Failed ablation, what next?

I just watched a video on YouTube presented by a physician who is an expert on A-fib and its treatment. The video is entitled "10 Things You Need to Ask Your Doctor Before an Ablation." I thought I was pretty savvy on what to expect but I had to admit that I did not know all the things I should have asked about the ablation I am going to have in the next 6 weeks. I'm a nurse but have no expertise in this area. I was surprised to learn that some electrophysiologists do mostly "standard" ablations which involve only the one wall with the pulmonary vein areas that are sort of the standard problem in early A-fib cases. I also learned that a patient should ask about the doc's success rate, whether he does more complex ablations, his level of experience with all types of ablation procedures. I want a pulse field ablation but this video suggests that this method is most successful with smaller areas of A-fib cells and that more chronic cases are not necessarily appropriate for this method. I think you should search on YouTube to see if you can find this information. I was told originally that I needed to be on an anti-arrhythmic before the actual ablation, but I found Flecainide very troublesome--with some side effects and then reading the Black Box warnings, I decided that since I was in NSR when I started that med, I wouldn't know if it was doing any good anyway! I told the APRN that I have been in NSR since June and I didn't want or need to be on that medication before getting the ablation (they want you in NSR for 3 months before the procedure apparently.) I don't have a problem with Cardizem but I am not ever taking Flecainide again. I, like you, want to be treated before the A-fib spreads any further. I hope you get your answers and that you look around for the best treatment source since there are many options out there. You don't have to take one opinion only; since I have been diagnosed, I have learned that there are experts out there with better results than some local options and I would be willing to travel to get the best options. Good luck to you! As the song goes: it pays to shop around!

Hey there,

What were your side effects while in Flecanaide?

PFA is safer for the patient, and it normally doesn't require a TEE to ensure the energy isn't likely to damage the phrenic nerve and the esophagus, both of which run right behind the left atrium's outer rear wall. So, less to go wrong, less to do. It's effectiveness at 'success' is statistically insignificant at the moment between it and RF ablation. That may change, though, as more and more EPs become trained, acquire the equipment, and gain experience. It may be substantially better than RF, all things considered...just not at present.
A conscientious EP will challenge the heart in order to start AF or flutter so that he can map the rogue cell locations and zap them. They do use at least two chemicals, but even intravenous caffeine will do if nothing else. The two preferred are adenosine and isoproterenol. But more than that, before they release you to Recovery, they'll repeat that challenge. In my EP's case, he also routinely cardioverts the heart, even if it has turned to NSR by the time he's ready to call me done.
As a human being, if an EP is having poor success rates with PFA, you could appreciate that he would rather default to RF, certainly after a nasty run of failed ablations. I would. But considering that the failure rate for both techniques is about 25%, I would think that PFA would not have a higher rate of failures for any one (trained) EP than RF. I may be wrong, maybe only about your EP, but I don't think so. He would probably WANT TO do PFA because it presents less risk of damage to you on that basis alone.
If it helps, cardioversions have never worked for me. I know an aged woman who has had 50. !!! Obviously, none of them worked for her for more than a month or two. My longest lasting one was a whopping 16 hours. My first ever cardioversion never did work. To add insult to injury, I came to just as the tech pressed the button for the third, most powerful, jolt. That was NOT fun.
If you look for Dr. Lee's video channel on YouTube, and search for a recent one, 'Why do catheter ablations fail,' he goes into some detail about what is happening in the more complex cases and why some EPs are simply not experienced and/or skilled enough to do the job. So, if you have means and can afford to skip around looking for the very best EPs (that I have heard of in the USA, I'm Canadian), then you need to get in line behind Dr. Andrea Natale at the Texas Cardiac Arrhythmia Institute in Austin, or Dr. Pasquale Santangeli at Cleveland Clinic. They're worth the wait. Note that Natale has privileges in several mid-western and western hospitals, especially in CA. He often travels to them to perform in-situ operations for patients who can't travel much.
One last thing that I didn't get to, but as an afterthought: as it was in my case, sometimes the lesions created in a first PVI do not close properly against each other to create a contiguous 'dam' of fibrosis (over which the electrical impulses cannot pass, so no more AF!). If there is a sufficiently large, and clean, gap, those signals can escape the pulmonary vein ostia and do their worst. So, maybe a re-do of that simple and initial ablation is all that's really needed for you. Maybe. Your persistent category of AF doesn't bode well for that simple remedy, unfortunately, but with no experience as an EP, I can only guess. I think the EPs often redo the 'dam' of scarring, maybe using RF this time, and if the heart lurches back into NSR, then it's all done. Happened exactly that way for me on my second ablation, same EP. He was working around the third pulmonary vein when my heart suddenly resumed NSR as he did one zap. They stood back, watched, hi-fived, and he said he didn't even work on the fourth vein. He didn't even cardiovert me, which is his normal practice. He knew he had found what he'd missed the first time. As I said previously, I'm into my 30th month and going strong. Called his office on the first anniversary and introduced myself to Crystal, and said why I was calling, she actually laughed. I wanted them both to know how important their respective skills were to me.

I'm happy for you that you've had good success with your 2nd ablation. Am I reading your reply right in that you were once persistent and now you are paroxysmal, and at one time cardioversions weren't working and now you convert on your own?

I had ablation Sept 8 and felt great for 8days then back into afib. My son talked to EP and was told if this didn't work, as he did not think it would because of the damage to my heart for having afib so long, He would do a pacemaker. Has anyone had this done as a help for AFIB.

I can't be for sure I can remember having a 200 beat per min. on and off about 10 yrs ago and my BP monitor would have the afib heart with slash but when I would go to Dr. everything was good. I did not have constant AFIB until 4 yrs ago when I had a UTI that went sepsis and I went to ER thinking I was having heart attack when Dr found sepsis as well as AFIB so hospitalized for both. It was under control with a few flair ups a year but amiodarone always regulated my heart and I would stop the medication... I always thought it was a stress ful situation that set it off. This last time my cardiologist sent me to EP who decided I needed ablation. As I write this I am back into Normal Sinus for first time in 14 days. I am thrilled to death. I know I'm in blanking phase so I am so hopeful this holds

I had ablation Sept 8 and felt great for 8days then back into afib. My son talked to EP and was told if this didn't work, as he did not think it would because of the damage to my heart for having afib so long, He would do a pacemaker. Has anyone had this done as a help for AFIB.