Catheter Ablation

[bensteg1]

Does anyone know if catheter ablation success rate is dependent on whether or not a person is in normal sinus rhythm (NSR) at the time? Meaning, is it better to be in AFib at the time of the catheter ablation procedure or better to have NSR the time of the procedure?

[mjames1]

My ep prefers his patients to be a normal rhythm at the time of the ablation, but will do it either way.

Jim

[Paulbounce]

Hi Ben.

Fear not! If you aren't in AFib at the time of your ablation your EP will soon make sure you are👍

Rgds Paul

[mjames1 in reply to Paulbounce]

Paul, Triggering afib, at least during an initial PVI, is not the way many top ep's work. They will simply ablate the pulmonary veins empirically based on prior evidence. After completing the PVI, some may try to trigger afib, to see if.any remains, but many will just let the PVI stand for itself. There is no evidence that I know of that one way is better than the other.

Jim

[Paulbounce in reply to mjames1]

Hi Jim.

I stand corrected. You are indeed right - that's the beauty of this forum. We learn something new all the time. I always thought you needed to be in AFib so the EP could see where the 'bad' signal was entering the heart. I got it wrong.

Enjoy your evening.

Rgds Paul

Edit. There are a few cases when the EP will induce Afib. On the whole though, it doesn't seem to be necessary.

Copy and paste:

The success of catheter ablation for atrial fibrillation (AFib) is generally not dependent on whether the person is in normal sinus rhythm (NSR) or AFib at the time of the procedure. In some cases, a patient might be intentionally brought out of NSR into AFib during the procedure to help identify the problematic areas, but this varies based on individual circumstances.

[mjames1 in reply to Paulbounce]

Paul, Your point is not entirely lost. Being in a fib or triggering in afib can play an important role in follow up ablations where an initial PVI has failed.

One of the reasons many EP's do not try to trigger Afib initislly, is that some studies show that triggering afib may not have clinical implications and can result in unnecessary burns. .And yet some eo's do. Personally, I'm with the less is more approach especially on the first go around.

Jim

[bensteg1 in reply to mjames1]

Thanks for the information!

[mjames1 in reply to bensteg1]

I see you're from the United States as I am. Not to say that you can't find a good EP elsewhere, but we do have a great group of EP's in the United States as long as you go to a high volume center. So good luck with your ablation if that is what you're gonna have. Best decision I ever made regarding a fib and wish I had done it sooner.

Jim

[bensteg1 in reply to mjames1]

I am in Boise, Idaho so not sure how "high volume" we are. I have an EP that seems capable and who has successfully performed much more complicated procedures. As he states, this procedure does not "keep him up at nights".

I have a feeling inside that my severe end stage arthritis was a major factor in me having Afib. I just had full hip arthroplasty ten days ago and have since reduced my Amiodarone from 200mg to 100mg once per day. I know there is not a lot of evidence to back my feelings, but I have found literature suggesting that the inflammation from the severe end stage arthritis could be a major trigger for Afib.

I am left pondering if I should wait to see if Afib comes back before scheduling the procedure.

[mjames1 in reply to bensteg1]

I would say over 200 -300 a year would be high volume and over 1000 total. Just ask. If it's less than that, I would seek out an EP at a top ranked teaching hospital, which does a high volume, insurance permitting. US news and world Reports has a pretty decent ranking system of cardiac hospitals., Also, at this point in time, I would be looking ideally for Pulse Field Ablation (PFA) although I I still think volume and reputation more important than the individual technique

Jim

[Paulbounce in reply to mjames1]

Jim wrote:

Also, at this point in time, I would be looking ideally for Pulse Field Ablation (PFA)

✅

Rgds Paul

[ozziebob in reply to bensteg1]

I would think, if you were treated with corticosteroids for your severe end stage arthritis, then that could well have been a major factor in the aetiology of your AF.

[ian16527 in reply to ozziebob]

Is there a link with steroids?Had a fair few years ago

[ozziebob in reply to ian16527]

Yes indeed. An online search will quickly find relevant research, although it is also made worse with the higher doses. I would definitely do some research re your particular meds and dosage and duration.

[MaryCa in reply to bensteg1]

Loads on research on Google scholar linking AFib to inflammation. I'm absolutely certain an anterior approach hip replacement triggered mine. My thigh was like a tree trunk with inflammation. I hadn't taken antiinflammatories in years so that wasn't an issue for me as someone else said below. I find co enzyme q10 great to help lower inflammation. My crp blood tests definitely show lower levels of inflammation since I started taking it. Loads of research to support that too. I also take magnesium taurate and my EP actually put it on my discharge prescription.

[Debjimmay in reply to mjames1]

Hi Jim. I am in the US (Ohio) and considering a PFA. Are you able to recommend a good EP? This is actually what is holding me back from having it done. I’m just not sure who to go to and I want make sure I go to the best. Thanks.

[mjames1 in reply to Debjimmay]

Cleaveland Clinic is #1 I may have a name there I will look

[Debjimmay in reply to mjames1]

Thank you!

[mjames1 in reply to Debjimmay]

Just sent you a PM

[Debjimmay in reply to mjames1]

OK thanks. I would appreciate that. I’ve checked a couple doctors at Cleveland clinic and they don’t seem to be on our insurance so I’m hoping I can find at least one that takes our insurance.

[mjames1 in reply to Debjimmay]

There should be a general appointment office or something at the Cleveland clinic and they would know who takes what insurance. That might save you from calling each individual doctor.

Jim

[mjames1 in reply to Debjimmay]

Daniel Cantillion at Cleveland Clinic but they have many other excellent eps. I wld call their office and see who does pfa.

Jim

EDIT: Looks like Cantillon left CC for a private sector job.

[bensteg1 in reply to Paulbounce]

Thanks Paul and Jim.

[Karendeena in reply to mjames1]

My EP wasn't concerned either way, not sure if they trigger AF or not but I do know I want into AF during the ablation. What I don't understand is how they can do the mapping using 'clever mathematics' if you are not in AF 🤔

[Abbyroza]

I would not think it will make much difference, as it is guesswork anyway.

This is what EP John Mandrola whites about it, himself being an experienced EP, who has performed hundreds of ablations:

“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”.

[localad]

not much choice here; I had been in constant AF for two and a half years when I had my PV ablation. I dropped into NSR as they ablated.

[wilsond]

If you are in nsr when you go in for it,the EP will stimulate you into AF.

[Karendeena]

My EP says it makes no difference.

[ian16527]

When I had my cryoablation 2 years ago the report said no re entry after 15 mins but not sure what this meant so perhaps he tried to induce af at the end of the procedure

[MaryCa]

It makes no difference. They'll trigger it anyway if they need to. The only time I had to be cardioverted was during ablation. And I went in, in nsr, and came out in nsr