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Pulse field ablation
Has anyone had a pulse field ablation? I have three precious ablations but none have worked because the place in my heart that the cardiologist needs to ablate is too close to my esophagus. I am scheduled to have one in mid December. He said I have a 60% chance of it working. Does anyone have any experience with this? Has anyone had one? Has it worked? Any insights or downsides are appreciated.
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@aard While cryoablation is still used at times, it seems to have fallen out of favour in the EP world. It doesn't work as well as the other two methods, particularly in the obese patient (as noted in the following article):
https://pubmed.ncbi.nlm.nih.gov/40188998/
Comparing PFA and RF, the results, to date (with changes expected in favour of PFA as its use balloons and more experience is gained and applications are approved), they have the same outcomes after one full year, although fluoroscopy exposure is higher in PFA than in RF, while collateral tissue damage is less in PFA:
https://pubmed.ncbi.nlm.nih.gov/40761535/
The more I think about this, the more inclined I am to conclude that the one-year-free-of-AF criterion is a decent one. It's a good long time for the heart to recover from the ablation experience, to be in healthy NSR, perhaps for the left atrium to return to a state of reduced enlargement (it does happen quite often), and for the heart to stabilize itself with a lower heart rate, which also has to happen for many ablatees, and it can take many months.
After one full year, many ablatees have recurrent AF. Is this because the technique is not very good, or its application, or is it that the heart continues to advance its 'agenda'? I suspect it is the heart's inclination, already being disordered (which ablation doesn't fix, only blocks) to continue to deteriorate with new foci, mitral valve prolapse, or non-reversed enlargement, or AV node block that changes the morphology of the heart, etc.
Those are my thoughts on the matter.
@gloaming
I may be out of the loop on the latest, but I haven't seen any evidence of it falling out of favor in the EP world; the article regarding cryoablation in obese patients is interesting - thanks for providing the link. I know that my EP has had great success with cryoablation, ....me being one of those success stories. He is one of the preeminent cryoablation specialists in the U.S. Mostly, I'm just wondering what experiences others have had.
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