Failed 1/18/24 ablation. Shocked 2/1. In AFIB again 3/18.

Are you in constant AF? Are you sure it isn't flutter? Going into flutter is surprisingly common after a catheter ablation. Have you had a 12 lead ECG to confirm? If yes to those questions, then it's still about halfway through the blanking period of 10 weeks. It's too early to consider it a failure.

If it matters, I had my first ablation in late July of 22. I was in the ER only six days later with intractable AF at 145 BPM. I was given Amiodarone to get me back into normal sinus rhythm (NSR), and had to stop metoprolol cold...that very night. The Amiodarone worked, but I eventually was deemed a failure at the 19 week mark when I went into AF again one afternoon and my Galaxy watch showed AF. My EP accepted that evidence and I had a second ablation that seemed to have taken until two weeks. I went from six days after my first ablation to two whole weeks, both times into the ER for evaluation. This time, my heart converted back to NSR after about nine hours and I was sent home, but now taking 100 mg of metoprolol. Turns out I ought to have been cardioverted. I see that you don't do well with that procedure. Neither did I, but only because my heart would revert to AF within hours. The point I hope you see, though, is that while my first ablation was eventually deemed a failure, the second, despite the glitch at the two week mark, has had me free of AF, even of PACs, ever since. I celebrated my first year back in steady NSR on the 14th of February.

The blanking period is normally 10 - 12 weeks. The literature says to not be dismayed if you have the odd run of AF during that period. If you're still paroxysmal, and not really in flutter vs. AF, and convert after even 24 hours, you're still not technically failed. I appreciate that it is unwelcome, and unsettling, especially weeks later....but let's not jump the gun just yet.

If you go more than 24 hours with an HR above 100, you should commence metoprolol and/or flecainide, maybe Amiodarone, but only with the blessing of an electrophysiologist or a cardiologist. If the flecainide doesn't seem to help, and you're not a candidate for Amiodarone (yet), ask if you can trial diltiazem and/or propafenone, the former another rate control like metoprolol, and the latter another anti-arrhythmic. It's worth a shot.

Finally, and this is the hard part for me to type, and for people in your shoes to accept, but 25% of all index ablations, the first ones you get, fail. Or, you get a lot of PACs, but no AF any more. In my experience, 'cuz I had them in abundance after that first sixth day AF, they were highly symptomatic and I didn't feel I had gained anything over the AF. Or, you get flutter. Either way, only a 12 lead ECG and read by a highly experience cardiologist or EP, can show what's going on....really. If you get bad news, it's not the end of the world. AF doesn't kill you...uncontrolled, yeah, but drugs can mitigate that, AS CAN a second, a third, a fourth ablation. I know people on another forum who have literally had umpteen ablations and/or cardioversions (how about 53 cardioversions?!?!?!?) The key in this is to soberly evaluate the skill and tenacity of the EP trying to help you, or who is ostensibly doing so. You might need a better EP. If it matters to you, at the top of his field is Dr. Andrea Natale at the Texas Cardiac Arrhythmia Institute in Austin. He travels to several western hospitals, perhaps to a place close to you.

First, thanks for your reply, your experience makes me feel very fortunate and good that my one ablation four years later seems to have “cured” my AF issue - for the time being!

Although your problem is not a late recurrence read this whole article.
Having persistent A-fib is more unhealthy that being cardioverted.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8873127/#:~:text=Early%20recurrence%20within%20the%20first,recurrent%20atrial%20fibrillation%20%5B35%5D.
Late arrhythmia recurrence after atrial fibrillation ablation: incidence, mechanisms and clinical implications"
But here is an important section: "It is well known that untreated PAF often progresses to persistent AF and ultimately results in acceptance of permanent AF. Therefore, early treatment of PAF is critical to improve long-term outcome [22, 23].

In the majority of patients suffering from PAF catheter ablation results in stable sinus rhythm as shown in long-term follow-up studies [5, 20]. However, most patients need multiple ablation procedures to restore durable sinus rhythm [24, 25]. According to one meta-analysis study, patients suffering from PAF undergoing multiple ablation procedures using RF energy have a long-term success rate of about 80%, whilst success rates for patients undergoing only one ablation procedure is around 53% [24]. Recent data suggest there are several reasons for this significant difference, with pulmonary vein reconnection probably being the most prominent one [26]. Long-term success rates are significantly lower in patients, with persistent AF resulting in only a 20–45% rate of 5‑year arrhythmia-free survival after multiple RFA [13, 27]. The ideal ablation strategy for patients with persistent AF has not yet been identified [21, 27]."

Thank you. I’m foreseeing more shocking with dread, but my surgeon hasn’t offered any other options except shock and re-cut. I’m finding the anesthesia for both is causing mental problems, as it always had with other surgeries. I foresee a hard end of life ahead, but maybe I need to go from Fairfax VA to Mayo or John’s Hopkins (only an hour away) to get a higher-level life plan. I appreciate the article-I’m not a great researcher, as you are.

@bill0996. AFIB is very common and usually the biggest concern is strokes not death from it. I have it on and off but my issues is PVCs.

I have cardiomyopathy which they say was caused by a virus getting into heart and causing scar tissue way back in 2001. But I have a ICD/Pacemaker. What is your EF?

I have had one ablation on right ventricle that was success. I now have 3 areas in LV that are causing my PVCs which are a real pain in butt. But I am a very active exerciser and do Sprint Triathons. I wanted my EP to do another ablation on LV but chose to put me on medication and right now they are monitoring it's success to see if need to raise dosage so this will take some time. It actually has gotten worse.

I think the anxiety over AFIB is the feeling it causes. VFIB is much more dangerous and why having my ICD/Pacemaker is a great reduction in my worry over VFIB. I have been shocked over the almost 20 years with AICD/Pacemaker. As I wrote to another poster about having one it is like having your own EMS team waiting to bring you back to rympthm. I am told the ICD success rate back to rympthm is about 99%. Doesn't mean it will stop happening again.