Re: Segmental vs other ablations

[Guest guest]

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