Ablation vs med management?

Posted by megansims @megansims, Aug 14, 2023

Tachycardia. During the ablation, they fixed the Atrial Tachycardia, and also induced Atrial Fib/Atrial Flutter, which they also ablated. I had symptom free period for a year and a half, and the Atrial Tachycardia (SVT) returned. On the monitor, my burden of SVT/PACs was at 24%. They recommended another ablation. They were unable to induce the rhythm and have been trying different medications. I am so sensitive to most meds and have side effects worse than the SVT. We have tried Beta Blockers (which do not work as mine is vagally mediated), Diltiazem, Flecainide, and now Norpace. The doctor is not opposed to another ablation but wants to try at least a few more meds. Because of my sensitivity to meds, I am hesitant and wondering if the standard of care would point more to trying another ablation? I am 48, not in any other meds, no other significant history related to the heart.

I am not sure if I should just keep on trucking and trying meds, or if I should push more for another ablation. I would be so sad to do it again and have it not be successful again, but the meds all seem awful.

Interested in more discussions like this? Go to the Heart Rhythm Conditions Support Group.

gloaming | @gloaming | Aug 15, 2023

Has propafenone been tried? Multaq, Sotolol....? I don't know how you'll feel about my advice, nor how my advice will be taken by the good folks who monitor the discussions at Mayo, but on the afibbers.org forum where I am, the two chief moderators both have extensive experience on the subject, and both have been successfully ablated by Dr. Andrea Natale of Austin Cardio in TX. He is well known, travels to several hospitals, mostly out west, and performs ablations and watchman implants almost daily. He was trained by the vaunted Dr. Pierre Jais in France. If you are not averse to travel, and want one of the top 10 electrophysiologists on the planet....

Justin McClanahan, Moderator | @JustinMcClanahan | Aug 15, 2023

Hello @megansims. I'd like to invite @diane69, @kai, and @danab who have all undergone two ablations.

@megansims - Am I understanding correctly that you have already had two ablations and you are considering a third? Or did I misread that as you are potentially facing your second ablation but your provider wants to try medications first.

If you are comfortable sharing, what sort of side effects have you been experiencing and have you shared them with your provider?

megansims | @megansims | Aug 15, 2023

In reply to @gloaming "Has propafenone been tried? Multaq, Sotolol....? I don't know how you'll feel about my advice, nor..." + (show)

Thank you for the advice! Appreciated greatly!! Multaq, Sotolol are not appropriate for my situation, but we did try Multaq. I will look into an outside EP consult/ablation as well. Thank you!!
As for the ablation, I had one successful ablation in 2021 that lasted a year and a half. The second ablation was attempted but they were unable to induce the rhythm so they recommended medical management. I have mostly CNS side effects (headaches , anxiety/agitation, nausea, dizziness, etc. I have a normal blood pressure that is low, so I have less room to wiggle with the heart meds. I am trying Norpace next but am cautiously skeptical as I have had so many issues. I know the ablation is not risk free, but it would be nice not to spend the rest of my life in meds (I am 48).

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