Paroxysmal Atrial Fibrillation - PFA to the rescue?

Posted by endgame @endgame, Nov 9, 2022

Hello,
I'm a 57 years old male with Paxoxymal AFIB in the last 4 years.
Other than AFIB, I'm pretty healthy. and active.
I'm on Flecanaid and things are pretty much under control (Using Pill in the Pocket of extra Flecanaid when needed – a few times a year).

It was recommended to me several times to have an ablation sooner rather than later, since it is likely that at some point the drugs won't work and the chances of success of the ablation will be lower if I postpone the procedure too much.

I've read quite a lot about the new and promising ablation technology called PFA (Pulse field Ablation) and was thinking about waiting with the ablation and giving PFA some time to mature.

My cardiologist heartily recommended that I go ahead with a regular Cryo ablation since it is not known if PFA turns out to be as good as everyone hopes and might take years before becoming the new Gold Candidate.

Any advise and prior experience will be highly appreciated.

Interested in more discussions like this? Go to the Heart Rhythm Conditions Support Group.

Read the Book, "The AFIB Cure" by John Day MD, and Jared Bunch, MD both noted electrophysiologists which addresses the questions you raise in a comprehensive and detailed way. Good luck whatever you choose to do.

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End — Also suggest you read as much as you can about the state of ablations… many inflated claims of "success"… it's a money-maker so there's tons of marketing out there.

On the other end, there've been many failures… requiring multiple repeat ablations… each with serious potential complications… check out the consent forms all patients have to sign-off on before these procedures are undertaken.

All the best!

/LarryG

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Thank you both for weighing in. Much appreciated.

The main focus of my question here is not about the pros and cons of ablations in general (of which I've already done a thorough research) but rather on the novel PFA procedure which might be a game changer in terms of success rate and safety.

How mature is PFA.
Is it already commercially available or is it only used in experiments ?
Assuming that nothing alarming is found, how long will it take for it to become the primary ablation tactic for PAF? Are we talking about months? A year? Several years?

Thanks again…

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According to the genetic test I have high risk of AFid I’m trying to just concentrate on POTS and the team to help me 🙏🏻❤️‍🩹

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Firstly, it's a progressive disorder. Almost every ablation, regardless of initial success (AF-free for one year), will eventually be deemed a failure. It's just the nature of the disorder. It returns, and you have to rinse and repeat.

Modern RF and cryo ablations are very safe and have the same efficacy. Of course there are occasional glitches, but it's the same for any procedure. The newer PFA promises to offer less collateral damage, but I think it means picking fly poo out of the pepper. By that comment I mean that things can change nastily and quickly with heart conditions. The earlier you get an ablation, particularly with paroxysmal AF, the better your chances of 'success'. If you can stand to wait until someone offers you PFA, then go ahead. But every month is a tick…tick….

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I have never heard of PFA. In reading about it just now, it sounds like my esophagus might have been spared “receiving some heat” during my ablation (my electrocardiologist’s description) and resultant “heartburn.”

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I had the Radio Frequency Ablation 3 years ago. I was diagnosed at 65 years old by cardiologist who noted my family history. Subsequently I found a very experienced EP and did very well with procedure. Prior to having I found a site called StopAfib.org that is very active in reporting current studies, latest procedures, etc on a patient centered format. This year at their convention one of the featured presentations was on the New Pulse Field Ablation. You can find information in their library at their website. My personal results are not what I had hoped for (1 and you are done). The heart grows new tissue areas that need to be ablated and it becomes necessary to start drugs to control. Then a decision is required for a 2nd procedure.
I’m now wearing a loop recorder which transmits my heart activity to my EP who will have a better picture of what’s going on. I suspect a 2nd Ablation will be necessary and I will opt to have it mainly because of the unpleasant side effects most drugs have. Hope my thoughts on this helps everyone.

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72 YO here, just had cryo-balloon ablation 2 weeks ago. Hoping my EP will let me go “pill in the pocket” soon, also due to the side effects. Also hoping to go 3 or more years before repeat. Maybe I can arrange for colonoscopy & ablation together 😂

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