Continued advancement with Pulse Field

[OzJames]

In my deliberations over when to have PFA this popped up from Medtronic, see link, a new Trial of 85 patients. I've been looking at the Abbott PFA technology which had dual mapping and pulsing function which is not yet approved and works within a balloon and appears to have great accuracy.

The other during the Trial Medtronic have improved the Pulse function and the later cohort who had use of this were at 100% success at the 12 month mark. The earlier cohort were at 81% at 12 months. This is not approved yet either.

The point is these companies are spending big money, i think Medtronics acquired the company that has the mapping science for $900m so they are serious. I would hope this technology might also be used in a mini maze but not sure if this is possible.

This is the debate going on in my head, wait till this technology is approved or go for an ablation sooner. I seem to be in good health with only slight dilation of atria, my cardiologist said its pretty normal at my age all other functions are good. In holding pattern deciding what to do and currently on low dose of metoprolol 12mg and flecanide 20mg twice daily. Have a read if you've not seen it.

news.medtronic.com/2024-04-...

[bean_counter27]

I've already made the decision to hold off on ablation until it produces a quality of life improvement for me. Recent echo and echo stress test almost 5 years since paroxysmal AF diagnosis, were all good. My last AF episode was 4 months and 10 days ago, episodes are over in hours and generally only have a minor impact on me. So basically, I have to go backwards significantly to seriously consider an ablation. I know AF is almost always a progressive condition so I expect to have an ablation at some stage and note that unlike you, I'm already on high dose of Flecainide (150mg) BD +25mg Metoprolol BD. Hopefully I still have ample time for PFA to become fully developed/fine-tuned and available from PFA experienced EP's in Western Australia.

Good luck with your decision. Keep us posted on your progress.

[OzJames in reply to bean_counter27]

yes that seems a reasonable approach especially seeing this new tech around PFA improving so quickly. During the same Medtronic’s trial they went from a Pulse 1, 2 and 3 version of their catheter so who knows what version will be around in say 2 years!

[Iamfuzzyduck]

I think the big difference with the newer systems is that the mapping is built into the catheter avoiding the need for two devices? I think only you can decide. I personally didn't want to wait because mentally I wouldn't be able to relax knowing that I would have to have it done at some point, so I just wanted it done. I would not have had it done if it wasn't pulse field though, I would have definitely waited. I have been discharged with Eliquis only, no other meds, and after three months I will be med free. But only you can decide how long you want to delay it, for myself I couldn't find a good enough excuse not to have it done when I did, but waiting for an optimal device may be a good enough reason for you. I do worry about how much tissue has been destroyed, but it would have been less than the other two methods, they just haven't determined what the optimal amount is with PFA. I am still in recovery in that I am not yet 100% two weeks later, but I can still run, do crossfit etc, just at a reduced capacity while I heal. I do not have as much stamina. I walked up the stairs yesterday with a pile of bedding, and after I got to the top I felt light headed and had to throw the washing down and grab a shelf to steady myself, that was weird and I need to tell my treatment team but it is still early days...

Good luck in your decision process, it is hard to figure out the right thing!!

[OzJames in reply to Iamfuzzyduck]

It does prey on the mind and sounds like you made the right decision. In the early days of my journey with AF 1993-2022 I’d only get it on average once every 5 years and cardiovert myself through exercise the same day. Since 2022 3 more episodes and cardioversions to get me back to sinus. At the moment I’m feeling good but I do hate that feeling of having to be careful with eating, sleeping over exercising etc…. and having to take any drugs! May you have many many years of Sinus rhythm!

[Iamfuzzyduck in reply to OzJames]

So I just went through my pre procedure notes again, (I also had an extensive pdf from the abbot study so I was overwhelmed with info before I went in). I had two sites of entry for the catheters, a small one in my left groin I assume for the mapping device, and a larger one in my right for the other device. Minimal bruising and the left site healed very quickly. They had said they may need to do a third in the neck, I don't know what for but they didn't need it. And then both devices go into the left atrial chamber via through the septum or whatever it is called between the two chambers, as far as I can make out, and I don't know if this is at the same time. So maybe the one device will need a smaller hole through the two chambers, but it would maybe have to be a larger single device to accommodate the two? I am just conjecturing at this point, but maybe this has explained a little?

[OzJames in reply to Iamfuzzyduck]

Thanks that’s really useful… and yes the ew devices have a cage or balloon which is about 8mm and has contact points all around it to discharge the pulses without having to rotate or position the device, apparently this results in more accuracy and quicker procedure time. The new Medtronic’s 360 sphere says 10-15 minutes! I think Abbott was 30 minutes Again the new devices are not approved yet

[Iamfuzzyduck in reply to OzJames]

I was quoted up to 20 minutes for my device (I think Farapulse) and a further 40 minutes to repair the entry points (in heart and catheter placements?? I didn't catch what the EP said but I assume it was mainly the puncture between the atrial walls?)

[MikeThePike in reply to Iamfuzzyduck]

If anyone is having any procedure it may be wise to avoid any neck insertions completely. I remember some time ago a member posted saying they were feeling suicidal about neck pains they say started after catheter insertion in the neck. Just something to think about. Best wishes.

[Iamfuzzyduck in reply to MikeThePike]

I was relieved that I didn’t have one through my neck!!

[JOY2THEWORLD49]

Hi

I read all about it as well.

Risk is not there as it is NOT EVASIVE.

Chances are that you will wait. Risk is risk.

Also it has a high rate of success and you would want that.

Also captured news sometime again that some balloons were recalled because they weren't inflating.

cheri JOY. 75. (NZ)

[OzJames in reply to JOY2THEWORLD49]

Thanks for your thoughts!

[MikeThePike]

I think PFA is a great advancement but it's worth remembering that it isn't really any more effective at curing AF than RF ablation.

[Alphakiwi]

Talking about dilation of atria how large is slightly dilated. Mine was measured at 74ml volume

[OzJames in reply to Alphakiwi]

not sure he just said mildly dilated and said nothing to worry about as all other functions good. I never gave it a second thought after that but maybe I should?