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Contact Force Sensing Catheter

2018 AF Symposium Live Case: Isolating the Left Atrial Appendage using RF Energy

by Steve S. Ryan, PhD.

Rodney Horton MD

Dr. Rodney Horton from the Texas Cardiac Arrhythmia Institute in Austin, TX, demonstrated in a live case how to isolate the Left Atrial Appendage (LAA) using Radio Frequency (RF) energy.

Side note: If you been in the EP lab before, the first thing you notice when viewing Dr. Horton at work is no one is wearing the lead aprons and protectors required when using fluoroscopy (x-ray). That’s because he uses 3D non-fluoroscopy (no radiation) imaging techniques.

Patient background: An 82-year old male with persistent A-Fib had a previous PVI but still had Flutter. He was also hypertensive. He also had a dual chamber pacemaker. Previously Dr. Horton had isolated the patient’s Coronary Sinus but hadn’t worked on his LAA.

Before the live case, Dr. Horton found that the patient had re-connection in one vein which he isolated before the live case demonstration began.

The Live Case: Mapping and Isolating the LAA

Live Streaming Video from AF Symposium at

Live Streaming Video at AF Symposium

Dr. Horton used a mapping catheter in the Left Atrial Appendage (LAA).

To isolate the LAA, he used 40 watts radio frequency (RF) energy and a contact force sensing catheter with pressure readings above 10 but not higher than 25. The pressure readings indicate how hard the EP is pressing on the RF catheter to make a particular burn.

He discussed that if the LAA wasn’t contracting properly after the ablation, the patient would have to be on anticoagulation for life. (He, of course, discussed this possibility with the patient before the ablation.)

Dr. Horton rarely isolates the LAA during a first ablation unless he is absolutely sure it needs to be done. He stressed that the phrenic nerve often drops over the top of the LAA. For that reason, he doesn’t ablate too deep into the LAA but ablates at the base of the LAA. 

…he isolated the LAA and the Flutter disappeared as we watched.

Applause, Applause

There was excitement and clapping when he isolated the LAA and the Flutter disappeared as we watched.

Dr. Horton demonstrated for all the attendees that the LAA should also be mapped and isolated. And that isolating the LAA can be very effective in returning a patient to normal sinus rhythm.

Editor’s Comments:
No, no to Fluoroscopy: It’s a type of X-ray and its effect is cumulative. Therefore it should be avoided if possible. (Hence, the need for the staff to wear the lead aprons.)
Instead of fluoroscopy, Dr. Horton uses a non-radiation 3D imaging technique called Intracardiac Echocardiography (ICE), a form of ultrasound.
On a personal note, Dr. Horton has said that not having to wear those heavy lead aprons would probably add 5-10 years to his ablation career.
Importance of the LAA in Isolating A-Fib: More and more EPs are realizing how important the LAA is in mapping and isolating non-PV triggers. Many Master EPs after isolating the PVs, now go right to the LAA as their second isolation target.
What this means for patients: When selecting an EP for your catheter ablation, discuss the Left Atrial Appendage (LAA) as a possible site of non-PV A-Fib triggers. Ask your EP:
 “During my ablation, when you’re looking for non-PV triggers, will you also map and isolated the LAA, if necessary?” (You want an affirmative answer to your question.)

If you find any errors on this page, email us. Y Last updated: Sunday, February 25, 2018

Back to 2018 AF Symposium Reports

Retired Nurse: Over 3 Years A-Fib Free (Husband Had A-Fib, Too)

My A-Fib Story at

Lisa S. from Arizona

A-Fib Patient Story #82

Retired Nurse: Over 3 Years A-Fib Free (Husband Had A-Fib, Too)

By Lisa S. from Arizona, October 2015

My name is Lisa S., and I live in Arizona with my husband. We have been happily married for 46 years and we both have had A-Fib. [We hope her husband will also write about his A-Fib experiences.] I write this in the hope that it will help others make proper decisions about their A-Fib.

Healthy Lifestyle But A-Fib Runs in My Family

I am a senior citizen who lives in a healthy manner. Along with my husband, I take care of myself, eat well and exercise regularly. I also try to keep stress out of my life as much as possible.

I would like to mention that A-Fib runs in my family. I have a nephew who had his first ablation at 18 by a pioneer in the field. It took two more ablations for him to be A-Fib free. Now in his 40’s, he feels he is cured. I have a brother and a sister who also have A-Fib.

September 2006: First A-Fib Attack

My first episode started in September 2006 when I woke up at 2 AM with an urgent need to urinate. My heart was beating so hard that I thought it would come out of my chest. My pulse was irregular, I had chest pain and was dizzy. I was anxious and scared.

Reluctantly, I woke my husband and told him I needed to go to the emergency room. Upon our arrival, the medical staff told me I was in atrial fibrillation and would monitor me until I got out of it. In the morning, the emergency room cardiologist decided that he would do a cardioversion to put me back in sinus rhythm. It was scheduled for 1 PM. At 12:50 PM, to my great relief, I went back into sinus rhythm.

I was discharged from the hospital with a pill-in-a-pocket, Flecainide 100 mg, if I got another episode.

Pill-In-The-Pocket Works, Until It Doesn’t

I thought I would be free from other episodes. But 10 months later I woke up at 1 AM again with an urgent need to urinate. My heart was beating out of my chest and my pulse was over 130 per minute. But this time at 1:47 AM I took Flecainide 100 mg and was back in sinus rhythm at 2:15 AM with a pulse of 68.

Keeping a Log or Diary Important

I kept a log of all my episodes of A-Fib and of my symptoms as I wanted to see how often they were happening and their severity. (In the early years, I got only 2 or 3 episodes.)

A-Fib begets A-Fib, and this pattern was happening to me.

I read on the A-Fib website that A-Fib begets A-Fib, and this pattern was happening to me. Keeping careful notes was important to me as a long-retired nurse. Accurate record keeping often helps doctors make a diagnosis.

In August 2009 (while my husband was in the hospital for a successful ablation by Dr. Andrea Natale), I had an episode that night in my hotel room and, later on that week, another one.

There are many patients who write about keeping an A-Fib Diary about their episodes, triggers, etc. Just enter the word “diary” in the ‘Search’ box in the upper right of this page.

Stops Flecainide, Deals with Excessive Urination

In August of 2010, my internist suggested I see another cardiologist who worked closely with Dr. Natale. My new cardiologist stopped my Flecainide because it made me sick during my A-Fib episodes. He prescribed another antiarrhythmic drug, Multaq, 400 mg/day.

My cardiologist instructed me to eat salty foods such as chips and nuts while in A-Fib and drink plenty of water so as not to get dehydrated.

I also wanted to know why I urinated so many times (10-15) during an A-Fib episode. Apparently, when in A-Fib, the “atrial natriuretic peptide hormone” in the atria kicks in and acts as a diuretic to lower the blood pressure and regulate the calcium and salt in the body.

My cardiologist instructed me to eat salty foods such as chips and nuts while in A-Fib and drink plenty of water so as not to get dehydrated. I was also told that my A-Fib episodes were vagal, from the vagus nerve.

A-Fib Progresses and Becomes More Frequent

From October 2010 to February 2012, I suffered 11 episodes of A-Fib with my symptoms getting more severe every time.

On January 7, 2012, during an A-Fib episode, I borrowed my husband’s Holter monitor to record my episode. My cardiologist made me erase it because it was not “my” monitor. I protested and told him it should be recorded.

Finally, he did give me a monitor to wear 24 hours a day for 30 days. As luck would have it, during that period I did not have any episodes.

(Dr. Natale could not believe that my cardiologist had done this. I subsequently got a new cardiologist, Dr. Timothy Marshall, and he is wonderful.)

Back in the Emergency Room

My episode in February 2012 landed me in the hospital. I woke up at 1:00 AM with an urgent need to urinate, palpitations, irregular pulse, dizziness, chest pain and I felt like I was going to pass out.

I went to the emergency room and was unable to convert back on my own, so I was given Cardizem IV, Lovonox and Magnesium 1000 mg to bring me back into sinus rhythm. While giving me these drugs, the “crash cart” was kept outside the room.

May 2012: Ablation Procedure with Dr. Andrea Natale

After that episode, my cardiologist advised me to have an ablation with Dr. Andrea Natale. I had already made an appointment in March 2012 for a consultation. Dr. Natale said I would be a good candidate for an ablation. I was put on Coumadin two months before my May 2012 ablation procedure and stopped taking it 5 months after my ablation. I now take Aspirin 81 mg daily.

On May 18, 2012, Dr. Natale successfully ablated my pulmonary veins. He did not need to do the left atrial appendage.

Participant in Clinical Trial for Contact Force Sensing Catheter

I was also taking part in a random experiment with a Contact Force sensing catheter. This probe helps the electrophysiologist determine the amount of pressure applied on the heart muscle as he uses the radio-frequency heat catheter.

It wasn’t until a year later, that I found out the Contact Force sensing catheter was used on me.

To read more about the Contact Force Sensing Catheter, see my AF Symposium report: The New Era of Catheter Ablation Technology: Force Sensing Catheters.

Three Years After the Successful Ablation

I have been episode-free for over 3 years—knock on wood. I hope I am cured but I do not dare say as I do not want to tempt fate.

I had GERD at the time Dr. Natale performed the ablation. After the ablation, GERD caused chest pain. When I was discharged from the hospital and came home, I started making my own yogurt and, after eating it for two weeks, I felt much better. It is also excellent for the gut.

The only symptom that keeps persisting is waking up once or twice at night with an urge to urinate. I suspect that the “Atrial Natriuretic Peptic Hormone” or “Atrial Natriuretic Hormone” (ANH for short) is still active in the muscle of my heart, since an ablation does not remove the hormone. I discussed this with my urologist recently, and she said it is quite possible because my urine output is quite large for nighttime (I had measured my urine output for a period of time).

If you have A-Fib, do something about it. Do not wait until it takes control of your life. It will not go away!

My Parting Thoughts was a great source of information, and my husband and I are grateful to Dr. Ryan for keeping it up-do-date.  We thank him also for being available when we needed him.

If you have A-Fib, do something about it. Do not wait until it takes control of your life. It will not go away!

If you have questions, please contact Steve Ryan, and he will get in touch with me.

Lisa S.
Arizona, USA

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If you find any errors on this page, email us. Y Last updated: Sunday, March 5, 2017

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