Ablation growing into 'tailor-made' approach for AF.

Ablation growing into 'tailor-made' approach for AF

By MARK McCARTY

CDU Washington Editor

The concept of "one size fits all" is falling more out of favor every day in modern medicine, and a presentation at the 87th annual meeting of the American Association of Thoracic Surgeons (Beverly, Massachusetts) underlined that concept in the cardiac ablation sector.

Fred Morady, MD, a professor of cardiovascular disease at the University of Michigan Health Systems (UMHS; Ann Arbor) titled his discussion "Catheter Ablation for Atrial Fibrillation: Does One Size Fit All Our Patients?" Morady said that the answer "is obviously no," at least not for paroxysmal atrial fibrillation (PAF), which teremd "clearly a different arrhythmia" from chronic AF. Morady's discussion was on circumferential ablation, an approach that eliminates the need for the long and winding percutaneous approach and gets around the need to stop the heart, a requirement of the Maze procedure.

However, Morady also does not rely on a standardized set of lesions to do the job, but induces AF, ablating only after seeing where the heart's electrical system is malfunctioning. The idea is to ablate only the areas that need ablating and no more.

"There are multiple mechanisms that contribute to AF," Morady said, including nerve tissue located in the pulmonary veins and various other musculatures in the area of the atria. He said that AF can be very mechanism-specific, describing the case of a 60-year-old man who demonstrated no rapid pulmonary vein (PV) activity, but had right atrium fibrillation, nonetheless.

"So instead of doing a left-side procedure, all we did was circle" the source of the AF at the right atrium and ablate the external surface of the heart with a Lasso catheter, made by Biosense Webster (Diamond Bar, California).

However, Morady said that circumferential ablation had limits when applied …