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Is Pulse Field Ablation a Better Choice Than Cardioversion

Posted by bens1 @bens1, Oct 24 6:30am

My wife has AFIB (not sure of the type). They started her on metoprolol, colchicine and prednisone but the electrophysiologist is thinking of doing an electrical cardioversion. Is that better that the pulse field ablation as a next step?

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gloaming | @gloaming | Oct 31 11:49am
In reply to @fucci "I’m a little dismayed that the people on this group appear to assume that ablation is..." + (show)
@fucci

I’m a little dismayed that the people on this group appear to assume that ablation is a cure for Afib. It does reduce the occurrence of Afib IN SOME people. So does cardioversion.

I have had 4 ablations.. the 4 th left me with pulmonary hypertension…, Each ablation left me with a new atrial flutter.
I’ve only had one cardioversion and that left me without Afib for about 10 months. The only time I was Afib free for more than a week in the last 20 years.

Cardioversion does no damage to the heart( the current thinking).
Ablation cause scar tissue to achieve the desired effect, but the new techniques only damage the one spot and doesn’t effect surrounding tissue (the current thinking).

However, I have had paroxysmal Afib for 20 years. So, many times I wound up in sinus rhythm before the scheduled cardioversion.

There are some people who go to the emergency room whenever they go into Afib and get a cardioversion.

That being said, the conversation should be had with your EP and a cardiologist, to ensure you get the procedure that is specific to your particular case.
When I first started with Afib, no one could tell me what caused it…. The current knowledge at the time was due to thyroid problems. They are learning more each day.., including learning your triggers.

And learning different types of Afib.
Good Luck with you issues and please speak with your Ep.

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I have been participating in this group for some time, and can see no reference to ablation being a 'cure' for AF. In fact, I take pains to correct such misapprehensions if/where I see them on any forum in which I participate across the www.

Cardioversions don't damage the heart, but they're not great at stemming the tide of AF. In my own case, having had four spread across two years: the first didn't stop my AF, and to add insult to injury, I came to just as the tech depressed the button for the third of the three allowable zaps. Was NOT fun!! The second, about 15 months later, I stayed in NSR for a grand total of 16 hours. Third, four hours. Fourth, 20 minutes....back into AF right after the cardioversion.

A visit to a good EP (and this is key) had me in NSR for six days. Seven months later, same gentleman tried again, and I'm happily in NSR 19 months later. Ablations CAN work permanently for a few people, maybe 2 or 3/10. The rest of us will almost certainly develop a new re-entrant and AF will come back. Another ablation may work, it may not...depends on the type of progression and on the EP doing the work....again, depending on who does the job! It is key to find a really experienced, busy, highly sought, EP who knows he/she can probably fix you. BTW, AF returning also depends on you and what you put your body through. Stress, too much high intensity exercise, bad diet, too much alcohol, six cups of coffee each day, other drugs, financial woes, house fire, illness, or almost any other comorbidity (diabetes, COPD, disease-induced comorbidities, etc) can cause the heart to go back into arrhythmia.

As for 'the new technique', that's what we've been discussing. Pulsed Field Ablation (PFA) and it is supposed to be better for not damaging nearby tissue, unlike RF. And that is why a TEE is needed for the RF technique. However, PFA is currently only approved for a simple pulmonary vein isolation (PVI) because that's all it's designed to do currently. It is not designed to isolate the left atrial appendage, for example (LAA), nor can it treat the Vein of Marshall. It can't be used to make lesions on the coronary sinus, nor can it be used on the septum.

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fucci | @fucci | Oct 31 1:15pm

Whew! Sorry I commented. You have sufficiently chastised me…. Feel better? I am now resigning from this site.

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