What determines the need for a second ablation?

The need for a second ablation is that being in AF sux. That's it.

It won't kill you. But it can make you wish you'd have an early exit....if you know what I mean. I was horribly symptomatic, and my EP was (thankfully) sympathetic. That combination comprises the magic that the EP needs in order to ablate you a first, second, or even a fifth time. I know several people, only obliquely on another forum, who have had six ablations. The last one, in the 'right' hands, did the trick for one of them, Dr. Andrea Natale at the Texas Cardiac Arrhythmia Institute in Austin....arguably the top EP on the continent.

AF is not a death sentence. But it can make living almost unbearable. Once I knew what an ablation offered, not promised but offered, I couldn't wait. Six days after the index ablation, I was in a local ICU and quickly placed on amiodarone to bust up the chaos my heart was going through. It settled with the amiodarone and I was able to get off that worrisome drug inside of seven weeks. But, my AF returned. I sent a reading from my Samsung Galaxy watch to his office and he immediately agreed I was back in AF and needed a second ablation. I trusted him, and agreed to let him try again. He has very good credentials (Top Canadian Cardiology Student in Canada in 2002). When I awakened from that second effort, he came by and said he was ablating around the third pulmonary vein when my heart went into steady and happy normal sinus. He said he didn't even bother to cardiovert me as he does for all his ablatees before sending them out to recovery. He had just found that one teensy gap he'd missed last time. It might be as simple as that for you.

@gloaming Thank you for your detailed response! Definitely very helpful- just returned from cardio office in LaJolla- placed a monitor on my chest for a week- found a flutter today- plan B next week- thanks again!

@jimbehun to reinforce gloaming’s message, my friend needed a second ablation and that did the trick- no more AF. Apparently there were spots that the EP missed the first time around. It’s still an evolving art with technology and expertise improving success rates. We are fortunate to be at this time in medical advances, 20-30 yrs ago it would have required open heart surgery to do what is done routinely now with a catheter.

I’m waiting for my second ablation. I was a setup for having a failed first one. Mine worked for 5 months, which probably means one of my pulmonary vein’s PFA scars healed. I’m having a lot more SVT and PACs now so as my EP says, “your atrium could use some work”. I’m not looking forward to round two but I loved those couple months of no afib.

@diane987654321 As I have said repeatedly, the chances are that any one successful ablation is time-limited. I frequent several fora where heart health, especially tachyarrhythmias, are discussed by people who need to talk about their experience. Time-after-time a person says they had an ablation in 2017, and now they're experiencing AF again. An inquiring mind would ask, 'How did it go between 2017 and now? Then answer, for the huge majority, would be' Amazing! I was able to live normally again. No anxiety, no waking up with a pounding heart, able to hike 'n bike...' But they have all come back to report that they are once again in AF. This is NOT universally true...some people can have a simple cardioversion and never have a lick of arrhythmia again before their funeral. But for me, and the rest of We The Great Unwashed, we should probably prepare ourselves for another ablation. It might be two years....only...or it might be twenty. I'm a month over three years now, blissfully living free of AF. But I keep reminding myself that there will probably come a day....a day when that familiar swelling in the chest comes back and I feel the thumps. I won't be happy (who would?!?), but at least there is the possibility of a repeat ablation. As I post here often, I know two people, one female, one male, who have had at least six ablations until a bright bulb finally figured out how to stop their AF. And philosophically, wouldn't it be worth a whole year free of AF, if that's all you could get...for some of us, those of us who are highly symptomatic and who feel well and truly miserable when in AF?