Pulse field ablation

Hello. I have had two ablations, both RF, and only the second one worked.

The 60% probability of success is probably correct, for PFA, but only because he/she thinks you're a more complex case and that even PFA is not likely to get to the right spot. And, he/she is correct because the run-of-the-mill electrophysiologist (EP) is inexperienced with complex cases. I'll explain:

Most EPs will want to do a PVI first (pulmonary vein isolation) because 90% of all paroxysmal cases, which I take it you are (?), can be successfully ablated with a simple and quick PVI. However, only 75% of all PVIs work, at least the first time. Why is there a disparity between the 90% estimate of all cases needing only a simple PVI but that only 75% of first attempts (called 'index' ablations) work? If you're working hard behind your eyes, you'll guess that it relies on the skill and experience of the practitioner.....the EP. As with all surgeries, all kinds, the surgeon is the key factor. And there are surgeons and there are surgeons....if you follow. You want the best EP you can afford, even if it means a hotel stay for three nights in that city.

So, this has nothing to do with PFA or with RF. The technique matters, but ONLY IN THE RIGHT HANDS....EXPERIENCED HANDS. Unfortunately, not all EPs have the expertise to deal with a case like yours because you have had three attempts with zero success. To me, this means the EP is not ablating the right tissues. And that's only if an ablation will work at all in your case. It could be that your case is not treatable by ablation.

My advice, as very inexpert as I am, with no medical training, is to find another EP, a better one, probably upwards of 45 years old, in a large center, who performs RF and PFA, but who claims to deal with complex cases, and who performs 6-10 ablations every week year round. If you have the means and can travel, I can recommend two whom are highly regarded in their field: Dr. Andrea Natale at the Texas Cardiac Arrhythmia Institute in Austin, and Dr. Pasquale Santangeli at Cleveland Clinic. There are others who are excellent, but you'll need to ask around, get your info sent to them, consult over the phone, and see if they 'd like to take a crack at your self. PFA, sure, RF- why not....it's the handler that makes the difference. Yes, PFA is going to be safer because it offers less of a risk for esophageal damage, but again, in the right hands, with a TEE shoved down your esophagus, there's no reason to have damage form an RF ablation (yes, there's a risk, always, but it's so small in the right hands that you just discount it). Again, RF would still work if that's what is needed, PFA is less risky, but the technique, either one, only works for you in the right hands. THAT..................is your challenge.

Thanks so much for your insight. My cardiologist is one of those few experts who does a ton of ablations with my type of afib. He is with Penn and started the cardiology afib program over 25 years ago. In his early 50s. Penn and his program were one of the few hospitals in the country to get approval for the PFA technology. My electrical issue is close to the pulmonary veins and they monitored the temperature of the esophagus and only stopped when it reached the threshold temp. I am confident with his skills but question whether the energy will make a difference and this will be successful. Meanwhile I feel fine living in afib on eliquis and metoprolol. I don’t have other issues. I just didn’t know if it was worth going through this a fourth time and having to heal again from the procedure.

I had one yesterday! I had to stay overnight but it was not bad. I don't know what to tell you except that I was newly diagnosed a year ago in October and my sypmptoms were still proxysmal. After reading the latest information from experts on YouTube, I learned that there are several options for a patient to try when they are first diagnosed, but the best option is ablation for the best chance at a "cure". I wish I had had mine done months ago, but my cardiologist didn't offer that until I got informed and pushed for it! One cardioversion, several breakouts over the months--short-lived but still annoying--and a trial on Flecainide that may have "worked" but had side effects and a scary list of side-effects! I found a very excellent electrophysiologist and a hospital that did pulse field ablations. I am hopeful and I wish I had done it sooner! According to the experts, the longer it occurs, the more it spreads and the harder it is to treat with ablation. You need a really good doc to do this so check out his creds and ask lots of questions! Good luck! I truly feel your pain!

@wews I understand your position. For me, AF was not acceptable, mostly because I am symptomatic (people told me I looked grey after my first failed PVI, and I was both anxious and feeling unwell all the time. It was hard to relax most of the time because I always felt like pacing). The other part of it being unacceptable, for me personally, was that I had read and devoured all I could find, even on published tech papers and journals, and learned that the progression of AF should be carefully managed and slowed so that the heart doesn't enter permanent AF and eventually succumb to heart failure, which is a distinct possibility. Echocardiograms already showed moderate atrial enlargement, which is not desirable.

So, depending on your own personal physiology, your response to being in AF frequently/most of the time, your motivation to have it stemmed, etc., a fourth time is not out of the question....not by a long shot. I know people who have had six or more ablations until the right person finally got 'er done. As in, got the right places zapped.

Thanks so much for your encouragement. I will give this a try. I do have very enlarged atria but I feel well. I exercise every day and don’t have any symptoms. This is why I wonder if I should bother having it. I just don’t want to end up in a worse spot. I guess it is worth trying.

@sjm46 Thanks so much for your insight. I tried Flecainide after my first ablation. I was in sinus only for a short time and had terrible side effects from it so stopped it. I have a great Electophysiologist who was one of the first to train and use this new technology at Penn. I am praying it will work this time since he thinks he can get to the place where the problem is in my heart without worrying about doing collateral damage to other parts. I am keeping my fingers crossed it works. Having it done Christmas Eve day since it is out patient so I am hoping for a Christmas miracle.

had one 4 months not working to well

@wews I am so excited for you! I am only two days in and I feel better already! No pounding of the heart at night! I read the surgical notes from the electrocardiologist after I got home yesterday and it sounds like he practically stood on his head to hit all the spots that needed to be "zapped". He reported some unusual anatomy and narrowing in places unique to me apparently. I think he worked on me for almost 4 hours and he used PFA so I am sooo pleased. I wish the very best for you. I think I have a good cardiologist but if I had not done my homework and checked out all the info on YouTube from the experts from all over, I would still be struggling with meds and having more outbreaks. I practically demanded that I get a referral to an electrophysiologist. I know I am not "cured" but I feel much more comfortable with advocating for myself. It helps to be a nurse and know what to expect on some level, but I was not nervous about doing this. I counted down the days! My husband had a progressive cardiologist years ago who told him "all meds are really poison and you only hope the benefits will outweigh the side effects." I truly believe that the less you can take, the better off you are so if surgical intervention is the best option out there now, I hope more people will pursue it! Again, good luck to you; I hope you will be as happy as I am to get this done. Merry Christmas!

@sjm46 thank you so much for your positive feedback. I pray he can get to all the spots and I can be back in sinus rhythm. It is wonderful to hear your cardiologists success! Congrats. So happy for you. If this technology can get to the places he couldn’t get to before then maybe I have a chance. I only take metoprolol but at one point was on sotalol and it was horrible. The side effects impacted my digestive system and made me feel terrible. I refuse to go on some of the other medications because of the side effects. I pray it goes well. It would be the best Christmas gift! Merry Christmas to you!

@wews I truly believe that you will do well; you have a hopeful, positive attitude. This chat line has been so helpful to me and I believe we all need support and encouragement to hang in there. We aren't alone in this journey and we can learn a lot from hearing other's experiences, so I truly appreciate your feedback too! Good luck and best wishes. Please let us know how you do. I know I counted down the days on my calendar for the ablation and went in fearless! I just knew it would help but I had no idea how difficult the thing was for my surgeon until I read his report on my chart. I sent him a huge thank you note this morning. I feel blessed! I know you will be too!