what about PFA in Uk

[37Polly]

We finally have PFA in the USA after watching, envious of Europe, for three year. We still don’t have it everywhere, but some premier hospitals provide it. It’s safer, faster, and so far shows better results.

I am four days post procedure, drove four hours each way, and had afib, atypical aflutter and persistent aflutter, as well as sub ventricle tachycardia all ablated with PFA in three hrs . I feel pretty good so far, but tired. Zero heart pain .only on long lasting propranolol and apixaban. Fingers crossed. However curious about why friends across the pond aren’t eagerly pursuing this option. Is it not readily available?

[Buzby62]

Is it not readily available?

Not yet, I think we’re up to about half a dozen places doing it across the UK now.

Best wishes

[BobD Volunteer]

There are some specialist centres offering it but to date, whilst recovery may be slightly easier, overall results are little better than existing catheter ablations.

[mjames1 in reply to BobD]

What Bob said.

The latest data are showing little difference in results, safety and complications, compared to RF or Cryo.

Recovery may be a little easier because the procedure is shorter, but even that is questionable because PFA requires general anesthesia while rf or cryo can be done under sedation.

This is not to say that PFA is not the future of catheter ablation, just that right now results are no better and no worse than with RF or Cryo.

Jim

[mjames1]

had afib, atypical aflutter and persistent aflutter, as well as sub ventricle tachycardia all ablated with PFA in three hrs .

First congratulations on the ablation and best luck to a speedy recovery!

However, unless things have changed significantly in the last year, PFA is pretty much only used for a PVI ablation and occasionally on parts of the left atrium wall -- so my guess is that your EP used RF and/or Cryo, along with PFA to ablate what you described, especially if he did any work on the right side of the heart.

Jim

[37Polly in reply to mjames1]

Actually he did use PFA…I read entire post procedure report . And while I agree more studies will be needed to prove whether it’s an improvement, faster with less anesthesia. ( not great for elderly). Lower to no risk of damage to surrounding tissue, easier recovery, and shorter wait times with at least equal outcomes is worth a lot to an aging lady with no time to waste. And i believe a reasonable topic to discuss, especially where folks have options. Just a thought. Time will tell.

Proress is hard to slow.😁🤗

[Teresa156 in reply to 37Polly]

Well done in getting PFA and I hope it really works for you. I researched into PFA at one of the first hospitals here in the UK that does it, St Barts ( only last year) and was also told it only ablates AF, not a flutter or tachycardia, which is what I also have, so perhaps things have changed. It was the hospital professor who responded.

Are you absolutely certain it was all PFA as your procedure still took 3 hours? It’s only that I thought PFA was quicker?

[37Polly in reply to Teresa156]

Some is very new. I think mine was on the spot decision. Plan was to use both but given what they found , changed gears. So far🤞🤞Will ask surgeon.

[mjames1 in reply to 37Polly]

Actually he did use PFA…I read entire post procedure report

I have no doubt he did use PFA, but that means that all the work was done on the left side of the heart and in places that the PFA instrument was appropriate. It is not appropriate for all places on the left side, because it's a very blunt instrument, compared to RF.

It sounds like your flutter issue was on the left side (atypical/persistent) but for typical right-sided flutter, again PFA is too blunt an instrument, and in these cases the EP would use RF or Cryo.

To be clear, I'm a big fan of PFA, just pointing out the current limitations which hopefully will change once the next generation(s) of PFA are developed.

Very happy that PFA was able to take care of all your issues.

Jim

[37Polly in reply to mjames1]

Time will tell. I appreciate the information and discussion. As you can imagine, family not quite interested 🤣

[opal11uk]

What is PFA?

[37Polly in reply to opal11uk]

Pulse field ablation.its been available in Europe for over three years. Just became available in the USA in 2024, in only the premiere hospitals. I went to mass general in Boston on Friday .

The studies being done so far show a much faster process about an hour to. 70 minutes requiring less anesthesia, and shorter waiting queues. Because it uses electricity instead of freezing or burning , it only works on heart tissue and cannot damage nearby nerves or the delicate esophagus . Recovery is easier and faster. And the doctors say the learning curve with the equipment is far quicker the devices require less finesse and are more accurate and fast.

. They are doing more procedures faster. Most people go home the same day. I have been watching and waiting for it to come to the USA. Finally here in best hospitals

Had it done Friday by a crack team in Boston . I am a small elderly female. As female tech team commented as I fell asleep

on the table “ not much real estate”😁🥰. So far pretty painless. A headache i was preparing for but no heart pain , in NSR, zero dofetilidfe, or rhythm med for first time in over six years. Praying and resting .

. We are not all the same, we need the options progress provides. Let’s talk more about them. Good grief we can’t all handle long waits , long anesthesia, damage in smaller bodies, and painful recovery. Do you think the best hospitals in the USA fought for this and announced with great fanfare because it was just the same old outcomes. Europe has Leg up but pretends it’s nothing.. i don’t understand.

Sorry for long harangue. I am in bed and have thought ond researched this alot. Polly, a very ancient professor.

[opal11uk in reply to 37Polly]

Thank you for explaining it to me, sound idea, good luck with your recovery x

[37Polly in reply to opal11uk]

Thanks. More hopeful than ive been in years.

[Ossie7]

very interesting post Polly . I had my 3rd ablation this May ( radio frequency ) following an initial cryoablation and then 2nd RF touch up of pulmonary veins . My EP classed the ablation as only partially successful as he was not able to fully ablate the superior venacava as it was too close anatomy wise to the phrenic nerve and the Sinoatrial node . He said he had done 75% but feel that without anti arrhythmia meds my AF would return . I am now thinking after reading your post , would he have been able to fully isolate this vein with pulsed field ablation ? Sadly he also said that would be my last ablation due to having my allocation of funding , which I find difficult to believe with others on this form having 4 or 5 ablations !! I was not happy to hear this .

[37Polly]

i really don’t understand the uk system. Ive heard people say they had choice between ablation type, but almost nobody say they have had PFA. Not much real information. Im getting all mine from recent conferences and papers ( last six months ). Sounds like you need a new doctor 😄

[Singwell in reply to 37Polly]

Not all hospitals offer it - simple as that . Why? Different equipment (cost) and practitioners will need updated training (time). Also, hospitals currently not investing in this newer procedure will be waiting to see if there are improved outcomes. If there are, and less side issues plus less returns to AF, then eventually they'll invest. It all has to balance - evidence based of outcomes- investment- cost. That's how the NHS works.

[Wilkie1]

I had a PVI ablation yesterday via PFA in the Royal Hospital in Belfast. The EP told me that they have been using this procedure between 3 and 6 months now. Afterwards he told me that he had followed it with a mapping procedure so he believed that it had gone well - said, so I used both a new procedure and an older one. It was performed under GA because, as the anaesthetist explained, they would be putting a camera down my oesophagus.I was in the Cath Lab for about 2 hours. Overall I was pretty blown away by the range of professions, how professional and personable each was with me, how effectively they worked together as a team and the degree of attention from nursing staff after the procedure.

[37Polly in reply to Wilkie1]

Very interesting. Depending on many studies of outcomes now underway I think we are likely to see lots morePFA. The reduction in waiting time. Easier recovery, and less tissue damage. Those are all major to patients! And who wants multiple procedures? That will be a BIG factor. Exciting progress.

[37Polly in reply to Wilkie1]

Say Wilkie…feels like a reach across the pond…my Dad was born in Belfast. Lovely to meet you🥰

[37Polly]

Wilkie, we should track our progress ❤️‍🩹