1/ Decided to take a 3-day break from #covidtwitter just as our paper was released 🤦🏻♂️. So now is my attempt to ‘clear the air’. We continue to share our data ablating at 50W, now with contact force. @TheRealWinkle noticed some trends with PWI and btw systems (Biosense and Abbott)
2/ But as you’ve all astutely said (@paulzei) this is non-randomized, both w/ patients & operators. 3 of 6 ablators routinely perform PWI (@hardwinmd, @PatrawalaRob, and myself), but each w/ differing methods re w/in-box lesions ie size of box, mapping entrance, pace&ablate, etc.
3/ All 3 of us have changed our PWI methods the past 3 yrs b/c of Roger’s initial observations incl more pace/ablate strategies despite initial entrance block or even ‘sleeve capture’-exit block b/c of observations of anisotropic isolation (current paper only thru 12/2017 cases)
4/ There shouln’t be an argument on IF the PW should be isolated based on cut&sew CM-III: doi.org/10.1016/j.atho…
I’ve been lucky to watch the amazing Dr. Luis Castro (@lcmd005) perform this, & as he implies while he cuts, you can’t get more transmural (or durable) than that! 😂
I’ve been lucky to watch the amazing Dr. Luis Castro (@lcmd005) perform this, & as he implies while he cuts, you can’t get more transmural (or durable) than that! 😂
5/ ...and we’ve see many pts for ablation after either C&S vs RF/hybrid Maze. C&S cases just do not have AF anymore nor any PW activity. Here’s our data from that series:
doi.org/10.1007/s10840…
doi.org/10.1007/s10840…
6/ So the real issue is HOW to achieve durable transmural PWI (as @MiguelVldrbno mentioned) which may not be possible in every case, even at 50W. Any attempts at less power will prove much harder w/ worse collateral damage...
doi.org/10.1016/j.hrth…
doi.org/10.1016/j.hrth…
7/ ...or a worse nightmare, leaving more behind that we can’t see 😱:
doi.org/10.1016/j.jace…
(Is Dr. Benedict Glover no longer on Twitter?)
doi.org/10.1016/j.jace…
(Is Dr. Benedict Glover no longer on Twitter?)
8/ So there’s much more to be discovered with PWI needing RCTs as @Dr_Nazarian_EP and @Ed_Gerst alluded too. STAR AF3 (@atulverma_md) will definitely shed some light. Hopefully @EPWoodsShop’s RCT (NCT03295422) that we are participating in will show the same or more using 50W.
9/ ...or perhaps #electroporation and/or #SBRT will soon make this whole discussion moot 😳
doi.org/10.1016/j.hrth…
doi.org/10.1016/j.hrth…
10/ To comment on the observation regarding the @BiosenseWebster vs @AbbottCardio data, which @TheRealWinkle did state: we did not have Surpoint at all for these patients (vs LSI), & we who use both systems do feel like it has kept us more ‘honest’ per lesion & may be the diff
11/ I hope that gives some perspective on our paper. Always eternally grateful 🙏🏼 to Roger (@TheRealWinkle) for tirelessly collecting and mining our data. Thanks for bearing with my non-COVID post and my first thread 😬
#EPeeps
#SiliconValleyCardiology
#EPeeps
#SiliconValleyCardiology
