RE: Summary of Dr. Pappone's presentation at the 2006 Boston A-Fib Symposium/question?

[Guest guest]

From all this, it follows that Dr. Pappone has done more ablations than

any other EP? Has he ever published data on his success rate? By the

same token, has there been any published data on the incidence of

esophagus fistula at his lab?

Joe Y.

Summary of Dr. Pappone's presentation at the 2006

Boston A-Fib Symposium

Dr. Carlo Pappone of San Raffaele University Hospital in Milan, Italy

discussed " The Use of Remote Magnetic Navigation in Catheter Ablation

for A-Fib. "

Dr. Pappone showed a video of a stereotaxis robotic navigation

system which uses a computer and magnetic fields to image the heart

and control the ablation catheter. The system synchronizes

fluoroscopic and CARTO mapping to create a 3-D real time image of the

heart. This system produces perfect ablation lines and uses a maximum

of only 4 grams of pressure on the heart wall. Soon the system will

be able to do automatic ablations and remote robotic ablations just

by moving a mouse. Dr. Pappone thinks this robotic navigation

technique will be the most important application for A-Fib in the

next two years.

Dr. Pappone said that he averages only 45 minutes doing a

Circumferential Pulmonary Vein Ablation (he can do seven ablations a

day). (See Pappone and the Pappone Method.) He now uses an irrigated

catheter with a 4mm tip at a maximum of 65̊ at 70 Watts.

(Author's Note: Dr. Pappone's procedure may become the ablation

procedure used by most doctors and medical centers, because it is

more cost effective, easier to learn, and is less dependent on

operator skill than other procedures. However, there are currently

some criticisms of this procedure that patients should be aware of:

---The use of high wattage catheters may lead to damage of the

esophagus [see d'Avila] and Atrial Esophageal Fistula---a hole in the

atrium and esophagus which often results in death.

---The extensive scarring of the atrium in Dr. Pappone's

procedure may possibly lead to impaired functioning of the left

atrium [see Wilber].)

Dr. Pappone also talked about a new refinement of his

Circumferential Pulmonary Vein Ablation procedure. He found that

ablating the vagal ganglia (areas of the heart where vagal reflex can

be stimulated) significantly reduces recurrence of A-Fib after 12

months.

In another study Dr. Pappone compared A-Fib patients who had a

Circumferential Pulmonary Vein Ablation procedure with patients who

received antiarrhythmic drug therapy. After a median follow-up of 900

days, survival for ablated patients was longer than among patients

treated medically, and the same as healthy persons. Ablated

patients' " Quality of Life " reached normal levels at six months and

remained unchanged after one year. This differed from patients

receiving medical therapy. " Pulmonary vein ablation improves

mortality, morbidity, and quality of life as compared with medical

therapy. "

Dr. Pappone discussed that catheter ablation is difficult to do

on A-Fib patients who have an artificial Mitral Valve, because of the

increased risk of damage to it. But he found that Circumferential

Pulmonary Vein Ablation is feasible for patients with an prosthetic

Mitral Valve, with outcomes similar to those of standard patients.

A-FibFriendSteve

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