Ablation

You need more feedback about what is really going on and what you fear or suspect might be going on. I suggest a Kardia 6L, only a few dollars, no subscription required (although if you subscribe you get improved function and data), and they're small and thin, won't take up any room in your purse or backpack. Take a reading any time your dread pops up and you think you might be slightly or fully arrhythmic.

Are you still on any medications?

I had my first (and hopefully only) ablation in November 2025; I had some PAC's afterward and was worried that I had traded in one arrhythymia for another, but I was reassured by my cardiologist that many people have these "skipped beats" sensation and I was much better off than before. After I stopped worrying so much about it, I have been fine with no A-fib and very little awarenss of an occasional PAC. I certainly know that everyone is different and I understand your anxiety completely. I would contact your doc if you continue to feel lousy; do you have a "mychart" way to ask a question or express a concern. I like this method so I don't have to get an appointment to find out if I should be concerned with something. Also, watch some YouTube videos on A-fib information to get some perspective on how your particular history of A-fib can affect your long term success with an ablation. I was encouraged that lifestyle changes can play a big part in how successful you can be with controlling the episodes. I gave up all alcohol, watch the caffeine (drink 1/2 caf all the time), keep well hydrated, try to sleep in a non-triggering position, avoid processed foods if I can, and lost 10 pounds, even though I was not overweight. I have been so pleased with my results. I exercise every day at the gym--a really vigorous workout for an 80 year old! So hang in there; try to relax, take your meds and learn all you can to protect yourself from "triggers." Good luck and know that you are not alone! We have lots of fellow patients!

I had my first (and only, so far) ablation on Oct 8, 2025 to fix atrial flutter. All seemed good at the time, and my EP said he even tried to stimulate Afib during the procedure, of which he was unsuccessful (and happy about). Metoprolol was cut from 50mg per day to 25mg per day on the day of ablation. On Jan 7, 2026 metoprolol was reduced to 12.5mg per day for a week, then stopped. By late Jan/early Feb 2026 I was noticing a few palpitations. I figured this was a short-term issue (primarily from readings). By April, I mentioned to cardiologist. He thought the issue would resolve. Palps continued to become more noticeable, particularly at bedtime and during the night, and I was dizzy a couple of times. In June, cardiologist order a Holter (actually a Zio) Monitor to be worn for 14 days. Results came in this week:

PRELIMINARY FINDINGS: Patient had a min HR of 45 bpm, max HR of 152 bpm, and avg HR of 63 bpm. Predominant underlying rhythm was Sinus Rhythm. First Degree AV Block was present. Intermittent Bundle Branch Block was present. 44 Supraventricular Tachycardia runs occurred, the run with the fastest interval lasting 5 beats with a max rate of 152 bpm, the longest lasting 13 beats with an avg rate of 113 bpm. Idioventricular Rhythm was present. Supraventricular Tachycardia was detected within +/- 45 seconds of symptomatic patient event(s). Isolated SVEs were frequent (14.6%, 179102), SVE Couplets were occasional (1.4%, 8861), and SVE Triplets were rare (<1.0%, 489). Isolated VEs were rare (<1.0%), VE Couplets were rare (<1.0%), and no VE Triplets were present.

I have a regularly scheduled cardiologist appointment on Aug 3, and cardiologist has already referred me to the EP group with appt on Sep 16.

In the meantime, does anyone have experience in reading and interpreting the results? The most concerning to me seems to be the (i) SVEs: 14.6% of all beats were isolated extra SVEs (179,102). There were also occasional pairs (couplets) and rare triplets??? AND (ii) Supraventricular Tachycardia (SVT) runs: 44 short bursts??? This is kind of unnerving.

Thanks in advance.

@vaughandodd Very understandable. The first thing to know about flutter, fibrillation, and ectopy is that they're kissing cousins. You'll find them under the back stairs after supper having a bit of a snog. (I hope you'll excuse the metaphor...it's rather apt, and I'll explain...)

Everyone has ectopy...or at least the variety known as PACs, premature atrial contractions. Some sources call it 'premature atrial complexes.' Every heart has them, but most hearts have two-maybe six each day. Inconsequential, and it would raise an eyebrow if there were none at all. They become intrusive when their number reaches about 1% of all beats in a 24 hour period, and they become a problem when they reach about 2.5-3% of all beats in a day. Increased morbidity is what they tell us. Your formal assessment has you well up on that upper limit, so you will need, and want, some sort of a concrete and 'doable' plan to reduce those SVE's. An ablation, in the right hands, can do that.

So, your SVEs are nothing more than PACs. You're getting a lot of them. Join me on the bench...I've kept the seat warm for ya. I went from AF to PACs, and the helpful outreach nurse from the cath lab told me my Holter showed, '...a LOT of PACs.' I emphasised 'lot of' because she did on the phone to me. Not good, and in about a month I was back in full blown AF. This may sound alarming, but each case is different. I was a complete ablation failure a whole six days out and in the local ICU and put on amiodarone. That short regiment worked after seven weeks and I was actually pretty good until visiting my youngest and her boys about six weeks later. I went into AF and had to return home. I had a second ablation three months later, which has me in NSR and very comfortable, and grateful, for about 3.5 years now.

It is often the case that ablatees for AF will soon develop AFL. Uusually it's just a simple correction, again in the cath lab, and that's it for a great many patients. Sometimes PACs evolve to become AFL or AF, or the other way around. It's like whack-a-mole for the EP who is decidedly not very happy to have you back in the cath lab inside of a couple of months or more. They really do like to get the job done the first time, but the failure rate for index ablations is 25%, with variance between the best EPs (85%) and the run-of-the-mill technicians who have failure rates in that oft-cited 25%.

So, unhappily, and I have no formal diagnosis for you since I am not qualified and not your PCP or cardiologist, you and I are on the 'index ablation failure' list. You apparently.

This topic, and the way I explain it, can get very windy and long, so I will stop at this point. There's a lot to know, but I chiefly want to tell you that, as much of a bummer as it surely is for you, it's not all down hill from here. If you are a candidate for a re-do, your EP will do it...I'm sure. If you have other problems that need attention and that make you a poor candidate for a second ablation (the BBB may be that, but again I wouldn't know...I'm not trained).