Successful PFA of multiple COX lines, Ligament of Marshall and a Chemical Ablation (Ethanol) of the Vein of Marshall

[iris1205]

Success! So yes, all you folks out there wondering or being criticized for multiple ablations... this was my 7th ablation. I am seven weeks post-intervention and remain AF/AT free. Also medication free for the first time in six years. Yes, I have continued the Xarelto for the time being.

My 4th PVI ablation lasted two years. Then all started back fiercely... which is why I was willing to keep trying ablations as long as they were trying a different method. I've said it myself on multiple occasions, to doctors, colleagues and friends... "repeating the same thing and expecting a different outcome is the definition of insanity". Multiple methods were tried as well as different lines created ( I can provide if curious) as well as a retrograde aortic approach - the sixth ablation.

I had reached daily episodes of AF and AT (with meds) of 8-10 hours at 150-230bpm. I'd tried all the meds available and Flecainide and a BB were helpful but not sufficient. I was being termed "Persistant AF" finally.

I am eternally grateful to my past EPs - who were commended by the current EP, he remarked "the prior ablations were performed well and there was not excessive scarring". I was fortunate to have the opportunity to have the last PFA procedure and am revelling in a medication free and AF/AT free life.

May you all be so fortunate, in whatever method you wish to choose! Thanks for all the support - If anyone has questions I'm happy to respond privately as well.

Best wishes for you all!

[MummyLuv]

hi and congratulations, long may you be afib free!

I too have had my Vien of Marshall ablated and all but the litmus lines from cox maze scars completed.

Do you know if your EPs have tried to complete the cox scar lines or have they done something else? Xx

[iris1205 in reply to MummyLuv]

Thank you!

I did not have a COX procedure, this was all done through catheters - left and right groin. They did cover the following lines:

Left Atrium:

Stated the PVI lesions were holding no reconnections, hence no need to repeat.

PFA lesion to mitral isthmus area and then repositioned to cover the ligament of Marshall area.

Additional PFA lesions to the posterior wall.

Right atrium: Bidirectional block across the previously created cavotricuspid isthmus line

Superior Vena Cava isolated as well.

Hope this helps !

[MummyLuv in reply to iris1205]

Those are quite a few of the cox lines. Hope it holds for you 🤞

[iris1205 in reply to MummyLuv]

Thank you! I thought all COX references were related to an external COX Maze procedure ! Thanks for the education !

[MummyLuv in reply to iris1205]

The method of doing cox maze is external/surgical. But he created a pattern of scarring that I wondered if your EP was doing. For example PV isolation was originally done as part of cox maze. This is a great chart. I had mine surgically including the vein of Marshall but excluding the litmus lines as these can’t be reached thorosxopically. Eps can also do some of these lines.

Image of cox maze

[iris1205 in reply to MummyLuv]

Thanks for that image! Hopefully, my file folder for AF will no longer require updates... over 13 years it has become quite voluminous with research papers.

Yes, many of those lines were also done in my previous ablation (#6) which was performed through the retrograde aortic approach including but not limited to:

Left septum above the right His bundle at a distance of 12 mm. The antrum of the 4 pulmonary veins, the anteroseptal part of the LA, and at the median CTI.

[Nan1]

Best wishes to you.

[DKBX]

Good job. I’m on my sixth; Sotalol has (so-far) kept me in NSR after a cardioversion. Nice to know there are options available if (when) Sotalol fails.

[iris1205 in reply to DKBX]

Great news... I don't wish ablations on anyone, but I obviously don't hesitate when my situation worsens! May you continue to stay in NSR!

[Cookie24]

Glad for you. I am looking at ablation #4 also Watchman. My current EP at top notch hospital has said I have a lot of scarring. Prior ablstions were done at local hospital. Wonder how your EP managed lead scarring

[iris1205 in reply to Cookie24]

He was impressed that there wasn't too much despite the number of ablations. I've been lucky to have excellent EPs. Good luck with #4 . At least you know it can be worth it!

[MiniMeGreen]

Happy NSR forever 💖