Ablation- Detecting where the rogue cells are....

[sunlovah]

When an Ablation is done, Is it identified pretty much, where the rogue cells are coming from or is it a bit hit and miss. Relatively new to all this but learning fast ....

[Buzby62]

I think it depends on the procedure and it’s called mapping the rouge pathways. I’ll be having a cryoablation of the pulmonary veins, I believe this is the first procedure for suitable candidates on the NHS at the moment and is not mapped. If a second procedure is needed to touch up any areas then this will be RF ablation with mapping to find the spots that need touching up. That’s my understanding as I’ve been told.

Not sure how this fits in with Pulsed Field ablation as this is not in my area yet.

[BobD Volunteer]

There is a very good booklet/fact sheet about ablation on AFA website and since there are several methods to try and do basically the same thing your question is harad to answer simply

To generalise it is thought that most of the rogue signals emenate from the four pulmonary veins which bring oxegenated blood back to the heart (left atrium) from the lungs. It is therfore considered important to isolate those veins. Cryo ablation uses a small balloon inserted via catheter into the entrances of those veins. It is then inflated with nitruous oxide which on expansion freezes the area which hopefully causes scar tissue. When this scar tissue properly forms it should act as a barrier to the rogue impulses. This method is most often offered as a first line attempt.

RF ablation uses a heating catheter to cause burn scars in the same areas though as a series of dots. Sorry I am not up to speed on exactly how PFA works but results so far are mixed I am told.

I many cases a cryo ablation is all that is needed but quite often a second touch up using RF is offered and in extreme cases additional lines can be drawn within the left atrium to isolate other areas which may be firing.

It took three RF ablations over four years to finally put mine to bed.

Yes , electical activity is monitored throughout the procedure but due to its mongrel mature there are no guarantees !

[KiwiBlake in reply to BobD]

Just to add to Bob's excellent and detailed response, with cryo ablation, if your pulmonary veins are not perfectly round/ circular, when the balloon gets inflated it may not make a complete seal around the inside of the vein, and therefore not create a complete band of scarring. That's when a touch up RF (hot burn) may be needed approx 6 months later to get the missed bits, where a rouge signal could get through. Hopefully I have that right Bob, please correct me if I've got that wrong.

Cheers Blake

[Hidden in reply to KiwiBlake]

Spot on! 👍

[M987 in reply to BobD]

Great summary. How long has it been since you had the third ablation and been in NSR?

I just had a second 3 weeks ago and after a lot of work, the doctor said a third may be needed to get rid of flutter he didn’t have time to fix. Although hopefully it will all be fine after healing period.

[mhoam]

I was in persistent AF when I had my cryo ablation. It definitely helped the EPs as I heard them discussing the active areas they could identify.

I was under light sedation so concentrating on the EP’s discussions helped me get through it😀

[Buzby62]

My understanding is to map the rouge signals you have to be in AF which they can induce for PAF patients not in AF at the time if they believe it’s necessary. When I asked I was told they would just do the cryoablation first without being in AF. Again everyone’s case is slightly different so you need to ask the question. In my case it seems to be NHS policy for suitable candidates to get cryo under sedation as they can get more done to manage the waiting list without an anaesthetist and as Bob says it works first time for many. My EP gave me an estimated chance of success as 60% 🤞

Hope this helps and all feel free to correct me.

[Docretd6]

It just so happens anatomically, that many of the brain nerves controlling the heart, - enter the heart from the outside, at the same place where the lungs veins (the pulmonary veins) join back on too. In an ablation it's these nerves that are being "disconnected" permanently by being fizzed away. The thing with the heart is that its individual heartbeats, follow the speed of the fastest "controller" in the chain, - the fastest contracting fibres in the heart are the "cheer leader," - and it's this cheer leader that's being quietened down.