Ablation, when it “didn’t work” or "made things worse"

Some arrythmias are epicardial meaning they come from outside the heart. There is a mini maze procedure that has worked in many cases. Adventist health is St. Helena CA does them as do other facitlities. Puncture incisions are made through the ribs, 3 on each side but they may need to deflate your left lung. Chest isn't cracked. I haven't seen reference to UCSF but that is where the first US procedure was completed for ablation according to UCSF. I believe they do the mini maze also.

@activegal In my experience, an EP will want all obstacles to success dealt with before they enter your heart and fiddle with pokey things that do damage to tissue. So, if you have mitral valve prolapse or stenosis, they would almost certainly insist you get that dealt with first. Orthopedic surgeons tell their obese patients to come back for their hip/knee replacements when they've lost 30-130 pounds, whatever the case. Or, their work is just a waste of resources and of their skills. Same for EPs who want to help, but would be working against themselves, and you, if they agree to treat an arrhythmia in a heart whose main problem, the most serious one, is mitral valve failure (because AF doesn't kill the patient.....can make 'em miserable, but it won't kill you).

Yes, ablations are not a cure. Once your heart is electrically disordered and formally diagnosed, that's it for life. Everything else that follows is palliative....meant to make you comfortable, and ideally to halt or to slow progression. Ablations, if they work, stop the fibrillation, and it is the fibrillation that leads to atrial enlargement, more heart valve damage due to the strains involved, and possibly heart failure in time. No fibrillation = slowed progression. No fibrillation means you'll almost certainly die from something else. But the literature also insists that even if you are in permanent AF, it is highly unlikely to kill you, even after years. It may lead to heart failure, which COULD kill you, but AF, in and of itself, is not a lethal condition. Stroke is the great risk of AF, and that is why almost all patients stay on a DOAC for life. By then, in most lives, well-aged, you have other things going on that also make the intake of a DOAC a wise choice.

The more advanced your progressed case of AF is, the more 'complex' it is, and the more tissue and locations must be both found and then ablated. Not al EPs have the training, the....[cough] gonads, or the experience to do what it takes to rid the complex case of fibrillation. That is why we over at afibbers.org forum harangue newcomers, and each other if we need an EP's services again, to do the homework and find the right EP who will do whatever can be done ethically and safely for you. The heavy slogging.

I feel for you...I absolutely do know what you're experiencing because......been there. People tell me I looked pale, even grey, in the weeks before my first ablation. Yeah, I needed two. I was in that unfortunate statistic where 25% of index ablations fail. But, same EP, same technique, seven months later he did the trick and I am free of AF for nearly 36 months now (Deo gratias!).

I believe that, the more you read up on your condition, the more you'll realize that an ablation....BY THE RIGHT EP... is still your best bet going forward. I don't know if you can wrangle it out of province, but my guy is Dr. Paul Novak at Pulse Cardiology in Victoria. He was the 2002 Canadian Cardiology Candidate of the Year.....not so shabby. 😀 If you can tap into some money, and don't mind travel and commercial lodgings in the USA, Dr. Andrea Natale at the Texas Cardiac Arrhythmia Institute in Austin is one of the very best on the planet.

Thank you @gloaming for your useful information. You confirmed what I thought. Fix the root problem then the chance of correcting the a fib will be more likely. If anyone on this forum has suggestions regarding surgeons in Canada that have experience with complex “redo “ surgeries on mitral valve repairs with moderate to severe stenosis, that would be very helpful. So far I’m looking at Dr. Vincent Chan at the Ottawa Heart Institute, Dr . Michael Chu at The London Health Sciences Centre and my original surgeon, Dr. Tirone David at University Health Network, Toronto but he is retiring this summer and is now 82 years old. Dr. David is world famous and has a vast amount of experience. A surgeon with experience with removing and restructuring the valve is not easy to find. It is easiest to pop in a biological valve but removal of the old scarred annulus band is the tricky part. My problem to date is getting a referral out of province due to my current cardiologist who is not wiling to give this. I am convinced there is no one with the advanced skills at redo surgery in NS It’s true. Here they just leave you on the shelf to wither, especially if over 60 years. Anyway, maybe someone on this forum has a surgeon that deserves consideration. I’m soon going to use more radical means to get a surgical consult from a cardiologist here. I won’t give up. But I’m not sure if I’ll be any better off with or without the surgery regarding reclaiming my past lifestyle but at least I should be alive for 5-10 more years. Thank you again.

Gosh this happened to me. I had first ablation for paroxysmal afib so I could get off meds, 3 months later I was in flutter, then ablation 2, then SVT and ablation 3&4. Now still on meds bc everytime with SVT had to go get converted at ED. None of the home techniques work for me. So wish I had never started this process.

@jennirdh So very sorry to see this. I think I would have folded up and called it a life the way it was going for me, and I only needed the second ablation. You must have a solid constitution.
😀

@jennirdh I'm so sorry, what a journey!

@gloaming thank you for the compliment! I did all this after cancer treatment, and last ablation was in 2019. This was all before I did my own research on everything, 2020 opened my eyes that I should not blindly trust doctors to know what is best for me and just do what they say, so since then I have been much much more discerning. But there is a lot of scarring etc and I am on Flecainide which is currently working for me.

@jennirdh
'...and I am on Flecainide which is currently working for me.'

Thank God for small mercies. And yes, without intending to get into politics, April 2020 showed discerning adults that the medical establishment has a lot to learn. We should all hope it happens because something like, or even worse than, 2020 is not far off. Not with the globe warming and what that does for mosquitoes.

I had afib and a successful ablation. However, my leaky mitral valve caused my afib to crop up again about a year and half later. Leaky/regurgitating valves can trigger afib, not sure about a blocked valve. I had mitral valve repair with an annulus ring and a couple goretex chordae replaced, which took care of the afib. Seems like it would be appropriate to take care of everything at once, but that is between you and your cardiologist, ...hopefully you can find one you can work with comfortably.
All the best to you!