A. Fib/A. Flutter

I know of two people, one male (retired EMT) and the other female (grandma who had a very trying life and who makes me feel like a schmuck she's so darned tough) who have have 11 ablations between them. They're alive 'n kickin'. I invite you to hop over to afibbers.org when you have a bit of time and look for posts by Carey and SusanD.

A sobering fact for you: still, today, even with the new PFA (pulsed field ablation), the failure rate for index ablations, meaning first attempts, runs about 25%. Some, the very best electrophysiologists, have success rates upwards of 85% for index ablations, but your average EP succeeds about 75% of the time. I was in that unfortunate 25% and needed a redo about seven months after the first, same EP. I am now 37 months free of the horrible symptoms and from the arrhythmia itself.

Do you have an specific questions?

I have had 4 ablations, and the last one fully awake bc the EP would have a hard time getting my heart to act up, since it was not happening all the time, and he was thinking the anesthesia was hindering the process. I started by having the first one so I could go off medication but then began flutter, then another and SVT started. And then the fourth. Guess what? Still on medication…

I have had 5 ablations, the first one in 2009. Also had the TT Maze surgery procedure. I tolerated all the surgeries well with no complications, and all the ablations worked well for a while but the afib/arrhythmias have always crept back over time. I am still on medication and get an episode about once per month, but it's manageable. My EP calls me her "challenging case." Everyone is different.

In total I've had 5 beginning about 12 yrs ago. 2 were for typical flutter. 1 for fib then was good for 5 years but the recovery took 6 months. Then atyipcal returned 12-24 got cardioverted and ws good for 8 months before it returned in Sept 25, cardioverted again. EP told me this will keep coming back and stated the new miracle PWA was great and lasted longer. Dec 25 I had PWA left the hospital in flutter with Flecainide that never works. EP called me and said the anesthetic can interfer and mask ectopic currents. He suggested another PWA using Isopropterenol, Did this on 1-30-26 was good for a week,. Now back in flutter. Now EP is saying the Vein of Marshal is the source. During this last visit he said the PWA could cause inadvertent cardioversion and hide the flutter giving a false sense of success. I'm skepital of all this BS now and feel like this is the wild west in procedures that are unpredictable and serve mostly to pad Dr's pockets. The ablation business is a 6 billion dollar industry according to Dr. Evan Levine.

@labexperiment I hate to offer this, lab, and certainly do not want to throw cold water on you....but....I think you're done with this EP. He obviously doesn't know what he's looking for, or how to find it.

First, do you mean PFA.....pulsed field ablation? PFA has fewer risks for the patient, but current statistics, now well into its widespread use for three years, does not show a significant record of success in keeping the patient free of AF or SVT or PACs. This is a strong indicator that the most important factor in an ablation is not the equipment or the technique, it's the skillset and experience of the practitioner. That is why we at afibbers.org tell people who newly present asking questions on how to deal with their AF is to shop around carefully for the best EP within a day's drive....if possible.

Complex cases, advanced cases, of AF can have numerous foci or re-entrants where the AV node is sending signals back up through the floor of the atrium, back up into the septum, into the Left Atrial Appendage, the coronary sinus, and into the front wall.....many locations, six walls or surfaces. Having to ablate the Vein of Marshall is not rare, but neither is it common. And the way they do that, as far as this uneducated brain knows...so far...is to run very cold saline or other compound through it to destroy some of its endothelial lining. The resultant scarring does the same thing as the scarring that RF or PFA ablations cause, and the scar tissue blocks the signals from coming out into the 'open' and running as a wave across the endothelial surfaces of the atrium...which in turn casuses the atrium to contract.

The business must be close to $5B, but that's only because patients insist they get ablations. Some don't need them, some quite clearly do, and they're willing to pay.

If you are kinda flush with some handy cash, and don't mind spending three/four nights in commercial lodgings, I can offer the names of two top-tier EPs: Dr. Andrea Natale at the Texas Cardiac Arrhythmia Institute (widely renowned, travels to multiple hospitals), or Dr. Pasquale Santangeli at Cleveland Clinic. By now, with several failed ablations, you need true expert care, and those two are the best. You are now a 'complex case', and would be much further ahead to have a different set of eyes fall upon you. My opinion.

PFA and PWA are the same. PWA is pulse wave ablation and PFA is pusle field ablation. Vein of Marshal is done by going into the coranary sinus with a wire then occulding the opening with a balloon and infusing 98% ETOH into the vein providing they can get hte wire into the vein. The opening is highly individual and varies between 1 and 3 mm.

I've contacted both ofthe EP"S you and others have provided. Thanks