New Ablation Method Reported

[Bruce Schwartz]

I came across a study in the October '04 Polish Heart Journal that to date, I've not heard anyone speak of. It involves the use of micrcoils, (which I gather is polyvinyl alcohol foam) as opposed to liquid alcohol for ablation of septal hypertrophy. Granted, the study is very small and follow-up is over a short time period. However, the method seems grounded in common sense. Such an approach would avoid the flow of alcohol to unwanted areas and therefore may reduce if not eliminate complications that could lead to the need for permanent pacing as well as several other very dangerous outcomes often associated with alcohol/ethanol ablation leakage. While gradient reductions do not appear equal to those achieved via myectomy they are nonetheless worthwhile.

I'd be interested in any feedback or knowledge that anyone has on what looks be, if nothing else, an extraordinarily creative idea. Link follows:


http://www.kardiologiapolska.pl/arch...pg=350&lang=en

[Laoshur]

I have actually had this exact procedure done, but to an entirely different portion of my anatomy - my uterus. It is a relatively common procedure now, although it was a bit unusual in the US at the time I had it done several years ago.

I was very interested in the statement about "moderate pain." I can scarcely imagine that the patients considered it moderate. It is common with UAE's (uterine artery embolization) for patients to be readmitted to the hospital because of intractable pain. I read this AFTER I had it done and after going through the process with nothing stronger than Tylenol. I was literally screaming with pain in the recovery room. I should mention here that I went through childbirth naturally without any pain meds of any kinds and never got close to screaming. I have also had a number of minor to intermediate level surgeries and never cried out once.

The doctor had decided that morphine was too dangerous for me and I am severely allergic (throat swells shut) to all codeine derivitives and anything similar. I went home with something, cannot recall what, and broke out in hives and itchy throat after the first dose. So I went through this basically without pain meds. I can tell you that I cannot imagine what it would be like to experience this in the heart!

Basically what happens with these coils is that the muscle dies slowly over several days from lack of oxygen. This is the reason for the pain. Think of what would happen if you placed a tight band around your finger and just watched it die from lack of O2 and you will get the picture of what the pain is like. So, if an alcohol ablation is a heart attack, imagine a heart attack that goes on for thee days!

So does this mean that I think this procedure is a bad idea? No. I have often wondered why no one does it this way. Am I a glutton for punishment? No, not that either. I just think that anyone undergoing this procedure must understand that it is not a piece of cake and must discuss pain control with the doctor in advance. My ob-gyn warned me that the doctor I was using had no bedside manner and was sometimes unkind to patients, so she encouraged me to go to a different doctor. But he had only done one or two of these procedures and the person I saw had done something like ten. But I did not comprehend how important the doctor's attitude would be in this kind of situation.

Hope this sheds a little light on why maybe more doctors are not trying this.

Rhoda

[Lisa Salberg]

I have known about this for a while and frankly I hoped it would NOT continue. I will comment further in a newsletter article.

Lisa

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Well, to be honest... i'd give it a try. My main objection to ablation is the relatively high incidence of post-ablation consequences (e.g. pace makers required in 10~25% of cases!). It seems this high incidence is attributable to the ethanol (paradoxically, HCM'ers are strongly discouraged to drink alcoholic beverages, and in ablation, it's alcohol in direct application ) as it is highly toxic to the heart. Besides, you have no full control over fluids anyhow.

Using mechanical means, the level of control (and some reverseability) seems much higher to me. There are no risks associated with toxic fluids. One thing i could imagine is the shunts coming free inside the ventricel . We need more research into this as it could be an alternative for ablation - albeit not resolving other potential drawbacks of ablation.

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[Toogoofy317]

I think I 'd have to agree with Rhoda on this one. I have a very high tolerence to pain. I.E kicked by a horse, rolled a truck, got hit by a car while on a bike two months later,AICD implant (did EMT clinicals the next week) and recently plowed a car head first into a guard rail. Even with these incidents I never cried or whimpered for that matter!

With that being said when I have chest pains it has put me on my knees. My episodes are caused from microvascular incidents that don't show up on an EKG only in my blood levels. Because of the frequency of my pain I'm now dependent on narcotic pain meds. So, if a microvascular incident can cause this much pain I can't even fathom what this would do to an already overworked heart.

I don't think we have to put our patients through shear torture to cure them. There has to be better ways! Quick fixes aren't always the best things.

Just my two cents,

Mary S.

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Well, i'm not into suffering either, but i'm wondering if indeed the experienced pain will or should differ from that of alcohol ablation. After all, a myocard infarct may cause excruciating pain, but may also come and go unnoticed. And, once the tissue is starved, it should be dead in 60 minutes or so (muscle tissue survives way longer than brain tissue, but it should be gone in that time). After all, survival and recovery rates after a non-scheduled heart attack :P largely rely on adequate treatment starting the first hour.

Mary, i understand you're suffering from a continuous series of mini heart attacks? Would scare me to death, i hope you keep surviving Sure this would hurt, because the nerves outlive the cells to tell the tale

[Toogoofy317]

Yes, these incidents do cause a lot of pain. But, from what I understand are not long term in damages. They said that on this level the heart can repair itself.

As far as I understand with the procedure it does not quickly kill off the muscle. That this happens over a series of days. Not, instantly as with the alcohol ablation. If I were obstructed I don't think I'd want the extra chest pain! I knew of a doctor who was doing this and it wasn't always with positve results. I will not name names but this was the same doc that told me there was nothing wrong go live my life however I want! Good thing I went to Dr. M Maron I had four of six risk factors for SCD.

Mary S.

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Well, i did some correspondence with the editor of the article, and today received answers. The reported pain is LOWER compared to ethanol ablation, but lasts longer (2~6 hours) as the tissue dies off. It shouldn't last for days. I've yet got to read some reports of it as it is being practiced, but i have some gut feeling that it may be saver and more predictable than alcohol ablation since the latter bases on toxic necrosis rather than (pure) starvation (like a normal cardiac infarct).

I'll ask the editor if i may share the reports with you all and then submit them to Lisa for publishing on the proper location of the site.

Note: a quick scan of the numbers seems to indicate NOT ONE patient needed permanent pacing afterwards, compared to 15~25% of alcohol ablated patients

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