a few hours. In the second ablation I also had alcoholisation of the Vein of Marshall.

Have you had any AF reoccurrances and how far persistent were you for your first ablation?

[mike1961 in reply to cuore]

Good to hear from you !

No AF occurrences since my second ablation on 03/01/23.

But a few short runs of atrial tachycardia (AT) around 120-140bpm for a few seconds probably once or so a week. I did get a few longer few minute episodes in the middle of 2023 but hopefully things have settled a little more now over a year on.

Before my second ablation I was persistent from 25/10/22 right through to my second ablation on 03/01/23. The persistent episode started just after a really bad bout of covid. The episode was mainly AT (120bpm daytime 2:1 conduction and 60bpm nighttime 4:1 conduction0 with some AF for an hour or two when switching from 2:1 to 4:1 conduction and vice versa. I was getting used to it after a few weeks and it didn't stop me living my life pretty well work and hobbies-wise.

As an aside, I still take 100mg Flecainide Acetate (FA) BID with 10mg Propranolol BID with it. I always found the original Tambocor FA with 3M on one side and TR 100 on the other FAR more effective than the generic FA available now.

Time will tell!!

Is your AF at a fairly slow rate now ? Is it now a lot slower after your ablations than it was before ? ?

Kind regards,

Mike

[cuore in reply to mike1961]

Sorry, I made a mistake in writing. I am in sinus most of the time, not AF. Dr. Jais did a really good job. He had said before my third ablation that it would take two hours, but it ended up being four hours and a half. As previously mentioned, I was one of his most complicated cases.

However, I did not escape taking rhythm control meds. I have been taking Propafenone 150mg x 2 since the ablation. After a year or so, I tried to stop this medication, but the AF came back, one time persistent for 49 days. So, I have remained on this medication.

Two months in persistent is not long compared to mine which was six months before my first ablation. Thus , I am not surprised you have not had AF for over a year since your second ablation. Also you had the new PFA combined with RF. My theory is that no one should ever get to persistent.

Also we both have had alcohol infusion of the Vein of Marshal for the peri-mitral atrial flutter. When I had it back in 2017, Bordeaux had been using the technique for only 4 months.

I went to Bordeaux three times because the system where I live in Canada is so slow. It was the best money I have ever spent.

Yes. When I do go into AF, I do not go over 100 beats per minute, so my AF is much slower compared to before my ablations

May you always stay in sinus.

[mwcf in reply to cuore]

Hi Cuore,

Thank you for your reply and good to know you’re in sinus most of the time and not AF!

I went to Bordeaux simply because of the centre’s - and Pierre Jais’ - reputation.

If I recall correctly the VoM alc. was done (first) to address AF issues rather than flutter. I had a line done with RF as the last part of my procedure to prevent possible typical flutter.

No regrets although the language barrier is challenging!

If and when need a third I’m toying with going to an EP here in the UK at Royal Papworth at Cambridge who in addition to being highly regarded also did a year post-doc with Jais at Bordeaux. My concern at Bordeaux is that as I get older if I have complications and needed intensive care…. paying for the ablation is one thing but if I needed care post-complications it could get very expensive at Bordeaux.

Anyway, time will reveal all good or bad!

Keep me posted as to how you’re doing now and again and I’ll do the same.

Best regards,

Mike

[pattijryan1954]

You can read more about PFA on our website at a-fib.com/in-development-sy... Wishing you good heart health, Patti Ryan