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Catheter Ablation

2020 AF Symposium: 5 Abstracts on Pulsed Field Ablation

The 2020 AF Symposium abstracts are one-page descriptions of A-Fib research, both published or unpublished. The abstracts are supplemental to the Symposium live presentations, panels discussions and spotlight sessions. This year the printed digest contained 55 abstracts. I choose only a few to summarize.

My Summaries of Select PFA Abstracts

Pulsed Field Ablation (PFA) was the single most important topic at this year’s Symposium. I summarized five of the PFA abstracts of most interest to A-Fib patients.

Lesion Durability and Safety Outcomes of Pulsed Field Ablation
The durability of PFA lesions is the focus of Dr. Vivek Reddy’s abstract. His research study followed 113 patients who each received a PFA ablation.

Pulsed Field Ablation with CTI Lesions Terminates Flutter in a Small Study
The use of Pulsed Field Ablation (PFA) may significantly improve CTI ablation lesions to block the Flutter signal. (CTI: Cavo-Tricuspid Isthmus)

Durability of Pulsed Field Ablation Isolation Over Time: Preliminary Study
Pulsed Field Ablation (PFA) is a new treatment. This study asked the question of whether PFA electrical isolation (lesions) regresses over time.

Pulsed Field Ablation vs RF Ablation: A Study in Swine 
PFA is “tissue-specific”. This study tested if surrounding non-heart tissue (the esophagus) would be affected. PFA ablation was compared to RF ablation. Swine (pigs) were used so tissue could be dissected and examined.

Using MRI to Check Pulsed Field Ablations (PFA)
Normally, during a RF or cryo ablation, doctors move the esophagus as far away as possible from where they are ablating. In this study they took no such precautions.

My Summary Reports

For more from the 2020 AF Symposium, go to My Summary Reports Written for A-Fib Patients. Remember, all my reports are written in plain language for A-Fib patients and their families.

2020 AF Symposium Abstract: Pulsed Field Ablation Follow-Up Study

2020 AF Symposium Abstract

Pulsed Field Ablation Follow-Up Study

Dr. Vivek Reddy, Mt Siani Hospital

Dr Vivek Reddy, Mt Sinai Hospital

Background: At the 2020 AF Symposium, Dr. Vivek Reddy demonstrated an ablation using Pulsed Field Ablation (PFA). Radically improving ablation treatment, PFA is:
• Tissue selective; affects heart tissue only and not other structures or organs.
• Very fast and precise; long-lasting lesions can be delivered in seconds.
• No direct contact needed only proximity, i.e., millimeters from the targeted tissue.
• Safer than current ablation energy sources, primarily because of its tissue selectivity.
• Offers two catheter shapes designed to fit into various areas of the heart.

But Does Pulsed Field Ablation Endure Long-Term?

The durability of PFA lesions is the focus of Dr. Vivek Reddy’s abstract, Lesion Durability and Safety Outcomes of Pulsed Field Ablation. His research study followed 113 patients who each received a PFA ablation.

Study Description: Patients were enrolled in 3 multi-center clinical trials which used a biphasic PFA waveform with a basket/flower catheter configuration.

Dwell time’ is the time transpiring from introduction of the ablation catheter into the body to the catheter’s removal.

Five EPs were chosen to do the PFA ablations. The 88 most recent patients were ablated. They were not under general anesthesia. PFA procedures required around 33 minutes of Left Atrium (LA) dwell time.

Follow-up Testing and Results: At 75-90 days, patients were invasively re-mapped.

Then, after 1 year, the Pulmonary Vein (PV) lesions were re-assessed and safety re-examined.

All PVs remained isolated. The primary safety event rate was 1.8% (1 pericardial tamponade, 1 groin hematoma).

The esophagus was carefully evaluated. There was no evidence of thermal esophageal lesions.

Cerebral MRI revealed no post-procedure swelling (ischemia). There was no PV stenosis. There were no latent safety issues. Invasive re-map procedures showed that lesion durability of the Pulmonary Veins reached 98%.

Study Conclusion

The researchers concluded that Pulsed Field Ablation (PFA) demonstrated:

• An excellent safety profile, no unexpected safety issues over a full year of follow-up.
• A very high rate of long-term Pulmonary Vein isolation (durable lesions).

So Does Pulsed Field Ablation Endure Long-Term? Yes!

Editor’s Comments

A year’s follow-up demonstrated that Pulsed Field Ablation (PFA) is a significant improvement over current ablation treatments. And these extraordinary results were obtained by 5 operators, which means that PFA is not dependent of the skill of a particular electrophysiologist.
I predict that Pulsed Field Ablation (PFA) will supersede all current ablation strategies. It’s almost too good to be true.

Unfortunately, it will probably take 3-5 years for PFA to be available for most A-Fib patients.

Reference for this report
Reddy, V. et al. Lesion Durability and Safety Outcomes of Pulsed Field Ablation in > 100 Paroxysmal Atrial Fibrillation Patients. AF Symposium 2020 brochure, Abstract AFS2020-19, p. 44. Ichan School of Medicine at Mount Sinai.

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2020 AF Symposium Abstract: Using MRI to Check Pulsed Field Ablations (PFA)

2020 AF Symposium Abstract

Using MRI to Check Pulsed Field Ablations (PFA)

by Steve S. Ryan

Background: Pulsed Field Ablation (PFA) is a new treatment for Atrial Fibrillation with some unique features. First, the ablations are tissue-specific, only affecting heart tissue and not the surrounding organs. Second, instead of direct contact to make lesions, as with RF ablation, all that’s necessary is proximity to the targeted tissue to make the ablation.

Pierre Jaïs, MD, The Bordeaux Group

In a remarkable statement that would strike terror in the heart of most Electrophysiologists (EPs), the French Bordeaux group stated about Pulsed Field Ablations:

Measures to alter lesion placement based on proximity of the esophagus and phrenic nerve were not taken.”

Normally, during a RF or cryo ablation, doctors move the esophagus as far away as possible from where they are ablating. In this study they took no such precautions.

Pulsed Field Ablation (PFA) study

Farapulse catheter – Five Petal Flower configuration

At this year’s AF Symposium, the French Bordeaux group presented an abstract of their study using Pulsed Field Ablation (PFA) with MRI.

Study Technique: With the Pulsed Field Ablation (PFA) waveform generator, they used a 5-spline 12F catheter to isolate the Pulmonary Veins (PVs). Then, they used MRI to check the PFA lesions to assess any extra-cardiac damage.

Study Results

NO DAMAGE TO THE ESOPHAGUS

Position of Esophagus behind the heart

In 17 patients, the esophagus was located directly behind and adjacent to PFA lesions at a distance of 0.5 to 2 mm. Post PFA ablation and using MRI imaging, they found no esophageal lesions.

They also found no discontinuities (gaps) in any isolated PV.

(With other energy ablation sources such as RF, the esophagus would be scarred, have ulcer-like damage, and fistula.)

NO PHRENIC NERVE DAMAGE

Phrenic nerve near heart

When they ablated the right PVs, they knew that they were right next to or close to the phrenic nerve.

Upon examination, PFA lesions were found in the area of the phrenic nerve but no damage was seen (despite the fact that there was consistent phrenic nerve capture during PFA delivery).

LESS THAN 60 SECONDS PER PATIENT

And even more remarkably, the total energy delivery time per patient was less than 60 seconds. This is much less time than with other types of ablation.

Editor’s Comments:
I expect Pulsed Field Ablation (PFA) will revolutionize catheter ablation for A-Fib. This is incredibly good news for patients and will make the EP’s job much easier requiring less time in the EP lab.

Better for Patients

Atrial-Esophageal Fistula No Longer a Threat: These are remarkable results! When using Pulsed Field Ablation (PFA), EPs don’t have to worry about damaging the esophagus, even though the PFA catheter may be very close to the esophagus. The dreaded complication Atrial-Esophageal Fistula will become a thing of the past! The same holds for Phrenic Nerve damage.
PFA is Tissue Selective: Instead of direct tissue contact as with RF ablation, all that’s necessary with PFA is to position the catheter in proximity to the targeted tissue. Because PFA is tissue selective, it’s easier and faster to make lesions without gaps.

Better for EPs

PFA Allows More A-Fib Patients to be Treated: Because PFA takes so little time, patients won’t have to wait for months to schedule an ablation. EPs will be better able to handle today’s epidemic of A-Fib cases. (One wonders how many PFA ablations a skilled EP will be able to do during a day?)
Better for Health of EPs: PFA may add years to an EP’s career and health. EPs no longer will have to wear those heavy lead shields for long periods of time to prevent fluoroscopy radiation damage.

But Not Ready Yet

It will probably take 3-5 years for PFA to be available for most A-Fib patients.

Reference for this report
Jais, P. et al. Lesion Visualization of Pulsed Field Ablation by MRI in an Expanded Series of PAF Patients. IHU Liryc, University de Bordeaux. AF Symposium 2020 brochure, Abstract AFS2020-37, p. 62.

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2020 AF Symposium Abstract: PFA+CTI Lesions Terminates Flutter in a Small Study

2020 AF Symposium Abstract

Pulsed Field Ablation With CTI Lesions Terminates Flutter in a Small Study

Illustration of right atrium, cavotricuspid isthmus (CTI) and tricuspid valve annulus.

Definition: Cavotricuspid isthmus (CTI) is part of the right atrium located between the inferior vena cava (IVC) ostium and the tricuspid valve.

Typical Atrial Flutter comes from the right atrium and is usually terminated by what is called a Cavo-Tricuspid Isthmus (CTI) lesion ablation line which blocks the Flutter. But for a CTI lesion to work, the Electrophysiologist (EP) using RF has to make small continuous lesions which require intense concentration to be gap free.

Even though a CTI lesion is one of the safest ablation procedures, there are some risks. Damage can be to the right coronary artery or to the AV Node and His bundle signal pathways.

PFA Makes Flutter Ablation Easier and More Effective

Ante Anic, MD, U. Hospital Center, Croatia

An abstract distributed at the 2020 AF Symposium by Dr. Ante Anic showed how the use of Pulsed Field Ablation (PFA) may significantly improve CTI ablation lesions.

Pulsed Field Ablation is fast, contact forgiving, and only affects cardiac muscle cells (cardiomyocyte).

In a small PFA study (3 patients), a continuous, non-conducting line of CTI lesions was made with a deployable 4-spline, multi-electrode basket-shaped tip catheter.

Study Results: Right atrium Typical Flutter was successfully blocked with bidirectional block (BDB) confirmed. Moreover, these CTI lesions required little time to make (3, 4, & 6 minutes).

Unlike with standard radio-frequency (RF), the Pulsed Field Ablation catheter required few ablation sites (4, 3, and 6 respectively). In effect, making a CTI ablation line with PFA was much easier and required much less precision and concentration.

After a 15 minute waiting period, bidirectional block (BDB) was confirmed in all three patients to make sure there were no Flutter signals. They also used adenosine in one patient to try to stimulate that patient back into Flutter with no success.

Overall, they found that the PFA lesions were persistent and completely blocked the Flutter.

Editor’s Comments:
Pulsed Field Ablation (PFA) has different catheter shapes which enable the operator (EP) to easily work in all areas of the heart.

PFA catheter shapes: (L) Basket catheter (R) Flower Petal catheter.

In this limited study, a Cavo-Tricuspid Isthmus (CTI) lesion was used to eliminate typical Atrial Flutter. The electrophysiologist (EP) used a basket configuration to make linear, focal lesions. PFA seems well suited to any heart configuration an EP may encounter.
Furthermore, EPs don’t have to worry about precisely positioning the PFA catheter for direct contact. Proximity is all that’s needed. PFA is fast and tissue specific. It won’t damage surrounding nerves and organs.
Though a small study, this abstract from Croatia opens up new frontiers for the use of PFA.

I see Pulsed Field Ablation (PFA) as a radically superior treatment for right atrium typical Flutter.

Reference for this article
Antic, A. et al. Acute Experience with Pulsed Field Ablation for Typical Flutter. University Hospital Center Split, Croatia. AF Symposium 2020 brochure, AFS 2020-26, p. 51.

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2020 AF Symposium Abstract: Durability of Pulsed Field Ablation Isolation Over Time: Preliminary Study

2020 AF Symposium Abstract

Durability of Pulsed Field Ablation Isolation Over Time: Preliminary Study

To better understand this report you should read it in conjunction with my report of Dr. Reddy’s pre-recorded video entitled, Pulsed Field Ablation (PFA) for AF.

This abstract, distributed at the AF Symposium, details a small preliminary study by researchers at Mount Sinai Hospital in New York. They investigated whether Pulsed Field Ablation (PFA) lesions last over time.

We know that Pulsed Field Ablation (PFA) makes safe and durable lesions around the Pulmonary Veins and it produces a zone of irreversible electroporation and cell death. We also know that surrounding this ablated area is a zone of reversible electroporation and cell injury that normalizes over time and turns back into normal tissue.

This study asked whether the level of electrical isolation after PFA regressed over time.

Comparing PFA Ablated Areas with Non-PFA Ablated Tissue

In this clinical trial, detailed voltage maps were created immediately after PFA and again after 3 months. They basically compared the areas of left- and right-sided PV antrum isolation with the non-ablated posterior wall area and, more importantly, with the borders between these two areas.

Results and Conclusion

After 3 months, the ablated areas remained isolated and the non-ablated areas stayed non-ablated. The distances between the borders remained the same.

The authors concluded that PFA isolation persists without regression.

Editor’s Comments:
Since Pulsed Field Ablation (PFA) is such a new treatment, the question of whether PFA electrical isolation regresses over time needed to be asked.

This small preliminary study confirms what we would expect. PFA isolation makes safe and durable lesions that lasts over time.

References for this article
Kawamura, I. et al. Do Pulsed Field Ablation Lesions Regress Over Time?―A Quantitative Analysis of the PVI Level of Isolation in the Acute and Chronic Settings. Ichan School of Medicine at Mount Sinai. AF Symposium 2020 brochure, Abstract AFS2020-54, p. 78.

Graphic source: Maor, Elad et al. Pulsed electric fields for cardiac ablation and beyond: A state-of-the-art review. Heart Rhythm, Volume 16, Issue 7, 1112 – 1120.

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AF Symposium 2020: Live Case of Difficult A-Fib Ablation of Atypical Flutter

2020 AF Symposium

Live Case of Difficult A-Fib Ablation of Atypical Flutter

by Steve S. Ryan

Atypical Flutter circuits can be the most difficult to map and ablate. This live case of Atypical Flutter was a very difficult and challenging ablation. It was certainly among the toughest situations electrophysiologists (EPs) will encounter.

This live catheter ablation from Boston was presented via streaming video. We observed Atypical Flutter during this live ablation.

A-Fib Patient History

Kevin Heist MD

Kevin Heist MD

Dr. Kevin Heist from Massachusetts General Hospital described the patient as a 73-year-old man who had A-Fib and Flutter for 13 years. The antiarrhythmic drugs, dofetilide (Tikosyn) and flecainide, were unsuccessful.

In 2007 he had a successful right atrium Flutter ablation at an outside facility (not Mass. General).

In 2009, while on warfarin, he suffered a spontaneous subdural hemorrhage (bleeding between the brain and the skull) while at work. Fortunately, he lived through it.

In 2013 he had his Left Atrial Appendage closed off by a Lariat device, though they found he still had a small stump of the LAA (which is common after lariat closure).

In 2018 he had a catheter ablation for persistent A-Fib. His Pulmonary Veins (PVs) and his posterior left atrial wall were ablated which terminated his A-Fib, but left him in Mitral Annular Flutter. They ablated extensively particularly in the Coronary Sinus. Finally, they were able to convert him from Flutter to normal sinus rhythm (NSR) by making a Mitral Isthmus ablation line.

2018 Mapping Data was Re-Processed and Updated

The Carto-3 mapping system from Biosense Webster with Smart Touch catheter

Dr. Heist showed the patient’s 2018 mapping. Then he used the new Biosense Webster Carto-3 mapping system with a Smart Touch SF catheter. It can accommodate more points than the traditional system, “it creates a best fit for arrhythmia mechanism.”

He showed the 2018 vectors around the Mitral Annulus which were re-processed through the current Carto mapping system. This electroanatomical system created vectors which showed both directionality and the speed of travel.

Targeted Ablation of Scarring and Reconnection

When Dr. Heist and his team started their initial voltage and activation mapping, they found that a portion of the left vein and the posterior left atrial wall had reconnected, and there was activation of the atypical flutter around the mitral annulus.

They found a portion of the left vein and the posterior left atrial wall had reconnected
In addition, they found passive activation of the left pulmonary vein from that flutter as it traveled across the mitral isthmus line into the left veins posteriorly. They directed their ablation to that point.

With voltage mapping they found quite a bit of scar in the rightward of the posterior wall and quite a bit of scar in the Mitral Isthmus region, but a small channel for activation of the pulmonary vein.

Dr. Heist said: “These advanced mapping systems give you a pretty clear ideas of breakthrough areas. So, we targeted our ablation to isolate the left vein and the posterior wall.” This Flutter seemed to be traveling around the Mitral Annulus and through the Coronary Sinus.

“These advanced mapping systems give you a pretty clear ideas of breakthrough areas.” – Dr. Kevin Heist 

At this point in the procedure, Dr. Heist described his plan to continue to move on to more ablation and if necessary, to Coronary Sinus ablation as was done in 2018 to achieve Mitral Isthmus block.

“We have moved to higher energy and shorter duration lesions and are using 50 Watts for 10-15 seconds commonly to perform typical pulmonary vein isolation. But here we may need deeper lesions than for the rest of the left atrium. We will use 40 Watts with a force of 10 or 15 grams. We’ve been using the lesion index and trying to reach lesion indexes in the range of 500.” (The ablation index is a marker or measure of ablation quality that incorporates power, contact force, and time in a weighted formula.)

Why No Use of Pacing?

Dr. Heist didn’t want to use pacing (entrainment) because he didn’t want to prematurely terminate the Flutter signal. Around this time, they saw some esophageal warming and had to limit their ablations.

Atrial Flutter Termination!

We watched as they actually terminated the Atypical Flutter!

Success! The patient’s atypical Atrial Flutter was terminated.

Nonetheless, Dr. Heist said they would continue the ablation in the Coronary Sinus and the Mitral Isthmus line. They might also ablate circumferentially around the Coronary Sinus to make sure there are no potentials present.

As the ablation team continued to ablate in the Coronary Sinus, they answered questions from the Symposium attendees. They then had to end the live case presentation because of time constraints.

Editor’s Comments:
This ablation procedure for Atypical Flutter has got to be one of the most difficult ablation cases I’ve ever seen performed live! Dr. Heist did everything possible to check for hidden or latent arrhythmia signal sources (a characteristic of a “master” EP).
In an email to the me after the AF Symposium, Dr. Heist shared:

• At the end of the procedure, all pulmonary veins and the left atrial posterior wall were isolated.

• The mitral isthmus through which the atypical flutter had passed was completely blocked (and remained blocked when the IV drug adenosine was given).

• No arrhythmia (flutter or fibrillation) could be induced by aggressive rapid pacing. That’s the best possible result for a patient! 

One can’t help but admire Dr. Heist’s and his colleagues’ tenacity in searching for and ablating this patient’s elusive atypical Flutter.

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FAQs A-Fib Effectiveness of Successful Catheter Ablation

 FAQs A-Fib Ablations: Effectiveness 

Catheter Ablation

Catheter Ablation

“How effective is a successful catheter ablation for A-Fib? What should I expect?”

Catheter Ablation Restores Your Life!: There are few medical procedures more transformative than going from A-Fib to Normal Sinus Rhythm (NSR)! Ask any former symptomatic A-Fib patient who is now A-Fib free. It’s like your life has been restored. Few medical advances have been so rapidly and widely adapted as catheter ablation for A-Fib.

Improved Quality of Life: There is an immeasurable improvement in your quality of life. You feel better both physically and mentally. You can exercise normally again. Your general overall health and mental functioning improve, you function better physically, you feel more vital, you can handle physical and mental health stress better. Your blood pressure improves.

You no longer live in fear of the next A-Fib attack. Your Ejection Fraction improves (the ability of your heart to pump blood to your brain and the rest of your body). Your brain works better, you think more clearly, you can handle work and study challenges better. Your A-Fib “brain fog” goes away. You no longer live in fear of developing A-Fib dementia.

Better Than Drugs: You improve much more than people on antiarrhythmic drug therapy. You feel better than a life on A-Fib drugs. “Using quality of life as the primary endpoint of a trial for the first time, we demonstrated that pulmonary vein isolation (PVI) is significantly more effective than antiarrhythmic drug therapy,” according to authors of the CAPTAF clinical trial.

Improved Quantity of Life: Not only is the quality of your life improved, but the quantity as well. You can expect to live longer as well as have a more healthy and fulfilling life. Your long-term risks of death, stroke and dementia are reduced and become similar to people who’ve never had A-Fib.

In one study (CASTLE AF), death rate was reduced by an amazing 47%. Staying in sinus rhythm means you have a 60% reduced rate of cardiovascular mortality (risk of death from stroke and other cardiovascular events).

If you want to live longer (and more fully), have a catheter ablation.

Return to FAQ Catheter Ablations
Last updated: Wednesday, April 8, 2020

2020 AF Symposium: Pulsed Field Ablation—A Game Changer for A-Fib

This year’s AF Symposium was abuzz about an emerging technology, Pulsed Field Ablation (PFA). It could change everything in the field of catheter ablation for Atrial Fibrillation.

Pulsed Field Ablation and how it works was presented by Dr. Vivek Reddy of Mount Sinai Medical Center, NY, NY. He also narrated a video showing an actual Pulsed Field Ablation procedure.

What is Pulsed Field Ablation? Pulsed Field Ablation (PFA) from Farapulse, Inc. is a non-thermal energy system that uses a series of ultra-short electrical pulses to ablate heart tissue. This series of pulses, or the “waveform”, makes a long-lasting lesion in a manner of seconds compared with hours for radiofrequency.

More importantly, PFA works on the selected cell types while leaving others alone (like the esophagus).

Proximity Not Actual Contact: Unlike standard ablation energy sources such as RF (heat) and Cryo (freezing), the PFA catheter does not require actual physical contact but only needs proximity to the tissue to be ablated. And it doesn’t cause scarring or char formation. …click for full report on PFA.

Update: My Post-Abaltion 2-Month Checkup

It’s been almost two months since my catheter ablation August 1, 2019 at St. John’s Hospital in Santa Monica, CA. And I’m feeling fine.

Just had a check-up with my EP, Dr. Shephal Doshi, on Wednesday. I haven’t had an A-Fib episode for a month.

My ECG looks perfect (see below). Notice how good the P-wave looks which often disappears when you have A-Fib. (Want to learn how read an ECG? See my article, Understanding the EKG Signal.)

Steve Ryan, A-Fib.com. ECG on Sept 25, 2019 by Dr Doshi. Verdict: all is normal!

My ECG on Sept 25, 2019 by Dr Doshi. Verdict: all is normal!

My Reveal LINQ Loop Heart rate Monitor Report

When you look at the report from my Reveal LINQ inplanted monitor, you can see I have had some tachycardia (marked in blue). But I think that may have come from the intense 100 meters sprints I do at the track. (Tachycardia is anything over 100 beats/minute.) Not to worry. Tachycardias do sometimes occur after an ablation. But one’s heartbeat usually returns to normal, as did mine.

Steve Ryan, A-Fib.com: My implanted LINQ heart monitor report 9-25-19. Note: Tachy and Pause.

My implanted LINQ heart monitor report 9-25-19. Note: Tachy and Pause.

As I reported before, during my first month post-op, I had one three-second pause at 2:00 am which isn’t of concern to me (marked in red).

Though my EP suggests putting in a pacemaker, I’d rather wait till after my blanking period is over. And even then, I’m against having a pacemaker unless I’m dizzy and feeling faint. Who wants to be burdened with a pacemaker for the rest of one’s life if it isn’t really necessary?

The Best News of All

And perhaps my best news is I don’t have to take my anticoagulant (Xarelto) any more. Yea!

Now it’s just one month to go in my 3-month post-ablation blanking/healing period. If it’s smooth sailing this next month, I’ll report again then.

For all my reports about the return of my Atrial Fibrillation after 21 years, see the following posts:

Sept 2018: Has My A-Fib Returned? I Get an Insertable Wireless Monitor
Oct 2018: Part 2: My Medtronic Reveal LINQ loop recorder21-Day results
Nov 2018: Part 3: PVCs/PACs but No A-Fib; False positives from my LINQ Monitor
July 2019: My 20-year Warranty Ran Out! My A-Fib is Back!
Aug 2, 2019: My Catheter Ablation was a Success—I was Home the Same Day
Aug 5, 2019: My A-Fib RF Catheter Ablations: 1998 vs 2019

A-Fib Pause: To Pace or Not to Pace…That is the Question

I’ve posted about my A-Fib retuning last Fall and subsequently having a Medtronic Reveal LINQ Insertable Cardiac Monitor (ICM)—one of the world’s smallest cardiac monitors—inserted just under the skin near my heart. Each night my Reveal Linq wireless monitor transmits that day’s data by wireless connection to my EP, Dr. Shephal Doshi.

Surprise—I Didn’t Feel a Thing

One morning in the week following my successful RF catheter ablation, at 6:27 am unbeknownst to me, my Linq recorder captured this episode—a seven-second pause:

The ECG signal strip is a graphic tracing of the electrical activity of your heart.

The next morning Dr. Doshi was on the phone telling me to come into the office immediately. He showed me the printout, and I was amazed.

In this second graphic, called a scatter plot, you can clearly see the dots representing the pause (outlined by a red box). The differences between consecutive R-wave intervals reveal patterns in the rhythm.

Scatter plots use horizontal and vertical axes to plot data points. Here the differences between consecutive R-wave intervals are plotted in order to reveal patterns in the rhythm.

Wow, 7-seconds—that’s a huge pause! It’s no wonder Dr. Doshi and his office called me the next day. He wanted to install a pacemaker right away and scheduled it for a week later. He also told me not to drive a car.

Remember: Your Best Patient Advocate is You

Unlike when I had A-Fib back in 1997, this time I wasn’t feeling any dizziness during the day.

At A-Fib.com, we always encourage you to be your own best patient advocate (which can include your spouse or partner. too.) And to not blindly follow your doctor’s advice. Always educate yourself. So I read up on pacemakers.

What is a Pacemaker?

In this instance, pacemakers are used to treat a slow heartbeat in people with A-Fib. It’s a small device that monitors your heartbeat and sends out a signal to stimulate your heart if it’s beating too slowly. The device is made up of a small box called a generator. It holds a battery and tiny computer.

Source: Pacemaker illustration from solarstorms.org

Source: Pacemaker illustration from solarstorms.org

Very thin wires called leads connect the pacemaker to your heart. Impulses flow through the leads to keep the organ in rhythm. There are also “leadless” pacemakers which are entirely installed inside your heart.

Installing a Pacemaker: The doctor programs and customizes the pacemaker for each patient to help keep their heart in rhythm. The surgery to put in the device is safe, but there are some risks, such as bleeding or bruising in the area where your doctor places the pacemaker, infection, damaged blood vessel or collapsed lung. You may need another surgery to fix it.

Life with a Pacemaker: Sometimes the impulses from a pacemaker cause discomfort. You may be dizzy, or feel a throbbing in your neck.

Once you have one put in, you might have to keep your distance from objects that give off a strong magnetic field, because they could affect the electrical signals from your pacemaker like metal detectors, cell phones and MP3 players and some medical machines, such as an MRI

In general, it is a permanent installation—you’ll have it for the rest of your life.

VIDEO: Traditional and Leadless Pacemakers Explained. Peter Santucci, MD, is a cardiologist with Loyola University Medical Center; he describes the traditional pacemaker and it’s installation using graphic animations.Then compares with the miniaturized leadless version. 2:30 min. Posted by Loyola Medical. Go to video.

Considering a Pacemaker: Pros and Cons

Patti and I discussed the pros and cons of a pacemaker.  In this instance, my heart was beating too slowly. But that’s normal for me. Because of years of running and exercise, my resting heart rate is in the high 50s, which is very low compared to others with A-Fib.

The three-month “blanking” period following my ablation is when my heart is healing and learning to once again beat in normal sinus rhythm. That’s why it’s common for A-Fib to recur during this time.

Illustration showing placement of the Medtronic Mica leadless pacemaker

Illustration showing placement of the Medtronic Mica leadless pacemaker

It doesn’t mean your ablation was a failure—think of it like planting a fruit tree. The tree might not produce fruit right way, but give it time to acclimate, absorb the nutrients in the soil, to grow stronger and bask in the sun. So I’m giving my heart some time, too.

Hitting the Pause Button on a Pacemaker for Now

In the meantime, I haven’t had another pause and have remained A-Fib free. I am hoping that this 7-second pause was a one-time thing and that my heart will stay in normal sinus rhythm in the months to come.

Dr. Doshi wants to install a “leadless” pacemaker which would be entirely installed inside my heart. Having that installed is a big step for me, one that I’ll have to live with for the rest of my life.

So, I decided to wait on having it installed. I’ll reconsider a pacemaker after my 3-month blanking period is behind me.

I’ll keep you posted on the status of my A-Fib post-ablation.

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