Comment by EP on Pulse Field Ablation

[Karendeena]

I had my post ablation review on Monday evening and I took the opportunity to mention about the availability of pulse field ablation at Glenfield Hospital in Leicester (I understand this has only just started at this hospital). I was surprised to hear that my EP said although it's quicker it hasn't got any better outcomes than PVA and he quoted 75%. In fact I was surprised he didn't appear to be over enthusiastic about it. Considering my EP is top in terms of research and a Professor I expected a different response.

What are your thoughts?

[BobD Volunteer]

This was the conclusion from experts at our Patients day last October. PFA may have slightly less side effects and be a little easier to recover from but results so far are on a par with other PVIs such as RF or cryo balloon. We live in hope .

[mjames1]

Yes, similar results, but quicker, so shorter time under anesthesia. Which at least for me is a big plus.

Also, PFA is less operator dependent. So for those of us who cannot find a "Star" ep, we can still expect very good results.

Also keep in mind that right now we are at first generation PFA. As the technology advances, we no doubt will get better results, perhaps surpassing both RF and cryo in all areas.

Jim

[Tiburon in reply to mjames1]

Thank you for those comments. Very helpful.

[OzJames]

I did read that the comparison results between PFA and RFA were based on first generation models of the PFA Catheter. I understand it is a highly competitive area and at least 3 companies are now into 2nd and 3rd generation models of their PFA Catheters. I think from memory Johnson has now entered the scene with their own model. I am keen on this and hoping in a year the results will be in favour of PFA. At the same time an Australian company has developed an MRI guided RFA Catheter which is being trialled in different countries still not approved however their benefit is that its catheter is far more accurate than current mode of mapping errant targets. The company is called Imracor if anyone wants to follow their updates

[CDreamer]

Everything I have read agrees with all above comments. Had I been an ablation candidate the appeal for me would have been less time on the table and lower rate of complications.

[Retired2020 in reply to CDreamer]

Had PFA 2 months ago. Didn't have to have general anesthesia, faster recovery time was all worth it to me.

[Karendeena in reply to CDreamer]

Me too! I struggled with recovery

[Jajarunner]

I'm hoping for a quicker recovery from my next (pf) ablation

[Ppiman]

I think it's maybe too new to have altered doctors' views of longstanding techniques. The studies I have read seem to show it is safer, rather than more effective.

Steve

[Karendeena in reply to Ppiman]

Agree Steve

[cockerfarley]

Hi KarendeenaI have a consultation with a top Prof on Monday and having already asked the question of his secretary, I suspect I will get this confirmed on Monday.

Your top Prof EP isn't based at Oxford by any chance is he 🤔

I also suspect that the cost of the PFA equipment is an issue here. I watched a y.tube video recently from a number of US hospital cardio's giving their initial opinion on the results and experiences of PFA and they more or less said its too early to make any real distinctions, but they did make it clear that the costs of PFA machines were 2 to 3x conventional ablation kit and that would need to reduce if it was to be more widely adopted.

Not sure if they were taking this cautious approach as a way to negotiate a cheaper price rather than openly declaring it's superior performance and then having no room to negotiate. Apparently PFA uses X rays and can be quite high doses, which won't be known for some time post procedure what any implications might be.

Anyone hear about this

[Karendeena in reply to cockerfarley]

Hi there, no my EP is Professor Ng at Glenfield in Leicester. He has just been made president of the British Cardiovascular Society and is a leader in research into rare cardiovascular diseases so I think I have one of the best 🙂I know he has also secured 7 million for research, 3 million from the British Heart Foundation which has been match funded by the University of Leicester and Glenfield Hospital.

I trust him completely and have been with him since my diagnosis in 2020.

With regards to the dose of x rays I think this is quite high anyway with radiofrequency ablations but I may be wrong. BobD might have the answer here. It did scare me but what do you do, I wanted relief from my debilitating episodes.

[Islandee]

I went in for an ablation and they could not do it as the area was right over the phrenic nerve which controls the diaphram and breathing. I have kept up with the information about PFA in the US because as I understand it, it would not damage the phrenic nerve. I am sensitive to medications and have tried numerous medications which did not help me and the side effects were awful. I live in the Seattle area and hoping that it won't be too much longer until it is available.

[Karendeena in reply to Islandee]

Is it not available at all anywhere close by? Quite a few hospitals in the UK are now moving into PFA I just missed it at our hospital, they started the month after my ablation.I think we will know more in near future

[Islandee in reply to Karendeena]

There are some doing the procedure on the east coast. I saw a couple hospitals in the Seattle area but it has just started. I'm waiting for them to have a little bit more experience. One of my doctors is at University of Washington, Seattle but they aren't doing it there yet. I thought a university teaching hospital would have been one of the 1st to learn the procedure. I'm keeping my fingers crossed. The FDA approved it's use in the US December 2023.

[lovetogarden in reply to Islandee]

Ah, I’m in the same situation. The area that I need ablated (right atrial tachycardia) is right over a phrenic nerve. Like you, hoping for pulsed field to become more available and hopefully be able to do the trick. Fingers crossed for both of us! (I’m also in the U.S.)

[cockerfarley]

Thanks Karendeena