14. “What is the typical length of a catheter ablation today versus when you had your catheter ablation in 1998 in Bordeaux, France? What makes it possible?”
The procedure I had back in 1998 was really primitive compared to what they are doing today. Compared to my eight-hour ablation, today an ablation usually take 2-3 hours (this will vary depending on the doctor and center, as well as on the difficulty of your particular case).
What has made it possible? In the last 20 years there has been an explosion in our understanding of Atrial Fibrillation and major technology advances as well. Such as:
• Advanced Mapping Technologies. In addition to 2D fluoroscopy, most centers now use advanced mapping technologies which provide the doctor with a 3D map of the heart and can even show the ablations as they are made.
• Irrigated Tip Catheters. Today’s ablation catheters have an irrigated tip which makes for more consistent and safer RF burns.
• Contact Force Sensing Catheters. These new catheters allow doctor to apply just the right amount of pressure to achieve a perfect ablation.
• Circumferential or Wide Area Antrum Ablation. When I had my ablation, the doctors ablated inside one of my pulmonary veins in what was called a Focal Segmental Ablation. But this technique required a great deal of manual dexterity, skill and finesse. Because doctors were actually ablating inside the pulmonary veins (PVs), it could result in stenosis—a swelling and narrowing of the PV opening. Doctors now ablate outside the PV openings to isolate the PVs from the rest of the heart.
• Pulmonary Vein Potentials. Back in 1998 you had to be in A-Fib for the doctors to find out where the A-Fib signals were coming from. This was a problem for me. Even though my A-Fib was well documented, when I arrived in Bordeaux, I wasn’t in A-Fib. They had a hard time inducing me into A-Fib. Nowadays you don’t have to be in A-Fib. Today’s mapping technologies can locate A-Fib hot spots or potentials even if they aren’t firing at the time.
• CryoBalloon Ablation. Another major improvement is CryoBalloon Ablation Catheters. Instead of having to make multiple, time-consuming RF circular burns around the outside of the PVs, the CryoBalloon catheter can make a circular freeze in one or two takes. And it’s safer for patients.
Just as important is the accumulated knowledge and advanced training of electrophysiologist and cardiologists. There’s no substitute for experience. Over the years since catheter ablation for A-Fib was invented (1996), doctors have gotten better and more experienced. Patient safety has increased with reduced complication rates.
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