AF is a progressive disorder. It may be slow, it may be fast, you may be symptomatic, you may not know it's going on. But it's always advancing. If you had two years in NSR, you had a good index ablation (index = 'first'). But your heart doesn't mark time or stand down in its desire to keep finding ways to beat chaotically. Most ablations last between 3-5 years. Some go on forever, lucky sods. Some are done inside of a whole first week, and I'm one such unlucky person. Second ablation, seven months later, has me in NSR for 39 months now. Not bad.

It is always best, or maybe 'handy' is a better word, if you are fibrillating while being ablated. But it's not necessary. The best EPs are trained in 'mapping' the heart's electrical circuitry and rogue foci, the places where the rogue signals are reaching the left atrium's endothelial lining and causing that vessel to beat. There is no nerve that makes that vessel beat....it's a spreading wave of voltage that normally issues from the sino-atrial node (SAN). When you first start fibrillating, that paroxysmal early stage, 95% of all rogue signals emanate from the ostia of the pulmonary veins where they empty fresh lung blood into the rear of the atrium. Ablating the ostia of the pulmonary veins is known as a 'pulmonary vein isolation', or PVI. Chances are that is all you needed, but here you are needing a second ablation. I'm three years ahead of you on that count. In case this is a defeating feeling for you, I know two people who have had five and six ablations, eleven between them, until they found the right EP to solve their complexity and rid them of their arrhythmia. That was Dr. Andrea Natale at the Texas Cardiac Arrhythmia Institute in Austin. He is world famous.

EPs have a range of options to make your heart fibrillate. It's called challenging the heart. They can use adenosine, caffeine, or isoproterenol. If those don't work, there's not much else they can do except to ablate around your pulmonary veins a second time, although that is unlikely to be effective. Instead, one or more other loci, the mitral valve area, the left atrial appendage, the coronary sinus, even the septum dividing the two atria....they can all harbour those rogue channels that raise voltage into the endothelium, and bang....your off fibrillating once more. As Dr. Scott Lee says on his 'AFib Education Center' channel on YouTube, there are six walls in the left atrium. The more complex the case, the more difficult it is to treat, and that's because not just the pulmonary vein ostia are now involved....it has spread.