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Baltimore, MD
VIDEO: Pulsed Field Ablation for AF Using an Integrated Mapping and Ablation Spherical Array Catheter
Click on image to watch the deployment of the Spherical Array catheter (Kardium Globe); 25 sec.
From the streaming video-on-demand of Dr. Reddy’s case and presentation is available at https://player.vimeo.com/video/676797282. 28:48 min. (Published by the 2022 AF Symposium.)
2021 AF Symposium Live Case: Vein of Marshall Alcohol Ablation
2021 AF Symposium
Live Case: Vein of Marshall Alcohol Ablation
by Steve S. Ryan
Background: In difficult cases of A-Fib (persistent, long-standing persistent), catheter ablation has had limited success. Adding ablation of the Vein of Marshall using Ethanol has been proven effective. In the VENUS clinical trial, the ethanol infusion ablation patients had significantly improved “AF burden, freedom from AF after multiple procedures, and peri-mitral flutter block” versus the ablation-only patients.
Dr. Miguel Valderrabano
Live from Houston
The AF Symposium audience watched on live streaming video as Dr. Miguel Valderrabano of the Methodist DeBakey Heart Center in Houston, Texas, demonstrated an innovative treatment for A-Fib using Alcohol Ablation of the Vein of Marshall.
The Patient: A 69-year-old male had been in persistent A-Fib for 3 years, He had been cardioverted and was on amiodarone. He was mildly symptomatic. He came to Dr. Valderrabano in June 2020 in persistent A-Fib for at least 7 months.
When the Symposium audience first saw Dr. Valderrabano in Houston, he had already performed a standard Pulmonary Vein Isolation (PVI) of the PVs when the patient went into peri-mitral atrial Flutter. He also had worked on the posterior left atrium wall.
The Vein of Marshall
Location of Vein of Marshall
The Vein of Marshall is a vein connected to the Coronary Sinus near its opening (ostium).
In difficult A-Fib cases (persistent, long-term persistent), it can contain A-Fib signals (potentials, triggers) which are hard to reach and ablate. It’s located within the mitral isthmus.
Mapping and Diagnostic Catheter
In this live case, Carto mapping had revealed that this patient’s Vein of Marshall did have A-Fib signals.
Dr. Valderrabano had a sheath in the coronary sinus and a LIMA catheter engaged in the vein of Marshall ostium. (A LIMA catheter can be bent into various shapes.) He advanced a miniaturized octapolar Baylis diagnostic catheter (which specializes in reaching previously inaccessible areas of the heart) into the vein of Marshall.
Innovative Treatment: Ethanol Ablation
Dr. Valderrabano demonstrated an innovative ablation treatment called Ethanol Ablation.
Using a 2 mm balloon catheter containing ethanol, he distributed ethanol into the Vein of Marshall starting distally (at the far end of the vein). He would deflate the balloon and re-inflate it with ethanol to continue the ablation.
He stressed that the Vein of Marshall is somewhat delicate and frail.
He very gently injected the ethanol and did it in stages (distal to proximal), 1 cc over 2 minutes. He was able to achieve peri-mitral atrial flutter block by ethanol to achieve mitral Isthmus ablation. The patient’s Flutter terminated after the first ethanol injection!
He wound up doing 5 injections to cover the entire Vein of Marshall and its branches.
The ethanol basically scars (denervates) the Vein of Marshall eliminating any potentials (A-Fib signal sources or triggers).
He did this in graduated stages to make sure the ethanol didn’t affect the left atrium. He pointed out that this ablation technique done properly is safe.
Editor’s Comments
Ethanol Ablation Difficult to Perform: This is the first time I had seen an Ethanol Ablation. It’s obviously not the easiest procedure to perform.
In the VENUS trial, 30 of 185 patients weren’t able to achieve ethanol ablation, even though the operators and A-Fib centers involved were some of the best in the world.
Ethanol Ablation—Potential Breakthrough Treatment! When you consider how difficult it often is to cure more challenging cases of A-Fib (persistent and long-standing persistent), Ethanol ablation as demonstrated by Dr. Valderrabano is a major breakthrough!
EPs now have a way to ablate previously inaccessible areas of the heart!
All too often before this, some patients with persistent/long-standing persistent A-Fib could not be cured and had to resign themselves to live with A-Fib for the rest of their lives.
Now there is hope for even the most difficult A-Fib cases. We may have reached a beginning stage in A-Fib research where no one has to live permanently in A-Fib!
If you find any errors on this page, email us. Y Last updated: Tuesday, June 8, 2021
Return to 2021 AF Symposium Reports
Hospitalized COVID-19 Patients and Cardiac Scar Tissue
Much has been learned about COVID-19 in the last year. Of special interest to A-Fib patients are the possible effects on the heart.
Some studies of hospitalized COVID-19 patients report it’s common to find scars on the muscular tissue of the heart (myocardial lesions). Even those with a milder case of the virus are experiencing adverse effects on their heart health.
Currently, we don’t know if those cardiac scars could lead to future rhythm disorders. In the short-term, there seems to be no consequences.
A-Fib causes fibrosis that remodels your heart
What’s All the Fuss about Cardiac Scar Tissue (Fibrosis)?
Scar tissue is basically dead tissue with reduced or no blood flow. Over time it makes the heart stiff, less flexible and weak. This fibrotic tissue overworks the heart and reduces pumping efficiency.
Danger of Fibrosis: Any type of scarring and fibrosis in the heart may eventually affect heart function that could lead to heart failure and sudden cardiac death.
COVID-19 and A-Fib? We know that being in A-Fib can lead to scarred tissue (fibrosis) especially over time. Could COVID-19 produce the same type of scarring and contribute to your A-Fib?
You can reduce this risk by getting the COVID-19 vaccine to protect your heart.
VIDEO: Feb 2021: “How COVID-19 Affects the Heart“
Interview with Dr. Teresa Daniele, chief of cardiology at UCSF Fresno who shares with us how COVID-19 can affect people’s cardiac systems; and how the virus can cause direct inflammation of the heart, weakness and formation of muscle scar tissue. Published by MedWatch Today. Feb 22, 2021. (3:13 min.)
YouTube video playback controls: When watching this video, you have several playback options. The following controls are located in the lower right portion of the frame: Turn on closed captions, Settings (speed/quality), Watch on YouTube website, and Enlarge video to full frame. Click on arrow icon to start playback.
Video: Atrial Fibrillation-Clot Formation & Stroke Risks
In atrial fibrillation, AFib, or AF, the most common abnormality of the heart’s rhythm, the atria contract in a rapid and disorganized way. As a result, the atria do not effectively pump blood into the ventricles.
Animation showing how A-Fib clots can form and travel to the brain causing an ischemic stroke. (1:39) Uploaded to YouTube on Jan 4, 2012 by Thrombosis Adviser.
YouTube video playback controls: When watching this video, you have several playback options. The following controls are located in the lower right portion of the frame: Turn on closed captions, Settings (speed/quality), Watch on YouTube website, and Enlarge video to full frame. Click on arrow icon to select.
If you find any errors on this page, email us. Y Last updated: Monday, June 7, 2021
VIDEO: Pacemakers—Traditional and Leadless Explained
Dr.Peter Santucci, 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.
YouTube video playback controls: When watching this video, you have several playback options. The following controls are located in the lower right portion of the frame: Turn on closed captions, Settings (speed/quality), Watch on YouTube website, and Enlarge video to full frame. Click on arrow icon to select.
If you find any errors on this page, email us. Y Last updated: Friday, August 16, 2019
Our A-Fib.com Video Library and My Top 5 Picks for the Newly Diagnosed
We have screened hundreds of A-Fib-related videos over the years and have carefully selected a short list for you. Our A-Fib library of videos and animations are for the reader who learns visually through motion graphics, audio, and personal interviews. These short videos are organized loosely into three levels:
Browse our curated A-Fib Video Library
♥ Introductory/Basic Level is for the newly diagnosed patient. Fundamentals of the heart’s electrical system, stroke risk and anticoagulation therapy, ECG/EKG, and catheter/surgical treatments. Helpful for the family and friends of an A-Fib patient, too.
♥ Intermediate Level is for the more informed patient. Videos offer details of the heart’s functions, types of heart monitoring devices, specifics of catheter ablation, maze and hybrid surgeries, and closure of the Left Atrial Appendage.
♥ Advanced Level videos offer a more extensive look at cardioversion, ECGs/EKGs, ejection fraction, catheter ablations/EP lab and maze/mini-maze surgeries. (May requires basic understanding of cardiac anatomy and A-Fib physiology.)
We invite you to browse our A-Fib library of videos and animations and try out a few of our titles.
Top 5 Videos for the Newly Diagnosed Patient
The newly diagnosed A-Fib patient has lots of questions. What is A-Fib? How do I deal with my symptoms? What are my treatment options? How does it impact my family? For answers, start with these videos.
1. Introduction to How a Normal Heart Pumps Blood
A short video about the path of a red blood cell through the heart’s four chambers to deliver oxygen to the body and then return to be re-oxygenated. Animation with narration. (Don’t worry about remembering the terminology, just follow the flow of the red blood cell). By The Children’s Hospital of Philadelphia. (1:00 min.) Go to video.
2. Stroke Prevention in A-Fib and Anticoagulant Therapy
Through interviews and animations explains how atrial fibrillation can cause stroke and why anticoagulation is so important; Discussion of: warfarin (Coumadin), the required monitoring, interactions with food, alcohol and other drugs: newer anticoagulants (NOACs) that do not require regular testing, aren’t affected by foods [but are expensive]. On-camera interviews with AF Association CEO, Trudie Lobban MBE and other experts (5:36) Developed in association with the drug maker, Boehringer Ingelheim. Go to video.
3. The EKG Signal and Conduction System of the Heart
The EKG signal
Excellent illustration of the heart and a fully labeled graphic of the ‘Conduction System of the Heart’. Descriptive text accompanies each step in the animation. First a normally beating heart, the electrical signal path and corresponding EKG tracing. Then the same heart in Atrial Fibrillation with EKG tracing of the heart in A-Fib. Go to video on the American Heart Association website.
4. About Magnesium Deficiency with Dr. Carolyn Dean
Most A-Fib patients are deficient in Magnesium. “The Best Way to Supplement Magnesium” with Dr. Carolyn Dean, the author of The Magnesium Miracle. Getting nutrients through food is not always possible; discusses side effects of too much and how you can tell if you have a deficiency. (3:39). Go to video. See also: “Importance of Balancing Calcium & Magnesium“ (1:00)
5. When Drug Therapy Fails: Why Patients Consider Catheter Ablation
Dr. Susan M. Sharma discusses why patients with atrial fibrillation turn to ablation when drug therapy doesn’t work. Presenting research findings by David J. Wilber MD; Carlo Pappone, MD, Dr. Sharma discusses the success rates of drug therapy versus catheter ablation. Transcript of the narration is provided. (3:00 min.) From Insidermedicine.com. Go to video.
Disclaimer: Videos provided for your convenience only; we make no endorsement of a specific treatment, physician or medical facility.
For more videos,
visit our A-Fib.com Video Library
Steve Ryan Videos
We’ve edited Steve’s most interesting radio and TV interviews to create several short (3-5 min.) videos. Check out Videos Featuring Steve S. Ryan, PhD, publisher of A-Fib.com.
VIDEO: Compares Apple Watch 4 EKG to Hospital 12-Lead EKG
Image from C/NET video
C/NET.com has posted a very informative short video featuring Dr. Gregory Marcus at the UCSF Medical Center who compares a 1-lead ECG from the Apple Watch Series 4 to the results of a traditional hospital 12-lead electrocardiogram (ECG/EKG).
Hooked up to a traditional electrocardiogram monitor, C/NET Senior Editor Vanessa Hand Orellana uses an Apple Watch 4 app to take her 30 second ECG reading.
Compare ECGs: See comparisons of Vanessa’s readings from her 12-lead electrocardiogram (ECG) monitor and her Apple Watch ECG.
EKG monitor from C/NET video
Learn the technology of how the Apple Watch captures the heart beat.
Dr. Marcus talks about appropriate uses of the Apple Watch ECG and the role of the electrocardiogram. (Note: Other wearable devices also let you take an ECG outside the doctor’s office.)
Go to video: Animations with location footage and on-camera interview. 4:26 min video. See the video–> Apple Watch EKG tested against a hospital EKG
C/NET VIDEO: Compares Apple Watch EKG to Hospital 12-Lead EKG
Dr. Gregory Marcus at the UCSF Medical Center compares a 1-lead ECG from the Apple Watch Series 4 (equipped with the right app) to the results of a traditional hospital 12-lead electrocardiogram (ECG/EKG) monitor.
Hooked up to a traditional electrocardiogram monitor, C/NET Senior Editor Vanessa Hand Orellana uses an Apple Watch 4 app to take a 30 second ECG reading. See comparisons of readings from the two devices. Learn how the Apple Watch 4 captures the heart beat.
Live footage, animation and interviews. Posted Dec. 6, 2018 by C/NET. 4:26 min. Transcript available.
Click on arrow to start video. Hover over video frame for player controls.You can pause playback, turn on closed captions or adjust audio volume.
If you find any errors on this page, email us. Y Last updated: Wednesday, December 12, 2018
NEW VIDEO: What Should I Expect After my A-Fib Catheter Ablation Procedure?
What to expect post-ablation
We have posted a new video that features Cardiac Electrophysiologist Dr. Darryl Wells.
He talks about judging the success of your ablation, why it’s difficult to predict which patients will be completely cured after one ablation procedure and why some require two procedures.
He discusses safety of the procedure and the appropriate age range for patients to receive the ablation procedure. (3:17)
Published by Swedish Heart and Vascular Institute. Go to video->
NEW VIDEO: The Hybrid Maze/Ablation for Persistent A-Fib
We’ve posted a new video about the Hybrid Maze/Ablation.
For persistent or long-standing persistent atrial fibrillation, it combines the complementary efforts of both the cardiothoracic surgeon and the cardiac electrophysiologist.
The surgeon works on the outside the heart and the EP on the inside of the heart to eliminate the Atrial Fibrillation signals.
In this video, two cardiac EPs and a cardiothoracic surgeon describe the advantages, safety and effectiveness of the Hybrid approach and who is a good candidate. Includes animation and on-camera interviews. Length 4:30. Go to video->
