Re: New member, French or Italian?

Posted August 29, 2004 · August 29, 2004

>Then there's other questions, the Italian procedure or the French

> procedure? Which one is more successful? No one knows for sure

> because there's been no direct comparison. So you see there a lot

of

> unanswered questions in the EP field right now. I'm on the verge

of

> the " go ahead " and it won't take much to put me over the edge but

it

> sure would be nice to hold off, if possible, to give myself the

best

> chance at success.

****************

, I have made the decision to have an ablation. My afib episodes

have suddenly become more frequent, though much, much milder,

strangely enough, which makes me think that I am about to go into

permanent afib.

I worry about it, because although I can function in afib, I am

not my normal self, either physically or mentally. There is a certain

dulling-down that comes along with afib, I assume from the loss of

blood flow. While I can still do everything, I simply do not feel

like doing anything I don't have to do. It's the difference of

jumping out of bed in the morning, eager to start my day in NSR, or

dreading getting up, in afib. I think this might be what clinical

depression feels like to those who suffer from it.

Anyway, there has been a direct comparison of the French and

Italian procedures recently at the U of Michigan. They randomized

something like 140 patients into two groups. After 6 months, 88% of

the patients who had had the Italian procedure were still in NSR

without drugs, versus 67% of the patients who had had the French

procedure. I hear that the U of Penn is undertaking a similar study.

I have had consults at Penn, at the Cleveland Clinic, who both

primarily do the French procedure, and with Dr. Calkins at s

Hopkins, who does the Italian procedure. I have been on the list at

Penn for a long time, because I want Dr. Marchlinski to do the

ablation. I am also on Dr. Natale's schedule for next February. Dr.

Calkins only has a two-month waiting list.

I have an appointment on Monday to talk all of this over with my

local EP. Then I guess I will decide.

, didn't you recently post about having to go to the ER during

your vacation? I know the feeling. I have taken several major trips

during my almost 3 year history with afib. I never had to go to the

ER, but afib did intrude. I want my life back, at age 54, I feel that

I am in the prime of my life, and I want to enjoy it.

Best of luck with your decision.

Posted August 29, 2004 · August 29, 2004

What's a bird's eye view of the differences between the French and

Italian procedures? Which does Dr. Natale do? Thanks.

p.s. I think you can buy plain red grape juice here, you just have

to look for it. Supposedly it has the heart protective benefits of

red wine.

Posted August 29, 2004 · August 29, 2004

> Anyway, there has been a direct comparison of the French and

> Italian procedures recently at the U of Michigan. They randomized

> something like 140 patients into two groups. After 6 months, 88% of

> the patients who had had the Italian procedure were still in NSR

> without drugs, versus 67% of the patients who had had the French

> procedure. I hear that the U of Penn is undertaking a similar study.

>

> I have had consults at Penn, at the Cleveland Clinic, who both

> primarily do the French procedure, and with Dr. Calkins at s

> Hopkins, who does the Italian procedure. I have been on the list at

> Penn for a long time, because I want Dr. Marchlinski to do the

> ablation. I am also on Dr. Natale's schedule for next February. Dr.

> Calkins only has a two-month waiting list.

>

>>

xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx

I keep remembering what my EP told me when I mentioned the U of M

study to him. He said I should remember one thing " There's a lot of

hype in the EP field right now. "

I too had consults at the CC <Natale> and also the Univ of Michigan

<Morady> and I'm not convinced that these procedures would be any

better than the variation of the French type procedure my EP does.

When I was zapped in Vegas the attending EP was a Dr. Rahul Doshi,

head of the EP department and assistant clinic professor of

medicine. He told me it was his opinion that the Italian procedure

had a better efficacy rate then the French. But it's hard for me to

believe that these other highly respected doctors wouldn't switch to

the Pappone procedure if they believed it would be better for their

patients.

At the 2003 Boston Afib Symposium, I'm sure you've been to this site:

http://www.a-fib.com/BostonA-FibSymposium2003.htm

" Dr. Jaïs described how the Bordeaux group's current Pulmonary Vein

Isolation techniques are achieving success rates of 82% in curing

patients with Paroxysmal (occasional) or Persistent A-Fib. (Success

is measured if a patient is in sinus rhythm without taking any

antiarrhythmic medications six months after a PVI.) An even higher

success rate of 91% is achieved when including patients who are in

sinus rhythm while still using antiarrhythmic drugs. "

And

" Dr. Pappone's success rate for patients monitored over a three year

period was 87%. He had approximately equal success with both

Paroxysmal (occasional) and Chronic (all the time) A-Fib. "

In time I'm sure the numbers will be in conclusively and the PVI

debate but I don't think they're there yet. I wish there was a

Internet source where we could actually see the burn patterns each of

these ablations make.

Are you sure Natale does the French procedure? This came from the

same site:

http://www.a-fib.com/NewResearch.htm#Improved%20French%20ablation%

20procedure

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 "

All of this leaves me confused and not knowing what to think or which

route to take.

P <MI>

Posted August 29, 2004 · August 29, 2004

P wrote:

<<All of this leaves me confused and not knowing what to think or which

route to take.>>

Me too.

Some tentative observations/speculations on my part. 1) Segmental is

more dependent upon the operator's ability to locate hot spots,

circumfrential is a more standardized, one-size-fits-all method. 2),

Both approaches appear to be very effective, but not perfect.

What I am even more interested in learning is the " truth " about those

unfortunates who are made worse by the procedure. When pulmonary vein

stenosis is defined something like greater than 50% narrowing, I get

worried. How many are getting 40%? Why is that not considered

significant? And which procedure has less of this stuff to contend with

or are they the same?

Then there are the general hazards, such as stroke, perforation, killing

the sinus node, gross error, etc.

- OU alum in MI

Posted August 29, 2004 · August 29, 2004