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O. R. report

CryoBalloon Ablation: Alarming O.R. Reports (Part I)

A two-part series by Steve S. Ryan, PhD

Often when A-Fib patients contact me, I’ll advise getting a copy of their O.R. (Operating Room) report so I can read exactly what was done during their ablation. The details in an O. R. report can be quite revealing and usually reassure me that their EP did a good job.

An O.R. report of a catheter ablation is a blow-by-blow account of your EP’s actions.

But sometimes the report is disappointing. I just read two O.R. reports of CryoBalloon ablations that left me alarmed and disturbed.

O.R. Report #1: Ablation Without Identifying the Source of A-Fib Signals

The first CryoBalloon ablation was performed at one of the most prestigious A-Fib centers in New York City.

At the beginning of the ablation, it appears the Electrophysiologist (EP) made no attempt to first map the source of the patient’s A-Fib signals (mapping at the beginning or before hand is standard procedure at most A-Fib centers).

During the ablation the EP did not check for non-PV triggers or even attempt to identify the source of her A-Fib signals or potentials. The EP merely ablated the pulmonary veins (PVs), but did check for entrance and exit block.

At the beginning of the CryoBalloon ablation, the EP made no attempt to first map the source of the patient’s A-Fib signals.

At the end of the CryoBalloon ablation, he did not verify all A-Fib signals had been terminated by trying to trigger A-Fib with pacing or drugs like isoproterenol. (Triggering A-Fib means a new round of A-Fib isolation.) Once again, this verifying step is standard protocol for most ablations at most centers.

Result: the CryoBalloon ablation appeared to successfully isolate the patient’s PVs, and luckily she seems to be doing well.

My Observations

What’s alarming is what the EP didn’t do! This CryoBalloon ablation was less than the standard.

The very minimum steps were taken: isolate the Pulmonary Veins and little more. There was no effort to check for non-PV sources of A-Fib signals. No verification that all A-Fib sources were terminated. In fact, this patient may still have spots producing A-Fib signals.

Why go through an ablation if the EP didn’t do a thorough job? If the patient’s A-Fib returns, a second ablation may be required.

Now you know why I was disturbed by this O. R. report. Now, let’s look at the second report.

O.R Report #2: Non-PV Triggers Still Causing A-Fib

I read another O.R. report of a CryoBalloon Ablation on a patient who was in persistent A-Fib for two months before the ablation.

After isolating the PVs, the patient remained in A-Fib.

After isolating the PVs, the patient remained in A-Fib…the EP simply electrocardioverted the patient back into normal sinus rhythm.

Instead of looking for and ablating the source of these non-PV triggers, the EP simply electrocardioverted the patient back into normal sinus rhythm. (That’s certainly faster and easier than looking for non-PV triggers.)

Result: The patient was back in A-Fib within a month.

MY OBSERVATIONS

According to the patient, when the patient and his family first met with the CryoBalloon ablationist, they asked the right questions:

“What will you do if I still have A-Fib after the ablation?”

The EP said he would not stop until all the A-Fib spots were found and ablated.

In reality, instead of doing that, he just electrocardioverted the patient back into normal sinus rhythm without looking for and ablating the patient’s still-firing non-PV triggers.

It’s no wonder the patient was back in A-Fib shortly after this ablation.

Again, I was alarmed and troubled by what I read.

Take Away: O. R. Reports

An O.R. report is a blow-by-blow account of your EP’s actions. Indeed, the details in an O. R. report can be quite revealing. In these two cases, alarmingly so.

Read our free report.

Read our free report.

If you’ve had an ablation that was less than successful, you want to know why! Your O.R. report would show what they found in your heart, what was done, and possibly why the ablation didn’t fulfill expectations.

Read more about O. R. reports in our Special Report How & Why to Read Your Operating Room Report

NEXT TIME, IN PART II: Is Performing CryoBalloon Ablations too Easy?

FREE Report: How & Why to Read An Operating Room Report

Special 12-page report by Steve S. Ryan, PhD

New FREE 12-page report by Steve S. Ryan

In our new FREE 12-page Report, How & Why to Read Your Operating Room Report, we examine the actual O.R. report of the catheter ablation of Travis Van Slooten, publisher of Living With Atrial Fibrillation performed by Dr. Andrea Natale, Austin, TX.

What is an O.R. Report?

An O.R. report is written by the electrophysiologist who performed the catheter ablation. It contains a detailed account of the findings, the procedure used, the preoperative and postoperative diagnoses, etc.

It’s a very technical document. Because of this, it’s usually given to a patient only when they ask for it.

New Report: How & Why to Read Your Operating Room Report

In our new FREE 12-page Report: How & Why to Read Your Operating Room Report, I make it easy (well, let’s say ‘easier’) to learn how to read an O.R. report.

Along with an introduction, I’ve annotated every technical phrase or concept so you will understand each entry. I then translate what each comment means and summarize Travis’ report.

Read more at: Special Report How & Why to Read Your Operating Room Report

Tip: If you’ve had an ablation, ask for your O.R. Report. If you or a loved one is planning a catheter ablation, make a note to yourself to ask for the O.R. report.

Free Report: How & Why to Read An Operating Room Report

Special 12-page report by Steve S. Ryan, PhD

FREE 12-page Report by Steve S. Ryan, PhD

In our free Special Report, How and Why to Read Your OR Report – Special Report by Steve S. Ryan PhD – A-Fib.com, we examine the actual O.R. report of the catheter ablation of Travis Van Slooten, publisher of Living With Atrial Fibrillation performed by Dr. Andrea Natale, Austin, TX.

What is an O.R. Report?

An O.R. report is a document written by the electrophysiologist who performed the catheter ablation. It contains a detailed account of the findings, the procedure used, the preoperative and postoperative diagnoses, etc.

It’s a very technical document. Because of this, it’s usually given to a patient only when they ask for it. You need to call your doctor or his office to obtain it.

Why to Request and Read Your O.R. Report

The O.R. report is a historical record of how you became A-Fib free.
The O.R. report is a blow-by-blow account of your EP’s actions. It’s as close as you’ll get to understanding your own ablation without actually looking over the EP’s shoulder during the ablation. The O.R. report is a historical record of how you became A-Fib free. (File with your A-Fib medical records for future reference.)

If you’ve had an ablation that was less than successful, you want to know why! Your O.R. report would show what they found in your heart, what was done, and possibly why the ablation didn’t fulfill expectations.

Studying an O.R. report can be very revealing…you may decide to change EPs going forward!

Reading an O.R. report can be very revealing. Were there complications? Was your fibrosis more extensive than expected? Was there a problem with the EP’s ablation techniques? Or with the EP lab equipment? This information will help you and your healthcare team decide how next to proceed.

Also, depending on what you read in your O.R. report, you may decide to change EPs going forward!

O.R. Report with closeup

Close-up of O.R. Report with markups

FREE Report: How & Why to Read Your Operating Room Report

In our FREE Special Report: How and Why to Read Your OR Report – Special Report by Steve S. Ryan PhD – A-Fib.com, I make it easy (well, let’s say ‘easier’) to learn how to read an O.R. report.

Along with an introduction, I’ve annotated every technical phrase or concept (in purple text) so you will understand each entry. I then translate what each comment means and summarize Travis’ report.

Get your PDF copy TODAY. Download How and Why to Read Your OR Report – Special Report by Steve S. Ryan PhD – A-Fib.com our FREE 12-page Special Report (Remember: Save to PDF  to your hard drive.)

Tip: If you’ve had an ablation, ask for your O.R. Report. If you or a loved one is planning a catheter ablation, make a note to yourself to ask for the O.R. report.

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If you find any errors on this page, email us. Y Last updated: Monday, July 18, 2016

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