AF Ablation Update – 2016

I do AF ablation. But, similar to my 2015 update, I continue to do fewer of these procedures. What is new in 2016 is more confidence that this is the right approach. My technique for ablating AF has not changed. I do pulmonary vein isolation (PVI) with point-to-point RF. Each burn takes 10-30 seconds, and at the end, the machine counts about 60-80 burns. If the patient has had atrial flutter, or previous heart surgery, or if I can induce atrial flutter, I will do a CTI ablation for flutter in the right atrium during the 45-min period of waiting to see if the veins reconnect. (CTI = cavotriscupid isthmus). I then check for other arrhythmia, such as PSVT or AT, often using isoproterenol, an adrenaline-like substance. The first thing to say about AF ablation in 2016 is that there are no major technical advances. It’s basic PVI. Some groups use cryoballoon ablation. Don’t ask; I don’t know which technique is better. Probably the one your operator is most experienced with. There are a few labs, primarily in the US, using FIRM ablation, but two studies published last year failed to reproduce the original FIRM results. European physicians are skeptical of FIRM. Another reason I do fewer ablations is that here in Kentucky, 8/10 AF patients I see have AF not as a disease, but as a manifestation of other diseases. These other diseases include obesity, sleep apnea, high blood pressure, diabetes, metabolic syndrome, excess alcohol intake or surges of inflammation–...
Source: Dr John M - Category: Cardiology Authors: Source Type: blogs