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Ablation, when it “didn’t work” or "made things worse"
Heart Rhythm Conditions | Last Active: Apr 13 12:25pm | Replies (19)Comment receiving replies
@gloaming
Do you know how successful an ablation would be in the case of a moderately to severely blocked mitral valve? I read that a fib is never “cured” . I also think there may be no point in doing an ablation given I went into a fib and heart failure from a pulmonary embolism but now realize my mitral valve annulus repair done 2012 has failed due to heavy scarring. So…. I can get open heart surgery to debride the annulus and probably end up with a pig valve and fix the a fib with a cox mace 4 …. Gold standard procedure, during the open heart surgery. I have no idea yet how long I will last before requiring surgery but I feel anxious about waiting. I’m breathless on exertion but pretty asymptomatic otherwise. So…. Do I try a catheter ablation in the meantime and hope the valve doesn’t get worse for a few years or just let them cut me open and get the full meal deal? Scared about all of it and feeling like my life has radically changed. Grieving the loss of my athletic lifestyle. Unfortunately, I’m trying to get a more proactive cardiologist because the guy I got stuck with doesn’t answer questions and just says he will keep me rate controlled on drugs. Never taken drugs in the past…. Not even Tylenol. Is it worth trying an ablation or wait for the big operation to fix? I read that after 1 year of persistent AFib, it locks in as permanent a fib and is very tough to get rid of. I feel asymptomatic with the continuous a fib except breathless on exertion esp climbing stairs of walking on a slope…. Only my Apple Watch and cardio mobile tell me I’ve been in 100% a fib since Jan 2026. However, a cardioversion Mar 20, 2026 got me into sinus rhythm for 3 whole days. I must say I felt incredibly good for those three measly days but was it physiologically or psychological? It really upset me when the a fib returned after those three days. Health care in my province of Nova Scotia, Canada has deteriorated. I’m trying to get referrals to surgeons out of province but my current cardiologist is not supportive. He says he is only offering to rate ( drugs) or rhythm control (see an electrophysiologist re ablation). Thank you b
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@activegal In my experience, an EP will want all obstacles to success dealt with before they enter your heart and fiddle with pokey things that do damage to tissue. So, if you have mitral valve prolapse or stenosis, they would almost certainly insist you get that dealt with first. Orthopedic surgeons tell their obese patients to come back for their hip/knee replacements when they've lost 30-130 pounds, whatever the case. Or, their work is just a waste of resources and of their skills. Same for EPs who want to help, but would be working against themselves, and you, if they agree to treat an arrhythmia in a heart whose main problem, the most serious one, is mitral valve failure (because AF doesn't kill the patient.....can make 'em miserable, but it won't kill you).
Yes, ablations are not a cure. Once your heart is electrically disordered and formally diagnosed, that's it for life. Everything else that follows is palliative....meant to make you comfortable, and ideally to halt or to slow progression. Ablations, if they work, stop the fibrillation, and it is the fibrillation that leads to atrial enlargement, more heart valve damage due to the strains involved, and possibly heart failure in time. No fibrillation = slowed progression. No fibrillation means you'll almost certainly die from something else. But the literature also insists that even if you are in permanent AF, it is highly unlikely to kill you, even after years. It may lead to heart failure, which COULD kill you, but AF, in and of itself, is not a lethal condition. Stroke is the great risk of AF, and that is why almost all patients stay on a DOAC for life. By then, in most lives, well-aged, you have other things going on that also make the intake of a DOAC a wise choice.
The more advanced your progressed case of AF is, the more 'complex' it is, and the more tissue and locations must be both found and then ablated. Not al EPs have the training, the....[cough] gonads, or the experience to do what it takes to rid the complex case of fibrillation. That is why we over at afibbers.org forum harangue newcomers, and each other if we need an EP's services again, to do the homework and find the right EP who will do whatever can be done ethically and safely for you. The heavy slogging.
I feel for you...I absolutely do know what you're experiencing because......been there. People tell me I looked pale, even grey, in the weeks before my first ablation. Yeah, I needed two. I was in that unfortunate statistic where 25% of index ablations fail. But, same EP, same technique, seven months later he did the trick and I am free of AF for nearly 36 months now (Deo gratias!).
I believe that, the more you read up on your condition, the more you'll realize that an ablation....BY THE RIGHT EP... is still your best bet going forward. I don't know if you can wrangle it out of province, but my guy is Dr. Paul Novak at Pulse Cardiology in Victoria. He was the 2002 Canadian Cardiology Candidate of the Year.....not so shabby. 😀 If you can tap into some money, and don't mind travel and commercial lodgings in the USA, Dr. Andrea Natale at the Texas Cardiac Arrhythmia Institute in Austin is one of the very best on the planet.