Ablation for AFib--Popponi Style?

[Guest guest]

Has anyone heard of the Popponi (sp?) style of ablation for PVI for

Afib? Might that be the Italian procedure (just guessing from the

name)? How successful is this style? Any info would be appreciated.

Thanks!

rowjo29

[Guest guest]

> I don't know if the circumferential lot have finally settled on one

> particular approach but the number of ablation circles can vary.

> You can have one circle around all 4 veins. 2 circles, each

encircling

> 2 veins, or each vein can be encircled separately. Often some

linear

> ablations are also added - either joining the circles

> or to another part of the heart, like down to the mitral valve.

> I think the jury is still out as to which one to go for

*********

, I recently went down to s Hopkins to talk to Dr. Calkins

about the Pappone procedure. As I understand, he and Dr. Morady in

Michigan are both doing the Pappone procedure, Dr. Morady being the

foremost EP in the US who is doing it. They both burn two circles,

each encompassing two pulmonary veins and connect the two circles

with another line of burns, like a pair of eyeglasses. The procedure

is said to be up to 88% successful. Dr. Calkins gave me success rates

of 65% to 88% successful, depending on the patient.

I would be interested in knowing where you read about EPs

encircling all four veins together, or encircling each of the four

veins seperately. I took a look at the links you provided, but they

both looked somewhat old, being from 2000 and 2002.

I get a hint from time to time that other EPs in the US are doing

this procedure, but so far, not a lot of detail.

Thanks,

[Guest guest]

> I don't know if the circumferential lot have finally settled on one

> particular approach but the number of ablation circles can vary.

> You can have one circle around all 4 veins. 2 circles, each

encircling

> 2 veins, or each vein can be encircled separately. Often some

linear

> ablations are also added - either joining the circles

> or to another part of the heart, like down to the mitral valve.

> I think the jury is still out as to which one to go for

*********

, I recently went down to s Hopkins to talk to Dr. Calkins

about the Pappone procedure. As I understand, he and Dr. Morady in

Michigan are both doing the Pappone procedure, Dr. Morady being the

foremost EP in the US who is doing it. They both burn two circles,

each encompassing two pulmonary veins and connect the two circles

with another line of burns, like a pair of eyeglasses. The procedure

is said to be up to 88% successful. Dr. Calkins gave me success rates

of 65% to 88% successful, depending on the patient.

I would be interested in knowing where you read about EPs

encircling all four veins together, or encircling each of the four

veins seperately. I took a look at the links you provided, but they

both looked somewhat old, being from 2000 and 2002.

I get a hint from time to time that other EPs in the US are doing

this procedure, but so far, not a lot of detail.

Thanks,

[Guest guest]

> I don't know if the circumferential lot have finally settled on one

> particular approach but the number of ablation circles can vary.

> You can have one circle around all 4 veins. 2 circles, each

encircling

> 2 veins, or each vein can be encircled separately. Often some

linear

> ablations are also added - either joining the circles

> or to another part of the heart, like down to the mitral valve.

> I think the jury is still out as to which one to go for

*********

, I recently went down to s Hopkins to talk to Dr. Calkins

about the Pappone procedure. As I understand, he and Dr. Morady in

Michigan are both doing the Pappone procedure, Dr. Morady being the

foremost EP in the US who is doing it. They both burn two circles,

each encompassing two pulmonary veins and connect the two circles

with another line of burns, like a pair of eyeglasses. The procedure

is said to be up to 88% successful. Dr. Calkins gave me success rates

of 65% to 88% successful, depending on the patient.

I would be interested in knowing where you read about EPs

encircling all four veins together, or encircling each of the four

veins seperately. I took a look at the links you provided, but they

both looked somewhat old, being from 2000 and 2002.

I get a hint from time to time that other EPs in the US are doing

this procedure, but so far, not a lot of detail.

Thanks,

[Guest guest]

> I would be interested in knowing where you read about EPs

> encircling all four veins together, or encircling each of the four

> veins seperately. I took a look at the links you provided, but they

> both looked somewhat old, being from 2000 and 2002.

Hi , I got it from a paper copy of a review article I have

Cardiovascular Research Journal Vol 54 Issue 2 p337

Ablation therapy for atrial fibrillation (AF)

Past, present and future

the abstract is

http://www.sciencedirect.com/science?_ob=ArticleURL & _udi=B6T14-456WTS2-3 & _coverD\

ate=05%2F31%2F2002 & _alid=201988413 & _rdoc=1 & _fmt= & _orig=search & _qd=1 & _cdi=4880 & _s\

ort=d & view=c & _acct=C000050221 & _version=1 & _urlVersion=0 & _userid=10 & md5=e36051b970\

23b8cb587b8005937040bb

but you'll need to see the entire article for the diagrams. In the

article, Pappone did each of the methods of 4,2 and 1 circle and a

chap called S.Ernst also did the one circle around all four.

it's from May 2002 - but I wouldn't consider this old as far

as information disseminating to the general population of EPs

I've just done a quick web search to see if I could find anything newer and

found this...

Acute Effects of Left Atrial Radiofrequency Ablation on Atrial Fibrillation

http://www.medscape.com/viewarticle/478828_print

Posted 05/28/2004 (Dr Fred Morady is in the list of authors)

Your spectacle description does appear to be the most common pattern but there's

two

other patterns they used too. One of the problems is atrial flutter turning up

after the procedure - I think the ablation line between the left inferior

pulmonary vein and

the mitral annulus is desninged to prevent this problem???

and here's one from Feb 2004 where they encircled individual veins in the

" extensive " study group

though I'm deducing this from " bidirectional and fully circumferential isolation

of all targeted PVs " rather

than seeing a picture

http://www.blackwell-synergy.com/links/doi/10.1046/j.1540-8167.2004.03385.x/abs/\

;jsessionid=eW0pGihImq0a

and if you want a robot to do it...

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=pubmed & dopt=Abstra\

ct & list_uids=15296917

this sounds similar to Saltmans endoscopic approach

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=pubmed & dopt=Abstra\

ct & list_uids=12821436

this goes around all four (on the outside of the heart)

and may 2004 EP lab digest has a good picture of a new device which does

individual veins...

http://www.eplab.com/eplab/displayArticle.cfm?articleID=article2720

how many of these strictly come under the banner " circumferential ablation " I'm

not quite sure - I'm using

it to describe the method of completely encircling one or more veins from an

anatomical point of view.

I hope the professionals have a good way of distinguishing one technique from

another

All the best

--

D

[Guest guest]

> I would be interested in knowing where you read about EPs

> encircling all four veins together, or encircling each of the four

> veins seperately. I took a look at the links you provided, but they

> both looked somewhat old, being from 2000 and 2002.

Hi , I got it from a paper copy of a review article I have

Cardiovascular Research Journal Vol 54 Issue 2 p337

Ablation therapy for atrial fibrillation (AF)

Past, present and future

the abstract is

http://www.sciencedirect.com/science?_ob=ArticleURL & _udi=B6T14-456WTS2-3 & _coverD\

ate=05%2F31%2F2002 & _alid=201988413 & _rdoc=1 & _fmt= & _orig=search & _qd=1 & _cdi=4880 & _s\

ort=d & view=c & _acct=C000050221 & _version=1 & _urlVersion=0 & _userid=10 & md5=e36051b970\

23b8cb587b8005937040bb

but you'll need to see the entire article for the diagrams. In the

article, Pappone did each of the methods of 4,2 and 1 circle and a

chap called S.Ernst also did the one circle around all four.

it's from May 2002 - but I wouldn't consider this old as far

as information disseminating to the general population of EPs

I've just done a quick web search to see if I could find anything newer and

found this...

Acute Effects of Left Atrial Radiofrequency Ablation on Atrial Fibrillation

http://www.medscape.com/viewarticle/478828_print

Posted 05/28/2004 (Dr Fred Morady is in the list of authors)

Your spectacle description does appear to be the most common pattern but there's

two

other patterns they used too. One of the problems is atrial flutter turning up

after the procedure - I think the ablation line between the left inferior

pulmonary vein and

the mitral annulus is desninged to prevent this problem???

and here's one from Feb 2004 where they encircled individual veins in the

" extensive " study group

though I'm deducing this from " bidirectional and fully circumferential isolation

of all targeted PVs " rather

than seeing a picture

http://www.blackwell-synergy.com/links/doi/10.1046/j.1540-8167.2004.03385.x/abs/\

;jsessionid=eW0pGihImq0a

and if you want a robot to do it...

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=pubmed & dopt=Abstra\

ct & list_uids=15296917

this sounds similar to Saltmans endoscopic approach

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=pubmed & dopt=Abstra\

ct & list_uids=12821436

this goes around all four (on the outside of the heart)

and may 2004 EP lab digest has a good picture of a new device which does

individual veins...

http://www.eplab.com/eplab/displayArticle.cfm?articleID=article2720

how many of these strictly come under the banner " circumferential ablation " I'm

not quite sure - I'm using

it to describe the method of completely encircling one or more veins from an

anatomical point of view.

I hope the professionals have a good way of distinguishing one technique from

another

All the best

--

D

[Guest guest]

> I would be interested in knowing where you read about EPs

> encircling all four veins together, or encircling each of the four

> veins seperately. I took a look at the links you provided, but they

> both looked somewhat old, being from 2000 and 2002.

Hi , I got it from a paper copy of a review article I have

Cardiovascular Research Journal Vol 54 Issue 2 p337

Ablation therapy for atrial fibrillation (AF)

Past, present and future

the abstract is

http://www.sciencedirect.com/science?_ob=ArticleURL & _udi=B6T14-456WTS2-3 & _coverD\

ate=05%2F31%2F2002 & _alid=201988413 & _rdoc=1 & _fmt= & _orig=search & _qd=1 & _cdi=4880 & _s\

ort=d & view=c & _acct=C000050221 & _version=1 & _urlVersion=0 & _userid=10 & md5=e36051b970\

23b8cb587b8005937040bb

but you'll need to see the entire article for the diagrams. In the

article, Pappone did each of the methods of 4,2 and 1 circle and a

chap called S.Ernst also did the one circle around all four.

it's from May 2002 - but I wouldn't consider this old as far

as information disseminating to the general population of EPs

I've just done a quick web search to see if I could find anything newer and

found this...

Acute Effects of Left Atrial Radiofrequency Ablation on Atrial Fibrillation

http://www.medscape.com/viewarticle/478828_print

Posted 05/28/2004 (Dr Fred Morady is in the list of authors)

Your spectacle description does appear to be the most common pattern but there's

two

other patterns they used too. One of the problems is atrial flutter turning up

after the procedure - I think the ablation line between the left inferior

pulmonary vein and

the mitral annulus is desninged to prevent this problem???

and here's one from Feb 2004 where they encircled individual veins in the

" extensive " study group

though I'm deducing this from " bidirectional and fully circumferential isolation

of all targeted PVs " rather

than seeing a picture

http://www.blackwell-synergy.com/links/doi/10.1046/j.1540-8167.2004.03385.x/abs/\

;jsessionid=eW0pGihImq0a

and if you want a robot to do it...

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=pubmed & dopt=Abstra\

ct & list_uids=15296917

this sounds similar to Saltmans endoscopic approach

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=pubmed & dopt=Abstra\

ct & list_uids=12821436

this goes around all four (on the outside of the heart)

and may 2004 EP lab digest has a good picture of a new device which does

individual veins...

http://www.eplab.com/eplab/displayArticle.cfm?articleID=article2720

how many of these strictly come under the banner " circumferential ablation " I'm

not quite sure - I'm using

it to describe the method of completely encircling one or more veins from an

anatomical point of view.

I hope the professionals have a good way of distinguishing one technique from

another

All the best

--

D