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Biosense Webster

Story Update: Ashley Mogg, a 23-Year Old Jamaican, Now A-Fib Free!

I’ve seldom been so happy to write about an A-Fib success story (actually an update)! A story that had such a miserable beginning.

A-Fib at 17 and Started Losing Sight!

Eighteen months ago, I wrote a story about 21-year-old Ashley Mogg from Jamaica. Her A-Fib was horrible. Her first A-Fib attack came at age 17 when she had just stopped playing field hockey. Ashley wrote:

Ashley Mogg from Jamaica

“I was feeling extremely unfit. My heart rate sped up and my chest got tight. My throat felt like it was closing, and I was starving for a breath. Then the most frightening thing happened―I started losing my sight! Pitch black was all I saw. I could hear my friend talking to me through it. It was so scary for me.”

Her doctor told her losing sight was a symptom of pre-faint or pre-syncope. Her stress test showed a heart rate that at times went up to 270 bpm.

Clinical Depression Sets In

To make matters worse, her cousin died suddenly. Then Ashley had to have an appendectomy which revealed a low grade Neuroendocrine tumor (cancer). Coupled with her dreadful A-Fib symptoms, she became extremely depressed and anxious (clinical depression is all too common in new A-Fib patients). She also suffered weight loss and became very thin.

No A-Fib Centers in Jamaica

Unfortunately, when I researched resources for her I couldn’t find any A-Fib centers or Electrophysiologists in Jamaica. It was heart breaking that such a young woman had such a debilitating case of A-Fib, and I couldn’t find anyone near her to take care of her.

November 2016: Asking for Funding and Help for Ashley

What I did was publish her story on and ask for donations to pay for her to see an EP in the U.S. (Read Jamaican Woman, 21, Living in A-Fib with Meager Treatment)

Dr. Natale confirmed that there was no EP lab in Jamaica and would try to find money from the A-Fib industry to help Ashley.

In addition, I sent Ashley’s story to Dr. Andrea Natale, a master EP with a world-wide reputation. A colleague of his, Dr. Francesco Santoni, emailed me that he tries to help arrhythmia patients in Jamaica through the Rotary Club and another foundation. Travis Smith, President of the Rotary Club of Downtown Kingston, Jamaica championed Ashley’s cause.

Dr. Natale suggested we work with Dr. Lisa Hurlock in Kingston, Jamaica at the University of the West Indies who could follow her arrhythmia. She met with Ashley and her mother, Loretta. Dr. Natale confirmed that there was no EP lab in Jamaica. He said he would try to find money from the A-Fib industry to help Ashley.

Dr. Natale’s Heroic Efforts to Help Ashley―Biosense Webster Donation

Dr Andrea Natale

Dr Andrea Natale

Dr. Natale obtained a donation from Biosense Webster (Johnson & Johnson) to cover travel expenses for Ashley and her mother to St. David’s Medical Center, Austin, TX including lodging, food and transportation. He also arranged for St. David’s to waive all fees for Ashley’s catheter ablation. The Texas Cardiac Arrhythmia Foundation accepted donations to help Ashley. Barbara Thomas and Amy Dixon coordinated everything at St. David’s.

(I probably don’t have all the names of everyone involved in helping Ashley. Please email me if I haven’t mentioned you or someone else who helped.)

Ashley, mom Loretta and hospital staff

July 2017: Ashley Has Her Ablation & is A-Fib Free!

On July 19, 2017, Ashley had her ablation. She is now A-Fib free. It was performed by Dr. Natale and his team at St. David’s Medical Center, Austin, TX. Since then, she has written that she is doing fine and has started college in Jamaica (she wants to go to medical school).

In an excerpt from her personal story (written before her ablation became a reality), Ashley shared these lessons learned:

“Educate Yourself―Find the Best Doctors Available. If you live in a country like myself where there are very few Electrophysiologists or heart rhythm specialists, find a reliable cardiologist as well as a general doctor who know your history. Do maximum research on your own and with your doctor and health care professionals. Stay informed.
…Stay positive…You are NOT ALONE!”

Remarkable for a 21-year old who has had a rapid beating heart since childhood.

March 2018 Update: Email from Ashley’s Mother

Loretta Mogg, Ashley’s mother recently wrote me:

Ashley and her mom, Loretta

“I am Loretta Mogg, the mother of Ashley Mogg. I want to express a heartfelt thanks to you for posting my daughter’s story and seeking help for her.
Just a little update. After nearly a year since her ablation, she is back in University and doing well. She is still determined to become a doctor.
Thank you for allowing God to use your own experience to change the life of another. Blessings to you and your family.”

Thanks to All, Especially to Dr. Natale

It’s impossible to adequately thank everyone, especially Dr. Natale, who helped Ashley in her incredibly difficult A-Fib journey.

I don’t know if we’ll ever understand how a young 17-year-old woman could develop such awful A-Fib symptoms. (Perhaps it related to her cancerous appendectomy.)

Faith and a Purposeful Life

Kudos to Ashley for not giving up with all she went through! She’s an incredible young woman. She had to grow up fast. She became a woman of faith with a purposeful life. In her own words, “It takes prayers and positive thinking to keep living with peace of mind.”

Be Inspired: You, too, Can Help Others With A-Fib

One-to-One, our A-Fib Support Volunteers are just an email away at A-Fib.comOne way to live a life of faith and purpose is to help others suffering with Atrial Fibrillation. Join our Prayer and Positive Thoughts group or our A-Fib Support Volunteers group.

Offering hope: Having someone you can turn to for advice, emotional support, and a sense of hope that you can be cured, may bring A-Fib patients (and their families) peace of mind.

We are blessed to have many generous people who have volunteered to help others get through their A-Fib ordeal (not all are ‘cured’). To learn more and how you can join the effort, see my article: ‘Want to Become a A-Fib Support Volunteer?

The New Era of Catheter Ablation Technology for Atrial Fibrillation: Force Sensing Catheters-2014 Boston AF Symposium

2014 Boston AF Symposium

The New Era of Catheter Ablation Technology: Force Sensing Catheters

By Steve S. Ryan, PhD

Dr Moussa Mansour

Dr Moussa Mansour

Dr. Moussa Mansour of Massachusetts General Hospital gave a presentation entitled “Role of Force Sensing in Catheter Ablation for AF.” In particular, he referenced the Biosense Webster’s Thermocool SmartTouch irrigated tip ablation catheter with force sensing technology and the St. Jude Medical’s TactiCath (Endosense) contact-force sensing ablation catheter.

Note: The month following Dr. Mansour’s presentation at the Boston AF Symposium, the FDA approved the Biosense Webster’s Thermocool SmartTouch irrigated tip ablation catheter with force sensing technology (February 25, 2014). The main competing system, St. Jude Medical’s TactiCath (Endosense) contact-force sensing ablation catheter, was approved for use in Europe (July 22, 2014) and hopes to get FDA approval by the end of 2014.

Just the right amount of pressure

Doctors (and patients) are excited about force sensing catheters, because they allow doctors to apply just the right amount of pressure to make a good ablation lesion. Previous studies have shown that even experienced operators sometimes apply too little pressure which can result in incomplete lesions and gaps, or they sometimes apply too much pressure which can lead to overheating and can damage or even perforate the heart. Researchers found a wide variance in contact force applied by doctors, and even a variance of force by particular doctors within the same ablation procedure.

The clinical trial for the Biosense Webster SmartTouch SMART-AF demonstrated for the first time that the consistent and stable application of contact force on the heart wall positively impacts the efficacy of catheter ablation. According to Dr. Andrea Natale, “Consistent and stable application of contact force has a significant impact on patient outcomes…and represents a major advancement for the clinical community.”

How the ThermoCool SmartTouch works

BisenseWebster Smart Catheter illustrations

Biosense Webster’s Thermocool SmartTouch irrigated tip ablation catheter with force sensing technology

The basic mechanism of the SmartTouch is a magnet and precision spring near the catheter tip. When the catheter makes contact with heart tissue, it bends allowing small amounts of electrode movement. Sensors record the micro-movements of the spring and monitor the transmitter coil location which sends signals back about the location of the spring. Changes in catheter angle and contact force are calculated by the changes in the position of the sensors.

The ThermoCool SmartTouch is usually used in conjunction with the Biosense Webster CARTO 3 electroanatomic mapping and navigation system which displays the contact force readings in real-time. (Contact force is usually measured in grams.)

How the TactiCath Works

Not yet approved by the FDA, the St. Jude Medical’s TactiCath contact-force–sensing ablation catheter uses an optical fiber system with three fibers. When the catheter tip touches tissue, the optical fibers bend changing the wavelength of the fibers. Software translates this information into a measurement of how much pressure is being applied. A console also displays the angle of the catheter. (In the TOCCATA trial, contact force (CF) measurements below 10 grams usually failed, “Clinical failure is universally noted with an average CF below 10 grams.”)

Preclinical Testing of force sensing catheters

Dr. Mansour pointed out how the same lesion depth can be achieved by a 30W energy level at 30 g contact force as a 50W at 20g.

In another study where operators were blinded to the force they were using, lower force (below 400gs FTL (Force-Time Integral) resulted in over 20% reconnections vs. only 5% with a force of over 400gs FTL (EFFICAS I) (TactiCath contact force sensing catheter).1

In a study where the force information was visible to the operator, more PVs were durably isolated (EFFICAS II) (TactiCath)2.

In another study, low contact force (0-10 [g]) resulted in 100% recurrence after 12 months; 10-20 [g] had 47% recurrence; over 20 [g] had only 20% recurrence3

Clinical Trials of Force sensing catheters

In the SMART-AF trial of the ThermoCool SmartTouch catheter, if operators stayed within their pre-selected force range 80% or more, they had a much higher success rate. In general, operators remained in their preselected force ranges 73% of the time. Possible reasons for catheter instability include the beating of the patient’s heart and their breathing motion.

Using High Frequency Jet Ventilation (which slows down the beating heart and breathing motion), improved catheter stability and contact force (FTL) (Mansour et al. HRS 2012).

Dr. Mansour’s Conclusions

•  Higher contact force during ablation results in deeper lesions
•  Contact force greater than 20g is associated with an improved clinical outcome
•  Increased percent of time within operator-targeted force range is associated with improved clinical outcome
•  Jet ventilation and steerable sheath improve the ability to achieve the desired contact force.

Editor’s Comments:
Contact force sensing catheters is a major medical advancement that will change the way ablations are done. Ablation lesions will be more durable and consistent. Instances of tamponade will be significantly reduced or possibly eliminated entirely. Catheter ablation success rates will rise.
Though it’s been less than 12 months since the FDA approved Biosense Webster’s Thermocool SmartTouch contact force-sensing catheter, anecdotal reports of its success are very encouraging. Experienced operators who already have a high success rate, report a 10%+ improvement using contact force sensing catheters. I’m surprised at how many top echelon EPs are already using force sensing catheters.
For example, Dr. Hugh Calkins of Johns Hopkins wrote the author:
“We have quickly adopted force sensing catheters in all of our atrial fibrillation and VT ablation procedures.  The additional contact information provided with these catheters is invaluable in maximizing the safety and efficacy of radiofrequency ablation procedures.”
Unfortunately, because of the added cost and technology challenges, the low volume operators who need to use force sensing catheters the most, will probably be the last to adopt them. (See my report about low-volume operators: Catheter Ablation Complications: A 2014 In-depth Review and Comparison with Anticoagulation Drug Therapy)
As a patient, ask your EP if they use contact force-sensing catheters. If the answer is no, should you make an effort to find an EP who does use force sensing catheters? Absolutely! Force sensing catheters will improve ablation success and durability, and will reduce complications. Even if you have to travel, it’s certainly worth the effort to find an EP who uses contact force sensing catheters.
Jet ventilation is an improvement, but may not be a game changer that you want to hunt for.
I intend to research which EPs are using contact force sensing catheters and make a special “Steve’s List” of them under the Directory Doctors/Facilities page of
Additional references for this article
Biosense Webster’s THERMOCOOL SMARTTOUCH Ablation Catheter With Force Sensing Technology FDA Approved. medGadget February 27, 2014. Last access Sept 11, 2014. URL

Lawrence, S. St. Jude flexible cardiac catheter approved in EU, aims for FDA. FierceMedicalDevises July 22, 2014. Last access Sept 11, 2014.’

Riordan, M. Contact-Force-Sensing Technology Noninferior to Existing Technology, Hints at Better Outcomes. Heartwire June 18, 2014. Last access Sept 11, 2014.

Perriello, B. J&J’s Biosense Webster wins PMA nod from FDA for force-sensing catheter. Mass Device. February 25, 2014. Last access Sept 11, 2014. URL

Reddy, V. et al. The relationship between contact force and clinical outcome during radiofrequency catheter ablation of atrial fibrillation in the TOCCATA study. Heart Rhythm. 2012;9(11):1789-95 doi: 10.1016/j.hrthm.2012.07.016

Return to Reports: 2014 Boston AF Symposium

Footnote Citations    (↵ returns to text)

  1. Neuzil et al. AHA 2011
  2. Kautzner et al. HRS 2012)
  3. Reddy et al. Heart Rhythm 2012

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