to Arthur

[paaljala]

Hi Arther , thanks for your reply to my queries . I think i have your symptoms in a similar way . Do you know how many foci were ablated in 2001 ? How did you pick the EP ? Is there no linc with Mg and A F if you are adrenergic AF ? my email is ' ***@**** ' , sincerely Paul

[arthur]

Yes.  The technique used in 2001 relied on a set of burn points that the EP would try to locate around a focus to isolate it.  As you can imagine, that's a tough way to isolate something you cannot see directly.  These days the most popular technique appears to be a collar or loop catheter which is designed to burn a circle up closer into the atrium to insure isloation of a PV focus regardless of where it is exactly.  This procedure would have probably been more successful in 2001.  The upside is a faster procedure, less trauma, less edema.  The downside is an added risk of perforating the atrial wall and esophagus...which has most EPs using a cold finger device inserted into the esophagus to prevent this from happening.  The esophagus runs along the backside of the thin atrial wall, and, in the past was not a great concern because the burns were further away in the PV ostia...now that the PV isolation procedure aims at isolating the whole PV ostia, it's something to worry about.  My EP told me that in the 100's of procedures he conducted, the perforation did occur once (but I don't know if the cold finger was being used at that time).

The occassional "rare" irregular beats under stress occur for everyone, and a bit more frequently with folks who have more foci...so, yes, I get little runs lasting a few seconds, and usually under stress.  

-Arthur

[paaljala]

hi Arther , is there an ablation technique that is available now-a-days that would have achieved a greater success than they used in 2001? Does your heart still have rare irregular heart beats under stress? sincerely Paul...p.s. i live in Sydney Australia and may be delayed in repliing

[arthur]

I believe one focus, responsible for about 90% of the AF triggered on the table (they put me in AF about 10 times) was ablated...leaving at least one other behind (in 2001). All the foci were in the PV ostia.  I picked the EP after going to several cardios, with one eventually suggesting an EP who specialized in such ablations.  The only link to Mg is that muscles need Mg to contract properly...so, some folks who have a very low Mg level may have issues that lead to arrhythmias...but I really don't think it's a common problem.  Of course, I have tried Mg just to rule it out, and found no perceptible effect (on PAC production).  The only major effect on PACs that I can definitely say is valid, is your level of anxiety.  It turns out that a heightened nervous system (like during an axious moment, or after eating too much, or when running) will allow focal signalling to reach farther than it normally does, precipitating PACs and other skips.  When I finally calmed down, (it took more than a year), PACs which used to show up 1-6/min basically show up very rarely now.  Hope this helps.  -Arthur