Will a tee echocardiogram before an ablation help your success rate
My wife has an ablation coming up in October. She has had a loop recorder in for a year and is undergoing a "tee" in September. They go down her throat and take a picture of her heart to evaluate the structure and effectiveness of an ablation as well as the fit for a watchman. Has anybody heard if the transesophageal echocardiography (TEE) raise the chances of the ablation being successful the first time? It is being done at Mayo.
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I know of a TEE being done for ablations, but in my (limited) experience it happens concurrent with the procedure. As the ablation is being done, each burn, the tip of the RF wand is placed against tissue and held there for a few seconds...depending on the energy being applied and how deeply the EP wants to destroy tissue below the endothelium. This is where the danger lies: the phrenic nerve and the esophagus both pass close to the area being cauterized, and nobody, but nobody, wants to damage those items. So, the TEE, placed down the esophagus, and with its ultrasound tip held at the same height as the left atrium, they monitor the placement of the RF tip to ensure it isn't going to burn those two.
I have never heard of a TEE administered prior to an ablation, but it's conceivable that the EP wants a pre-established situation of your heart, how much it is rotated compared to others, the separation of the pulmonary veins perhaps...just wild guessing. Maybe exactly where your nerve and esophagus are in relation to the areas about to be lesioned.......? The point is, if the EP wants it, it must be because she/he wants to ensure both your safety and his/her success....no repeats, please! The imaging provided is going to be important, and I would not be able to argue against it.
Thank you @gloaming. My wife is allergic to the contrast for an mri so they are using the TEE to look at the structure of the heart for the pulse field ablation and the insert of the watchman.
Before my ablation they did a CT scan to locate the esophagus and other critical organs around the left atria. They did use some contrast medium for the imaging.
So, to answer your real question, does it possibly improve the success of an ablation. Any information gleaned prior to the operation would be useful. I had contrast treadmill stress tests with CT scan, an MRI, an angiogram, numerous x-rays...and they all showed that ischemia (short blood supply and oxygen) was NOT my problem (it was sleep apnea...severe.) According the the EP on the YouTube channel 'AFib Education Center,' the single great determinant of success is the skill and process of the person performing the operation, followed by the complexity of the case....how advanced the AF is, how many walls of the vessel of interest are affected by the rogue signaling foci of cells. The more walls affected, causing more and more arrhythmia, the better and more experienced the EP is that you should hire. I think one can safely assume that the very best in any field use more and more information to guide them on their application.