[HSF] A. Fib.

[hgrmd at aol.com]

Dear Erdinc,

  Go to the website for the Society of Heart Valve Disease.  You'll find an abstract of my poster that I presented at the last meeting.  It will give you an idea.  I think the number of the poster is 162.  

  I totally agree with you discomfort in using Atricure to make the mitral isthmus line.  The reps tell you it's OK to fire across the coronary sinus and the mitral annulus.  My major concern is inadvertent injury to the circumflex.  What they recommend is to see how far the circumflex goes down the groove, and to then mark that area with methylene blue.  Through the inferior limb of the left atriotomy you should then see the mark and know where it is "safe" to fire the device.  The problem with that logic is, what do you do in a left dominant system?  When I was using Atricure for my mazes, I used to do the mitral isthmus line with a Cooper Medical Frigitronics cryoprobe.  Though it was slow (nitrous, instead of Argon gas.  The temp is only -60, instead of -160 as seen with a Cryoprobe), it had the advantage of not being disposable.  That way, I only opened one disposable device per case.



Hal


-----Original Message-----
From: erdinç naseri <enaseri at hotmail.com.tr>
To: openheart-l at lists.hsforum.com
Sent: Sun, 8 Jul 2007 11:24 am
Subject: RE: [HSF] A. Fib.





al,
an we have your paper if it is not accepted for publication.
reviously I used monopolar electrocautery for the treatment of AF in mitral 
ases( much different patient group than lone AF) then  a company provided us by 
tricure (bipolar RF ) but I am not comfortable with the line attaching the 
ulmonary vein window to the mid PML. It needs a stab incision in the left 
trial wall which although very simple makes me nervous because I can't see the 
ther blade behind the LA.Any comments?
rdinc> From: Hgrmd at aol.com> Date: Sat, 7 Jul 2007 13:18:06 -0400> Subject: Re: 
HSF] A. Fib.> To: OpenHeart-L at lists.hsforum.com> CC: > > Ajit,> Excellent 
oints. Nobody wants to have their chest split to get their AF > cured. The key 
s being able to offer a full set of lesions via a minimally > invasive 
pproach. I can do that. I just submitted an abstract to the STS > that outlines 
y methods and results in 107 patients. Knowing the politics of > AF, I'll be 
urprised if it is accepted. What I mean by that is the current > big names in 
F are on the payroll of certain device companies. It's an > uphill battle to 
et power sources from companies who don't play the game > published, even 
hough they may be the most effective in my opinion. If I'm being > oblique and 
urky, I hope you can read between the lines (I'm becoming a > little more 
iplomatic in my old age.).> Your point about the "success" rate after a 
urgical maze is quite apt. > Cox's original papers showing a 95% success rate 
ere based on telephone > interviews of the patients in which they asked the 
atient if they still had > palpitations and an irregular heartbeat. It is well 
nown that patients often > lose the ability to perceive AF, presumably due to 
enervation. > My personal success rate is gauged on spot ECG's, 24 hr Holters, 
r pacer > checks. Only the last method is truly reliable in assessing the AF 
urden. > Because of my interest in this field, I'm now striving getting 24hr 
olters > every 6 months for life. As you know, a small, but steady erosion in 
esults > occurs with time.> > Hal> > > > ************************************** 
ee what's free at http://www.aol.com.> _______________________________________________> 
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