Second ablation maybe

I've had 2

by sgmfish - 2024-07-22 16:39:08

The first was in R artium for flutter; the second in L artium (vein isolation) for AFib. Frankly, I had little problems with recovery for either (and I'm much older than you). I too have had lots of CVs, but now recent use of tikosyn seems to be working.

What sort of recovery issues did you have?

P.S. My EP and I already have plans for a 3rd ablation (Posterior Wall Isolation) if tikosyn stops working.)

Recovery

by godrew - 2024-07-22 17:38:51

I didn't actually have any complications from procedure.  From what I read and was told was that I would pretty much be back 100% and full strength in 4/5 days to a week after procedure.  Dr did say after procedure he was in there a bit longer than he though, so maybe that would equal a longer recovery. It took me 2 full weeks to be legit full power.  

A second ablation might be the way to go

by Gemita - 2024-07-23 03:48:38

Hello Godrew,

Atrial Fibrillation is frustrating and has a mind and a will of its own and is quite difficult to tame, isn’t it.

Although I haven’t had an ablation, I have discussed having an ablation (both a pulmonary vein isolation ablation and an AV Node ablation) at great length and continue to discuss all my treatments options with my EP on a regular basis.  The only reason why I haven’t agreed to an ablation is that on the whole my AF is well controlled and does not seem to have progressed in terms of frequency and duration over several years.  I am afraid of making things worse by intervention and like you, I feel so much better with a pacemaker.

When I discuss treatment options, my EP tells me that I would probably need two ablations to fix my AF, since it was seen during an EP study to be firing from multiple sites and that one ablation would probably not fix the problem.  The thought of two ablations and the increased risk from “two” procedures did not appeal, so I have held off and I have not been disappointed so far.  

However in your shoes since you are on a heavy weight med Tikosyn already and your doctor is thinking the next step would be Amiodarone, it would make sense to me to perhaps consider having another ablation as this should increase your chances of success.  I was quoted a 70% chance of success with a first ablation and as high as an 85%+ chance of a successful outcome with a second ablation.  An ablation is certainly supposed to be more effective than an anti arrhythmic med which I was told was only around 45% effective although I know many folks do extremely well on some anti arrhythmics like Flecainide, Tikosyn and Amiodarone which controls their AF for long long periods.  I was taking Flecainide for several years.

I understand you had a difficult recovery period from your first ablation.  Recovery will be different for each one of us depending on our EP’s experience, length of procedure and whether there were any complications and of course on your own health condition at the time of your procedure.  Maybe a second ablation will only need to be a “touch up” procedure, last for a shorter period than your first and you will recover more quickly?   Good luck whatever you decide.

Conditions

by piglet22 - 2024-07-23 06:06:01

When you read what others have to go through, I have to count myself lucky I only have heart block and a few ectopics thrown in.

Never fails to amaze me just how complex all the mechanisms are to keep this pump working properly.

Catheter ablations

by Selwyn - 2024-07-23 08:30:44

I have now had two ablations for atrial flutter and two for atrial fibrillation. That's 4 in total.

I remain in atypical atrial flutter.  I discussed a further ablation with my cardiologist a couple of weeks ago. The success rate depends on what the pathology is causing the problem. Difficulty increases the complication rate ( stroke, perforation, death etc.).  In general, typical atrial  flutter ( as a circular electrical conduction above the tricuspid valve) is a lot easier to do and had few complications. The  atrial fibrillation complication rate is about 3%. ( see below reference).

With regard to recovery - the recovery is the same after each ablation, more or less. As healing takes place with scar tissue on the inner surface of the heart, the outcome effect can take longer with the more burning ( or freezing)  that goes on. Eventually, the fibrosis blocks the electrical discharges.  

Having said this, if the inside of your heart already has fibrosis ( scar tissue), as mine has, the success rate is poorer and the areas needing to be zapped can be more extensive. This causes atypical atrial flutter ( as in my case). Complications are more likely with more extensive burning.

My second atrial fibrillation ablation was a success.  The success rate may be increased by the electrical mapping technique used ( See Ripple mapping). The ablation gave me the opportunity to be without cardiac medications ( I could not cope with beta-blockers). I still remain without heart medication. My atrial fibrillation has remained cured by the second ablation. Sometimes the effect of an ablation can wear off as tissue repair takes place.

All procedures are not without risk - blood clots, perforations, failure, death ( death rate being 1 in 1000). The consequences of a stroke may be severe and life changing.  I have asked myself, how much is my arrhythmia affecting my lifestyle?  At present I have opted not to have a further ablation. I may yet consider a further cardioversion ( complete with chest burns!) though the success rate may be poor given the underlying pathology ( cardiac fibrosis)  remains intact.

May I say, long term amiodarone is fraught with problems, some very serious. I opted not to have this drug. My brother ( X4 CABG) took amiodarone and has spent a year recovering from its side effects. Lung fibrosis can be life changing.   I continue to take blood thinners. As you get older the risk of a bleed or a stroke increases. - there are clever on-line calculators available to give you an idea of such risks.

To read about complications and rate, see https://www.ahajournals.org/doi/10.1161/CIRCEP.113.000768