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

@blwood1
Good info. Thank you for your reply.

@blwood1 looking forward to what you learn from 2nd opinion. I had an ablation in November 2025. Was on Flecainide before and after procedure. 3 months to s post ablation I was taken off the Flecainide and 36!hours later back in Afib. I was told to resume it. At the end of March I had an Afib event lasted 12 hours. Got a break for a while and I just had another event that lasted 36 hours. I wonder how common this is and if having another ablation will stop the Afib?

@tomandpatti
That’s disappointing about your first ablation. I haven’t had a first ablation just a first opinion from an EP I didn’t care for so I’ll hope the second EP Tuesday has a better prediction. I would hope the first ablation would at least reduce the burden but l’ll be disappointed in anything other than 100% stopped. I just had a 65 hour episode instead of my usual 40. I was at a potluck yesterday and couldn’t eat one of the 20 dishes there. Half because of my dysphagia and half because they would trigger my afib. So many food triggers for me. It’s as much a social problem as a health problem. It really all gets old.

Because I’ve had about 150 long afib episodes in the past 5 years, I’m not expecting to hear one and done, but it would be a welcome surprise! Since I stopped the cancer med that was triggering the afib I’ve gone from 5 episodes a month to one a month for the past 8 months, but it’s not slowing down from there. I’m sure my heart has remodeled in the last 5 years. I’ll let you know how the second opinion goes.

@tomandpatti It is somewhat common for a first, or 'index', ablation to fail to stop the arrhythmia. About 25% of all index ablations fail. This is for one reason: the ablation didn't completely surround, or isolate, all foci sending voltage into the left atrial endothelium. About 90% of all 'paroxysmal' AF is due to voltage escaping the ostia of the four pulmonary veins which empty oxygenated blood returning from the lungs to the heart. So, there is a 90% probability that a thorough job of ablating the tissues surrounding the pulmonary vein ostia will stop the AF. However, the skill, experience, and how much of a 'bad hair day' the electrophysiologist is having play a part in how comprehensively and completely the EP will ablate what needs ablating. Since we know that approximately 25% of all index ablations fail, it suggests that quite a few misses take place when moving the catheter energy tip around and touching it to the right spot, and then the EP steps on a pedal and counts for 10-18 seconds while the tip heats and destroys endothelial tissue near it. If there's a small gap that doesn't get heated, and fails to form a scar (the electrical voltage cannot cross scar tissue, and that's how ablation stops the signal from spreading away from the pulmonary veins), then some voltage will escape the pen or stockade, or ring, of scars and continue to cause the atrium to beat as chaotically as before the ablation.

Is it worth a second ablation? Well, that's up to you, but I would ask the EP what he/she intends to do more/differently from the first attempt. In many cases, and I was one such case, a second ablation was a re-do of the PVI...the pulmonary vein isolation. When my EP came to report what had happened after I was alert, he stated that he ablated the first and second ostia, and was in the process of ablating around the third pulmonary vein when my heart went into steady normal sinus rhythm. They watched for a bit, challenged my heart with isoproterenol, and when it stayed in rhythm, he knew he had just found the one tiny non-scarred gap he'd missed the first time. I have been free of AF since March of 2023.

In your case, it might be more involved. You may need a redo, or you may have a second or a third location that he/she failed to isolate, or even to detect the first time. Your left atrial appendage is another possibility (LAA), or your coronary sinus is another place where they find foci. Even the septum between the two atria can be a location where signal is getting through, and in some rarer cases the Vein of Marshall is involved. What is important, though, is the skill and experience of the EP when it comes to more involved or 'complex' cases....which you may be. So, it wouldn't hurt, if you can afford to do it, and have enough patience to wait for the appointments, to seek the assistance and advice of a 'better' EP. Unless, of course, you trust your current EP and he/she makes a convincing case for another attempt with a concrete plan.

My second opinion on an ablation went very well. I have full confidence in the EP and his NP, great team! Addressed all my concerns about added risks due to my many rare conditions. The only possible issue may be a rare venous anomaly found incidentally in an MRI report. He’s requesting the actual images for review and may order more imaging for mapping. He’s also planning to bring in an interventional radiologist due to the anomaly. If he can find a safe path to my heart, he believes there’s a 90% chance he can fix me in one PFA. That would be great. Again, if a safe path is available, he believes I’m a good candidate for the watchman as well. They’ll get back to me after they review the images. Probably the best experience I’ve ever had with a provider. So different from the first EP I saw.

I hand my second ablation on June 4th. I was told it would take about 6-8 weeks or longer for heart to calm down from being damaged. It becomes very irritated when ablated.

I was told to expect continued tachycardia and PVCs as my heart recovered from the ablation and calmed down to see the best results from the ablation.

I had 3 different areas with PVCs. What my EP told me was 1 (the main culprit) was access from inside the heart and ablated. The other two were coming from and area outside of heart and needed to be ablated from outside so could not do when inside the heart.