Posted by Linden La Viano on October 26, 2002 at 16:59:33:
In Reply to: Re: Radio Frequency Ablation posted by Ed Wehan on October 22, 2002 at 21:32:33:
The following article from the Cleveland Clinic should be of some interest for people who have had radio frequency ablations in the past which failed to correct their A-fib. However, as noted in my last post about Dr. Natale, his ability to successful treat A-fib and other heart arrhythmias far exceeds most other cardiac electrophysiologists in my opinion. Radio frequency ablation was totally painless in my case and the recovery time is virtually nil.
---Linden La Viano
Percutaneous Epicardial Approach to Radiofrequency Ablation PromisingDr. Robert Schweikert stresses that any arrhythmia patient who has failed conventional radiofrequency ablation should be considered a candidate for the epicardial approach.
Cleveland Clinic Heart Center electrophysiologists are first in the nation to offer percutaneous epicardial radio-frequency ablation.Cleveland Clinic Heart Center electro-physiologists Andrea Natale, M.D., and Robert Schweikert, M.D., are applying the new approach to arrhythmias origin-ating in the epicardium if standard radio-frequency ablation methods fail.
"Percutaneous epicardial radiofrequency ablation is an effective alternative for patients who fail conventional procedures for arrhythmias arising from the epicardium," says Dr. Natale. A few years ago, he traveled to Brazil to learn the percutaneous approach to epicardial arrhythmias used at the INCOR Institute in Sao Paolo. To date, he and Dr. Schweikert have performed nearly two dozen percutaneous epicardial radiofrequency ablations, with a 95 percent success rate and a zero complication rate.
"Virtually any patient who has failed conventional radiofrequency ablation for an arrhythmia should be considered a candidate for this new approach," says Dr. Schweikert. "One possible exception would be patients who have undergone prior open heart surgery, as adhesions can make access to the pericardial space difficult."
More than 90 percent of all cardiac arrhythmias originate in the endocardium, where conventional radiofrequency catheter ablation is more than 95 per-cent successful. However, the success of conventional radiofrequency ablation is low for arrhyth-mias arising from the epicardium, says Dr. Natale.
"Radiofrequency energy cannot pene-trate more than 2 to 3 mm, and usually cannot reach the target area of these arrhythmias," he explains. Patients who fail conventional abla-tion are left with few options, adds Dr. Schweikert. Typically, they are given more aggressive antiarrhythmic drugs, which may be ineffective and have a significant risk of side effects.
"Most patients who fail conventional ablation methods resign themselves to 'partial cure' or 'partial control' of their arrhythmias, and limit their activities and lifestyle accordingly," he says. "Some, after many unsuccessful ablation attempts, undergo atrioventricular node ablation and pacemaker implantation. In certain cases, patients face cardiac surgery."
In the percutaneous epicardial approach to arrhythmias, a needle is inserted under fluoroscopic (X-ray) guidance below the sternal bone, toward the heart shadow and the pericardial space. A guidewire is then advanced into the pericardial space, and a standard vascular sheath is inserted over the guidewire. This provides access to the pericardial space for the catheter, for both mapping and ablation. Once the arrhythmia's origin is confirmed via standard electrophysiologic mapping, radiofrequency energy is delivered through a conventional ablation catheter, and ablation is carried out using low power.
Initially, Drs. Natale and Schweikert limited their use of percutaneous epicardial ablation to the treatment of ventricular tachycardias. They have now performed the new procedure on several patients with supraventricular tachycardias.
The youngest patient they have treated to date is a 16-year-old boy with ventricular tachycardia, referred from Pennsylvania. "Conventional radiofrequency ablation had been unsuccessful. The boy was advised by his local physicians to have an implantable cardioverter-defibrillator, and his activities were severely restricted," says Dr. Natale. "We were able to cure him using percutaneous epicardial ablation, and he is once again playing sports and living the life of a normal 16-year-old."
After instrumentation of the epicardial space, overlap of the endocardial and epicardial activation sequence showed the earliest retrograde atrial activation site on the epicardial surface.To refer potential candidates for any type of percutaneous radiofrequency ablation, please contact Dr. Natale at 216/444-4293 or 800/553-5056, ext. 44293, or Dr. Schweikert at 216/444-3160 or 800/553-5056, ext. 43160.
- Re: Radio Frequency Ablation Roxann Cline 17:40:04 1/04/2004 (0)