Had second ablation - how long until a/fib bouts stabilize? Thank you!

I'll give it to you straight, and I have done a lot of reading on this topic, and have had two ablations about seven months apart:

The blanking period, normally three months, is meant to let the heart stabilize, heal its various burn lesions, and to decide if it wants to play nice. At the 13/14 week mark you are given a loop recorder or a Holter monitor for a day, maybe longer, to confirm the heart's current state. You get the results to you inside of two weeks, depending on the interpreting authority.

For the heavy majority of patients needing an index ablation (first ablation), the EP will only ablate around the pulmonary veins ostia, or their mouths, where they empty oxygenated blood from the lungs into the left atrium. Paroxysmal AF is 90% probably the result of rogue cells firing away inside the mouths of the pulmonary veins, so that's what almost all EPs will want to do first crack at you. The procedure is called a pulmonary vein isolation, or PVI.

The risk of failure of index ablations, across practicing EPs everywhere, is about 25%. This means only 75% of all patients receiving a PVI from any EP are going to find that they no longer have AF. Good! The rest need a re-do. I was one, and you're one. [Note: the very best EPs money can buy have a higher rate of success, more like 85-90%.]

Why a second ablation? Because the first was incomplete. Period. The EP didn't fully ablate a complete 'circle' of burns around the pulmonary vein ostia, or he/she didn't realize your case is more complicated and that you have other foci/re-entrants/rotors located in the other walls, the left atrial appendage, or the coronary sinus, as examples of other locations that should have been ablated because that's where your signals were coming from.

Remember, or in case you don't know it already, AF is a progressive disorder in the vast and heavy majority of patients. It moves at individual patient speeds from paroxysmal (comes and goes on its own, mostly behaves), to persistent, long-standing persistent, and finally to permanent. Hearts that endure longer and longer periods of AF will begin to change. It's called 'remodeling'. It's not good. So, the idea is to keep AF from happening to the extent humanly possible. The gold standard of care now is not drugs, not even lifestyle improvements (but they are both possibly key to long term success), but catheter ablation. It enjoys the greatest success across patients.

Last thing: second ablation attempts, across EPs practicing everywhere, have about a 85% rate of success, somewhat higher than the index ablations. Most EPs will re-ablate the pulmonary veins (happened to me, but this time, ablating around the third vein, my heart went into steady NSR and he knew he'd just ablated the one small gap he'd missed earlier. Remember, they're all but blind moving that catheter tip around and touching tissue and then stepping on the pedal to activate it). Then, they challenge the heart to see if it will go into arrhythmia. If it does, they know they must 'map' the atrium and look for other foci. He'll do those spots and hope for the best.

I'll give it to you straight, and I have done a lot of reading on this topic, and have had two ablations about seven months apart:

The blanking period, normally three months, is meant to let the heart stabilize, heal its various burn lesions, and to decide if it wants to play nice. At the 13/14 week mark you are given a loop recorder or a Holter monitor for a day, maybe longer, to confirm the heart's current state. You get the results to you inside of two weeks, depending on the interpreting authority.

For the heavy majority of patients needing an index ablation (first ablation), the EP will only ablate around the pulmonary veins ostia, or their mouths, where they empty oxygenated blood from the lungs into the left atrium. Paroxysmal AF is 90% probably the result of rogue cells firing away inside the mouths of the pulmonary veins, so that's what almost all EPs will want to do first crack at you. The procedure is called a pulmonary vein isolation, or PVI.

The risk of failure of index ablations, across practicing EPs everywhere, is about 25%. This means only 75% of all patients receiving a PVI from any EP are going to find that they no longer have AF. Good! The rest need a re-do. I was one, and you're one. [Note: the very best EPs money can buy have a higher rate of success, more like 85-90%.]

Why a second ablation? Because the first was incomplete. Period. The EP didn't fully ablate a complete 'circle' of burns around the pulmonary vein ostia, or he/she didn't realize your case is more complicated and that you have other foci/re-entrants/rotors located in the other walls, the left atrial appendage, or the coronary sinus, as examples of other locations that should have been ablated because that's where your signals were coming from.

Remember, or in case you don't know it already, AF is a progressive disorder in the vast and heavy majority of patients. It moves at individual patient speeds from paroxysmal (comes and goes on its own, mostly behaves), to persistent, long-standing persistent, and finally to permanent. Hearts that endure longer and longer periods of AF will begin to change. It's called 'remodeling'. It's not good. So, the idea is to keep AF from happening to the extent humanly possible. The gold standard of care now is not drugs, not even lifestyle improvements (but they are both possibly key to long term success), but catheter ablation. It enjoys the greatest success across patients.

Last thing: second ablation attempts, across EPs practicing everywhere, have about a 85% rate of success, somewhat higher than the index ablations. Most EPs will re-ablate the pulmonary veins (happened to me, but this time, ablating around the third vein, my heart went into steady NSR and he knew he'd just ablated the one small gap he'd missed earlier. Remember, they're all but blind moving that catheter tip around and touching tissue and then stepping on the pedal to activate it). Then, they challenge the heart to see if it will go into arrhythmia. If it does, they know they must 'map' the atrium and look for other foci. He'll do those spots and hope for the best.

@gloaming I should add one sobering thought (sorry): the literature I have seen suggests that you want the odd bit of ectopy or AF to happen in the first four-to-six weeks of the blanking period. If you go much beyond that, say near the end of the blanking period, no recurring AF or ectopy, but suddenly in Week Nine you get a long run of AF.....that's not a good sign. Again, you want the 'blips' early, not later in the blanking period. Events happening later suggest a poorer prognosis.

That sober fact said, I have seen numerous personal accounts posted here and on other health fora by people saying they had a lot of ectopy and AF for months and months, and had given up on their ablation and their EP. But, one day, a year later, they realize they haven't had any arrhythmia for weeks! After many more weeks free of AF, they begin to realize they needed more time to settle and that their EP did the ablation properly.

So, we all must trudge along a path toward resolution, whatever the end-state is to be. Some will have a breeze of it and go on to never have AF again. Some endure repeated ablations, and none seem to work (remember, the skill and the experience of the EP is probably the single most important determinant of success, not the technology or method of delivery, such as radio frequency versus pulsed field).

Lastly, I know of several people who have had five/six ablations until they saw the right 'guy' or 'gal' who stopped their arrhythmia. Don't feel tied to one EP, especially if they've had two cracks at you and you're still fibrillating. Find another EP. The two best I know, if you have the means and the motivation, are Dr. Andrea Natale at Texas Cardiac Arrhythmia Institute in Austin, and Dr. Pasquale Santangeli at Cleveland Clinic.

I'll give it to you straight, and I have done a lot of reading on this topic, and have had two ablations about seven months apart:

The blanking period, normally three months, is meant to let the heart stabilize, heal its various burn lesions, and to decide if it wants to play nice. At the 13/14 week mark you are given a loop recorder or a Holter monitor for a day, maybe longer, to confirm the heart's current state. You get the results to you inside of two weeks, depending on the interpreting authority.

For the heavy majority of patients needing an index ablation (first ablation), the EP will only ablate around the pulmonary veins ostia, or their mouths, where they empty oxygenated blood from the lungs into the left atrium. Paroxysmal AF is 90% probably the result of rogue cells firing away inside the mouths of the pulmonary veins, so that's what almost all EPs will want to do first crack at you. The procedure is called a pulmonary vein isolation, or PVI.

The risk of failure of index ablations, across practicing EPs everywhere, is about 25%. This means only 75% of all patients receiving a PVI from any EP are going to find that they no longer have AF. Good! The rest need a re-do. I was one, and you're one. [Note: the very best EPs money can buy have a higher rate of success, more like 85-90%.]

Why a second ablation? Because the first was incomplete. Period. The EP didn't fully ablate a complete 'circle' of burns around the pulmonary vein ostia, or he/she didn't realize your case is more complicated and that you have other foci/re-entrants/rotors located in the other walls, the left atrial appendage, or the coronary sinus, as examples of other locations that should have been ablated because that's where your signals were coming from.

Remember, or in case you don't know it already, AF is a progressive disorder in the vast and heavy majority of patients. It moves at individual patient speeds from paroxysmal (comes and goes on its own, mostly behaves), to persistent, long-standing persistent, and finally to permanent. Hearts that endure longer and longer periods of AF will begin to change. It's called 'remodeling'. It's not good. So, the idea is to keep AF from happening to the extent humanly possible. The gold standard of care now is not drugs, not even lifestyle improvements (but they are both possibly key to long term success), but catheter ablation. It enjoys the greatest success across patients.

Last thing: second ablation attempts, across EPs practicing everywhere, have about a 85% rate of success, somewhat higher than the index ablations. Most EPs will re-ablate the pulmonary veins (happened to me, but this time, ablating around the third vein, my heart went into steady NSR and he knew he'd just ablated the one small gap he'd missed earlier. Remember, they're all but blind moving that catheter tip around and touching tissue and then stepping on the pedal to activate it). Then, they challenge the heart to see if it will go into arrhythmia. If it does, they know they must 'map' the atrium and look for other foci. He'll do those spots and hope for the best.