Now Dr. Mandrola not only likes, but loves Pulse Field Ablation (PFA).

[mjames1]

Dr. John Mandrola previously had reservations about Pulse Field Ablation being a breakthrough in treating afib. Npw that he has personally seen it in action, he has changed his mind.

From his Substack 11/22

"Now I have used PFA. And. It is somewhat amazing. It ablates cardiac tissue quickly and easily. Patients hardly feel chest pain after the procedure."

And he goes on and on and on...

On a personal note, PFA would be my choice if I needed a catheter ablation, especially if the center was not high volume, because PFA is not as operator dependent as RFA or Cryo.

Jim

[Jajarunner]

Thanks for sharing that.

I'm undergoing my fourth ablation in 4.5 years soon. I'm dreading the months of recovering which it has taken me each time (six months or more to return to full or nearly full energy) especially since the other three lasted an average of 4 months before they failed.

There is a chance I will be be pensioned off on Medical grounds as my sick record is so poor with all those ablations and 10 cardioversions in that time, which I don't want. It's all very depressing but I cannot stay on amiodarone any longer.

I've heard the recovery is better with PFA and I hope Dr Mandola is correct about it's efficacy.

Reading this has really given me a boost, thank you for sharing 🙏👍🤞❤️

[Tplongy in reply to Jajarunner]

Have you considered a mini maze procedure if it’s appropriate for your circumstances rather than all these endless procedures?

[Jajarunner in reply to Tplongy]

I think that'll be my next line of call if this doesn't work. They say it's "just" atypical flutter this time so easier to treat 🤞🤞🤞🤞thank you for the information 👍

[mjames1 in reply to Jajarunner]

Yes, mini maze will not work for typical (right-sided) aflutter. RF is what they usually use. High success rate. PFA not used for typical flutter last time I checked. The PFA instrument is too blunt and designed mostly for pulmonary veins.

Jim

[OzJames in reply to Jajarunner]

There’s a new system on the horizon, have a read of my response to Jim

[KenRC in reply to Jajarunner]

Good luck mate, hope it works out well for you!

[mjames1 in reply to Jajarunner]

Yes, recovery seems better and efficacy about the same as rf or cryo. Another option is mini maze, which has shown better results in difficult cases, however longer recovery.

Jim

[Kennyb1968]

Hey Jim - not been on for a while. My ablation has kept me symptom free for over 3 years - I'm in constant AFIB but my resting heart rate is 63 and I'm jogging 30 miles a week and still hitting the gym. Life is good and I hope this finds you well.

[mjames1 in reply to Kennyb1968]

Hi Ken, Good to hear from you. Glad you're doing so well!

Jim

[Ppiman]

Yes - that was what I was told a few months back by my specialist when I was put on the NHS waiting list for mine. I can't say that I am looking forward to having an ablation, nonetheless, especially as my AF tends to be at a somewhat lower rate and less uncomfortable, of late, even if now far more frequent.

Steve

[cockerfarley]

Can I ask, which hospital Dr. Mandola works out of

[mjames1 in reply to cockerfarley]

His practice is in Louisville, KY. USA. My understanding is that he uses ablation sparingly, so he may not be high volume, which I think is important, but perhaps a little less important with PFA.

Jim

[OzJames]

interesting I wonder what version he used… since the Study comparing RFA and PFA some time ago, I understand they are up to version 3 of the catheter. I would be interested to see how they compare today. I saw an EP who now does PFA for AF and RFA for AFlutter and suggested he could do both at the same time if I decide to do.

At the moment Sinus is my friend and hoping to stay there for a long while. FYI Jim there’s an Australian company Imracor conducting Aflutter ablations at John Hopkins looking towards FDA approval. Hopefully all goes well as the system is using MRI guided catheters which sound like they will be more accurate than current technology and therefore lessen the need to have 2,3 and 4 ablations.

[mjames1 in reply to OzJames]

I don't know the version but I assume the latest available in the United States. Here, all the ep's who do PFA also do RF where needed in the same procedure. For example, that would cover those who have both afib and aflutter.

Jim

[PeachLove in reply to OzJames]

Can you please explain what RFA and PFA refer to? Of late, I have had atrial flutter episodes, requiring cardioversion. Historically, sometimes afib has shown up also. I am now on a waiting list for ablation, but have no details as to the type. When I ask my cardiologist what procedure will be used by the ablation doctor, he says it will depend on what the doc sees when he actually does the procedure.

[OzJames in reply to PeachLove]

the newer type of ablation is Pulse Field which is mainly used for AF the one that’s been around for a while is Radio Frequency Ablation. The later is what your doctor will most likely do for flutter. It also is used for AF but doctors are looking at PF more as recovery is quicker and less risks. Also a company called Imracor is doing Trials in Europe and now US for an MRI guided RF ablation for Flutter. This could potentially offer a more accurate ablation due to the clarity of targets and consequently a lesser need for follow up ablations

[cockerfarley]

Thank you

[EngMac]

Dr. Mandrola in, I think, in the last “This week in Cardiology” post has a reply from a doctor in Europe who raises some major concerns that need consideration. Dr. Mandrola is not so positive now about PFA even though 70,000 procedures have been done in Europe.

[mjames1]

What is the date?

[Model52]

Dr. Mandrola may be less critical than at first, but his last sentences in his substack still are essential: “I still believe real advances in AF treatment will occur in basic science labs not ablation labs.”

Ablation is guesswork.

This is Mandrola’s stance: “My main criticism of PFA remains: it is not a game-changer in AF treatment; it is merely another way to ablate atrial tissue. The main headwind of AF treatment is that we don’t understand the cause(s) of AF.

We don’t know why pulmonary vein isolation works; and we don’t know why it fails. Patients ask how I know where to ablate? This question always makes me smile. Because the true answer is that we do not know. We ablate the same area (PV isolation) in every patient. PFA does not answer any of these questions.

Finally, I (and my colleagues) could be wrong about PFA. I put the probability of this quite low, but there is a non-zero chance that PFA will be less effective than thermal ablation. One reason for this is that PFA’s cardioselectivity render it less likely to modulate neurologic input to the heart. Thermal ablation often results in ablation of the ganglionic plexi—resulting in a slight increase in resting heart rate. GP ablation associates (weakly) with procedural success.

In sum: I might have been too skeptical of PFA. There is a high probability that it will make current modes of AF ablation easier, and avoidance of a catastrophic but rare complication is a positive.

Future generations of the technology will improve it further. But I still believe real advances in AF treatment will occur in basic science labs not ablation labs”.