Connect
Recurrent atrial fibrillation after ablation with apical HCM
Hello everyone,
I am writing on behalf of my father, and I would be very grateful for any advice or shared experience.
My father is 68 years old and lives in Vietnam. He has a history of **paroxysmal atrial fibrillation**. In **July 2023**, he underwent **radiofrequency ablation with pulmonary vein isolation**. As I understand it, this was a **thermal ablation** procedure. Unfortunately, the experience was very difficult for him. The procedure lasted about **5 hours**, he had **severe pain**, and he **fainted multiple times** during the procedure. Afterward, he was extremely exhausted.
Since then, his rhythm problems appear to have recurred. More recent evaluations suggest that he has:
* **Recurrent atrial fibrillation / recurrent arrhythmia**
* **Apical hypertrophic cardiomyopathy (HCM)**, non-obstructive
* **Complete right bundle branch block**
* **Premature atrial and ventricular beats**
* **One documented episode of non-sustained ventricular tachycardia (NSVT)**
His recent symptoms have become more frequent and more severe. He now has:
* irregular or skipped heartbeats
* chest tightness or chest pain
* palpitations
* shortness of breath, even at rest
* dizziness, fatigue, and near-fainting
* episodes of low blood pressure
We also have Apple Watch ECG recordings showing:
* **Atrial fibrillation** on **December 24, 2025** with heart rates of **110 bpm** and **104 bpm**
* **Bradycardia** on **April 6, 2026** with a heart rate of **37 bpm**
Other recordings showed sinus rhythm, so this seems to be **paroxysmal/recurrent AF** rather than continuous AF.
Another important point is that my father had coronary angiography in **2012** and again in **2023**, and both showed only **mild coronary artery disease / mild atherosclerosis**, without major progression. So at this point, we believe the main problem is more related to **AF + apical HCM + arrhythmia risk**, rather than severe obstructive coronary disease.
Our family is now trying to find the **best hospital in Asia** for him, especially one with strong experience in:
* **recurrent AF after prior ablation**
* **apical HCM**
* **NSVT / ventricular arrhythmia risk assessment**
* advanced catheter ablation strategies
* ideally **less painful / less burdensome technology** than his previous thermal RF ablation
We are especially concerned because he is **not physically strong enough to go through repeated invasive procedures many times**.
We have considered the United States, including Mayo Clinic, but at the moment we are worried that:
1. the flight from Vietnam to the US may be too long and physically stressful for him, and
2. the cost may be very difficult for our family.
So I would sincerely like to ask:
1. Based on this kind of case, **which hospitals in Asia** would you recommend looking into?
2. Has anyone here had experience with treatment for **AF on the background of apical HCM**?
3. If a second procedure is needed, what kind of center should we prioritize?
4. Should we focus more on a hospital that is strongest in **HCM**, strongest in **electrophysiology/AF ablation**, or one that is very strong in **both together**?
Thank you very much for reading. Any advice, recommendation, or shared experience would mean a lot to my family.
Like
Helpful
HugInterested in more discussions like this? Go to the Heart Rhythm Conditions Support Group.
Connect
Welcome. I have had two RF ablations for AF. I have done a lot of reading, watched scads of videos, and I feel I have just enough knowledge to keep myself out of trouble, or just enough to be an annoyance to my cardiologist. 😀 Take your pick.
He is still in the paroxysmal stage, but it is more acute and he is experiencing symptoms. The paroxysmal stage, if he MUST have AF, is the place to be. AF gets more difficult to treat as he progresses to persistent, long-standing persistent, and then finally to permanent AF. He's a long way from there, but obviously his heart has established new pathways. Chances are the new foci are in the left atrial appendage (LAA or in the coronary sinus, perhaps in the mitral valve isthmus.
https://pmc.ncbi.nlm.nih.gov/articles/PMC6379491/
He would now be considered a more complex case, and this is where you would want the services of a top tier EP. Mayo Clinic has excellent ones, so does Cleveland Clinic, so does the Texas Cardiac Arrhythmia Institute where Dr. Andrea Natale calls home, but he travels with privileges to several hospitals, and lectures widely. One of the best on the planet.
Your Dad's hypertrophic enlargement is to be expected in a heart that has sustained bouts of arrhythmia for several years. When an ablation is successful (defined as one full year free of the treated arrhythmia), there is a good chance his enlargement will recede somewhat. This is not universally true in all patients, but many do find in subsequent imaging that their enlarged atrium or ventricle has reduce in size substantially. Whatever the case, it is a typical outcome of sustained and frequent arrhythmia.
A good EP can ablate a heart with enlarged vessels, but it may not last long. Enlargement tends to invite more arrhythmia. If the ablation succeeds, even for those first important few months, it might encourage recession, in which case that risk is also reduced.
25% of all index ablations, across the field, across practitioners, fail inside of a few months, or they don't work at all. Unfortunately, I was one unlucky such person. So, with that sorry history, I asked the gentleman if he'd try again, and he agreed to. He was the Canadian Cardiovascular Trainee of the Year in 2002, and is on the board of certified electrophysiology examiners for the Royal Canadian College of Physicians and Surgeons. I figured he'd do right by me, and he did.
Most ablations will fail in time. The reason is the heart is disordered, and the disorder tends to progress, at least in AF patients. It's a grim reality, but repeat ablations can put the heart back into health rhythm for a long time, long enough to reverse some of the cardiomyopathy and 'remodeling' as it is called. AF does NOT kill its patients. They'll almost certainly die from something else. They'll degrade over time, maybe be horribly symptomatic and miserable, but the disorder is not lethal. In fact, the procedure called ablation is really palliative.
Sorry, I have no knowledge of the best cardiac arrhythmia treatment centers in Asia, but Hong Kong would be a good bet, Singapore, Malaysia, but look long and hard at India as well. With all those people, somebody over there must be doing top drawer work.
-
Like -
Helpful -
Hug
2 Reactionshi linhtheban
Your father does seem to have more than his share of cardiac issues. @gloaming does have much knowledge regarding AF and treatments, but I have to disagree with his opinion that the arrhythmias have caused the hypertrophy in his left ventricle. I have Apical Hypertrophic Cardiomyopathy with AF with rvr (rapid ventricular rate). The Apical HCM diagnosis preceded the AF. AF is common in Apical HCM and is caused by the increased left atrial pressure and ventricular diastolic dysfunction. NSVT is also an issue with ApHcm.
My AF presented as persistent although I must have had episodes prior that didn't last long and never showed up on holter monitor. I was in Af six months before it was rhythm controlled with medication. I see a genetic cardiologist at Mayo Clinic in Rochester and an electrophysiologist in the heart rhythm clinic. He recommended medication to begin with. Ablations often take two or three with Apical HCM (Af is less tolerated and harder to treat when you have ApHcm) When in Af I have terrible fatigue and my heart feels like it is pounding all the time and heart rate often goes to 175 and is rarely below 115.
If possible, your father should first find a HCM specialist who would deal with the ApHcm and see that he could get the proper treatments for his arrhymias. I did some research and their are HCM specialists at Vinmec Times City International Hospital in Hanoi. This hospital is connected to Cleveland Clinic in the United States. Perhaps you could start by contacting this hospital.
As far treating AF when you have ApHcm, I can only relate my experience. Rate control meds were tried until I could see a doctor in the rhythm clinic. Unfortunately these meds did nothing for the AF, but increased my fatigue and lowered my blood pressure too much. Rhythm medication has been mostly successful. I was loaded (three days in hospital of get the drug) with Dofetilide (Tikosyn) and it was great for 10 months. Then I started having occasional breakthrough espisodes that would self convert back to sinus rhythm. When the episodes started getting closer together my Hcm cardiologist prescribed Jardiance to help lower my filling pressures and "fine tune the diastolic dysfunction." This has actually performed as he hoped. I have not had a breakthrough since the Jardiance took effect.
As ApHcm is a genetic disease and a child has a 50% chance of also having it, I would suggest you be screened for it. ApHcm can present at any time in your life. I was actually diagnosed at age 78 although I had an abnormal ECG at age 65 and it was missed. Wishing you good luck in finding appropriate treartment for your father. I know he has other issues beyond the Hcm, but if it is treated correctly, his quality of life should greatly improve.
-
Like -
Helpful -
Hug
1 ReactionI notice part of my sentence was deleted. I meant to say that @gloaming has a great deal of knowlegde about Af but that I disagreed with his opinion about your father's hypertrophy being caused by the Af. Sorry for the confusion.