[HSF] AF - LCPV

[prasannasimha]

Adequacy of the lesion is when blanching occurs. I have done HPE and 
seen transmural lesions (In fact  one person from Italy on the list had 
concerns regarding the extent of destruction as he did a few HPE studies 
but that is what we want !!) and we should be able to maintain the spark 
gap arc as it runs across - too slow /fast and it will stop. It is easy 
to do and is not as difficult as one thinks.
The lesions are always to be done biatrial if you want conversions in 
the 90 + % range. I have done  study showing lesser mazes have a lower 
conversion rate and presented it a few years back in the Asian meet at 
Bombay (Mumbai). I strongly believe in always having biatrial lesions.
Prasanna
Nasser F. Abou'Seada wrote:
> Very interesting Prasanna ..... your photos are very illustrating .... 
> that
> is a great point of consideration. I am using spray cauterization for the
> mouths of the pulmonary veins.... I know of some colleagues doing that as
> well .... but for sure your experience is far ahead of ours .....
> I have some queries ...
> - how can you be sure that the lesion is "enough" ?
> - what is your "end point" in applying the spray cauterization ?
> -  .... how do you recognize it ... the "end point" I mean ?
> - what about the trans-murality issue ?
> - Do you do the same thing for the Right Common Pulmonary Vein?
>
> NFA
>
>
> On 6/4/07, prasannasimha <prasannasimha at gmail.com> wrote:
>>
>> Same wattage (40 Spray) but the mouth of the pulmonary veins should not
>> be mistaken for just the burn - more importantly the common ostial
>> origin needs to be burnt.
>> The picture labeled dual orifice represents two separate orifices.
>> The picture labeled common pulmonary vein orifice shows a common
>> pulmonary vein orifice stretched open (There are actually two orifices
>> within it and the sucker has gone into one)whereas it looks like common
>> pulmonaryvein2 when unstretched.Burning within this just the individual
>> ostia would leave a left atrial trigger within the common pulmonary vein
>> area.
>> Prasanna
>> Nasser F. Abou'Seada wrote:
>> > Dear Prasanna, would you please elaborate more on how you do tackle 
>> this
>> > point of ablating the left common pulmonary vein - the common
>> > orifice- utilizing your technique of spray diathermy? .... what
>> > energy settings do you use here at this site, compared to other 
>> sites ?
>> >
>> > NFA
>> >
>> > On 6/3/07, prasannasimha <prasannasimha at gmail.com> wrote:
>> >>
>> >> The left superior pulmonary vein is one of the most common sites of
>> Afib
>> >> triggers and this is the one which is most important to ablate.
>> >> Unfortunately many do not pay attention to it and then complain of
>> >> reduced rates of conversion of Afib.The other variation to pay 
>> special
>> >> attention is the left common pulmonary vein- the common orifice 
>> should
>> >> be ablated as there are triggers between the common ostium and the
>> >> individual ostia and is another important consideration.
>> >>
>> >> Prasanna
>> >> Hgrmd at aol.com wrote:
>> >> > John,
>> >> >   I've used Cryocath for the last 4-5 years.  I've got a poster  in
>> >> the
>> >> > upcoming Society of Heart Valve Disease in 10 days in which my
>> >> results
>> >> were
>> >> > outlined. You can go to their website and get the  abstract.  The
>> >> bottom
>> >> line is
>> >> > that 95% of the patients were in AV synchrony  at their last
>> >> followup.  That is
>> >> > quite comparable to a "cut and sew"  maze.  One of the main
>> advantages
>> >> it has
>> >> > over Atricure is that the left  pulmonary vein lesions are done
>> >> endocardially.
>> >> > Dissecting the left  pulmonary veins on a redo so that you can 
>> get an
>> >> > Atricure clamp around them is  no picnic.
>> >> > Hal
>> >> >
>> >> >
>> >> >
>> >> > ************************************** See what's free at
>> >> http://www.aol.com.
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