Segmental vs other ablations

[Guest guest]

Found this article:

http://circ.ahajournals.org/cgi/content/abstract/102/20/2463

From this.. " there are specific breakthroughs from the left atrium that

allow ostial PV disconnection by use of partial perimetric ablation.

" ... what I gather is that the concept of pulmonary vein isolation at

the ostium by having to do a complete circle around the vein (or veins)

is not necessary. So a " segmental " ablation is where they just do a

segment of the vein close to where the focus is, but only a partial

circumference.

i.e. if you do enough of a defensive wall in front of the goal, you

can't get the ball through

Is this interpretation right? I seem to remember Steve chatted to Dr

Jais about this at a conference, if I recall rightly?

http://circ.ahajournals.org/cgi/content/abstract/108/6/657 was

interesting, too

Best of health to all,

Vicky

" You can convert some of the people some of the time,

but you can't convert all of the people all of the time "

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[Guest guest]

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It took me a while to find it after I saw this posting last month,

but Vicky posted an October 27, 2003, message (Message 21639) which

referred to a study by the University of Michigan that found that

circumferential ablation had a higher (88%) rate of effectiveness in

curing afib than segmental ablation (67%). At least that is how I

read the abstract of the study. That is some support for use of the

circumferential method. Does anyone have any statistics on the

relative percentage of the occurrence of stenosis, comparing

circumferential to segmental ablations?

In AFIBsupport , " Steve " <a-fibfriend@c...>

wrote:

> > Segmental vs other ablations

> Is this interpretation right? I seem to remember Steve chatted

to Dr

> Jais about this at a conference, if I recall rightly?

> Dear Vicki,

> Here is that article with Dr. Jais.

> SEGMENTAL VS. CIRCUMFERENTIAL ABLATION---NASPE CONVENTION, San

Diego, CA. May 9, 2002

> In an unusual format for a medical convention, NASPE

sponsored a debate on Segmental versus Circumferential Ablation of

the Pulmonary Vein Openings to eliminate A-Fib. The participants were

Dr. Natale of the Cleveland Clinic Foundation arguing on the

side of Circumferential Ablation, and Dr. Pierre Jaïs from the

Hôpital du Haut-Lévèque, Bordeaux (Pessac), France arguing

in support

of Segmental Ablation.

> ( " Segmental Ablation " refers to a technique of Focal

Ablation in which Pulmonary Vein Potentials in the heart are

individually identified and ablated, thereby eliminating the sources

of A-Fib signals in the heart. " Circumferential Ablation, " rather

than pinpointing Pulmonary Vein Potentials in the heart, uses a

circular catheter to ablate each Pulmonary Vein Opening (Ostium) in

the heart. This procedure " isolates " the Pulmonary Vein Openings so

that A-Fib signals from the Pulmonary Vein Openings can not get into

the rest of the heart. See Focal Ablation.)

> Though the jury is still out on the merits of each of these

procedures, in this author's opinion patients with A-Fib are probably

better served by medical facilities that use Segmental rather than

Circumferential Ablation. To quote Dr. Jaïs, " Why use a cannon to

shoot an ant? " Circumferential Ablation applies RF energy to the

entire Pulmonary Vein Opening (Ostium) rather than just to individual

areas of the Pulmonary Vein Openings that have potentials. This

increases the risk of Pulmonary Vein Stenosis---a swelling and

narrowing of the Pulmonary Vein Openings which restricts blood flow

into the heart. PV Stenosis can lead to fatigue, flu-like symptoms

and pneumonia.

> An additional problem with Circumferential Ablation is that

the Pulmonary Vein Openings are not always smooth and oval. With

current techniques it is not always easy to make continuous circular

ablation lines. Because the actual focal points or sources of A-Fib

signals are not destroyed as in Segmental Ablation, any break in the

Circumferential Ablation line can lead to more A-Fib. Dr. Natale

illustrated how in some veins, in order to better achieve a

continuous circular ablation line, he inserted the circular catheter

inside a Pulmonary Vein Opening. But the further you move a circular

catheter into a Pulmonary Vein Opening and ablate, the greater is the

risk of PV Stenosis.

> Segmental Ablation takes more time and effort, but currently

seems to be better for patients than Circumferential Ablation.

> A-FibFriendSteve

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