What downside have you experienced after an ablation?

Hi mishel,
I had been experiencing heart palpitations since 2017 or so, but was not correctly diagnosed until 2020 with a Ziopatch wearable heart monitor. The first cardiologist misdiagnosed me with a normal heart ( totally missed the mitral valve prolapse & regurgitation), and missed the arrhythmia by only doing an ECG. Had increasing incidents and then one night my heart did flip flops for six hours. The next cardiologist only caught the atrial flutter. Then went to a big teaching hospital, and two top EP cardiologists there picked up on the Afib, too!
Each of them recommended a catheter ablation as a first-line method of intervention, and I could forego most of the drugs.
In retrospect, I think I should have first tried more natural means of treating the AF and AFL. The actual ablation took upwards of 4 1/2 hours, as the EP discovered I had a septal pouch wherein the aberrant AFL cells were percolating. It was difficult to ablate this hard to reach area, so I was under the anesthesia about 2 hours longer than predicted. I had two ocular migraines following the procedure, and was plagued by frequent PACs for over a year. I found these more bothersome than the AF! I also experienced other types of arrhythmias (SVT/AT/sudden rate drops) which were picked up by the implantable loop recorder necessitated by the perceived arrhythmias.
A recent brain MRI shows increased brain changes since an MRI taken just prior to my ablation. Could that be a result stemming from the prolonged sedation or minor infarcts from the procedure itself? Who can say for sure….
It’s over 4 years since the ablation, and I am still in NSR with those blips along the way. Thankful for the return to normalcy, but still wonder if I did the best thing for me.

I had no difficulties. My first ablation failed at six days, I was hospitalized with a runaway atrial rate, 180+, and had to go on amiodarone for 10 weeks. A second ablation, same EP, came seven months later and this time he got 'er done. Whew! I knew I was in AF, while some patients have no idea. Same for flutter...I knew full well I was in arrhythmia, whereas two people I know hadn't a clue.

Everyone is different. Each EP is different. How you recover, and what subsequently becomes part of your daily experience, is unknown and unpredictable. I know of one person who had migraines. Some get flutter and need yet another ablation. Some only get some PACs or SVT. It's not a crapshoot in terms of stemming the AF if that was the original problem, but what happens after that won't be known until some time into the 'blanking period' of about 10 weeks that follows, after which you'll get a Holter monitor or some kind of measuring device that can track your heart rhythm, usually worn for an afternoon, over night, and you return it to the issuing party next day by about noon-ish. You get the results days, two weeks later...whatever the local rate is.

PFA is currently only used for the standard PVI (pulmonary vein isolation). That location is where something like 80% of all paroxysmal AF originates. The shape of the mechanical 'head' is designed to be placed at the ostia of the pulmonary veins and then energized. It currently cannot be used in the coronary sinus, for example, nor in the left atrial appendage.

About drugs: I was issued with both Eliquis, a DOAC (direct oral anti-coagulant) and metoprolol tartrate (the slow acting version). The risk of stroke when, and after (yes, after it stops!!!) fibrillating is at least six times as high as previously, generally, on average. So, your cardiologist should have you on a DOAC immediately. You can refuse, but then the cardiologist wonders what kind of a patient he/she is dealing with. If he/she just shrugs, go away happy, but with six times the risk. Metoprolol is a beta blocker:
https://www.webmd.com/drugs/2/drug-8814-2372/metoprolol-succinate-oral/metoprolol-succinate-extended-release-capsule-oral/details
Note that metoprolol can help with incipient hypertension, but in this case it is meant as a 'rate' control medicine that keeps the heart from beating too fast when it is in arrhythmia. Ideally, you should not have a heart beating at more than 100 BPM for more than 24 hours. Note also, that too much metoprolol can put you into bradycardia where your heart beats too slowly. If it drops below 45 BPM regularly when you're awake, I would question my cardiologist soon about it.

My last point, still about drugs: they tend to lose efficacy over time, and this because the disorder, itself, evolves over time. The disorder progresses, and not in the right direction. So, you'll need more of the same drugs, or you'll have to find another that works. Many do not tolerate all the various anti-arrhythmic drugs, and amiodarone is moderately toxic...you don't want to be on it more than a few months ideally. So, my real point is that if the drugs are losing ground for you, a mechanical fix is all that's left. Except, there isn't one. The closest you can come to 'fixing' a fibrillating heart is to ablate the locus or re-entrant point where the extra signal is getting in and forcing the atrium to contract. If it works, the ablation dams, literally, or places a stockade, of fibrosis/scarring around the affected area, and that scarring prevents the electrical impulse from moving outward and causing the contraction. Literally, ablation is the process of damming the area to prevent the signal from spreading. No signal spread, no contracting atrium. (Picture Mr. Burns with his evil look and saying, 'Eeexxcellennntt...').

There is a lot more to say, but it's already a book I've typed. You can google all related topics and read for another three hours easily.

My cardio has never even suggested an ablation and at this point I wouldn’t accept one. Started having afib back in 2007 and on and off for 5 years. Around 2013, he put me on tikosyn (dofetilide) and I have been fine ever since. With the exception of 2 episodes in 2022 which I attribute to Covid shots! No problems since. I’m sold,on tikosyn.

I was 60 when my afib started in 2006. Cardiologist tried me on two meds but neither worked. In 2008 I had a pulmonary vein ablation that took 10 hrs. It was done by the leading expert at University of Pennsylvania Hospital at the time. The afib was successfully stopped for 14 years. I was blessed. Last year (2023) I started with
aflutter. In July 2024 I had a Watchman implant to prevent clots traveling to my brain. In Nov I had another ablation. This one took 3 hrs but started afibbing a week later. Then had a cardioversion and all is well. My heart is 18 years older now which might account for the initial 2nd failure but I have faith in my electrophysiologist and his skill and reputation. Our hearts get older just like the rest of our bodies.
Keep looking for a good EP and follow his/her advice, if you can. If not, get a 2nd or 3rd opinion.
Blessings to you.

hi - I had two PFA consults this year, in June and Sept. Both EPs are well-respected/experienced. One was at Mayo/Rochester; and one was local/Silicon Valley. They both explained that PVI and PVI Redo should no longer be done with RF, nor cyro, due to PV stiffening [etc.]

hi - I started Dofetilide 500mcg BID in April, then reduced to 375 in July and 250 in Sept - it's working well for me, too!

So given the success of the last ablation, did your physician give you any indication of how long you would need to continue with the Eliquis?
My last (third) ablation seems to have worked as I’ve had no symptoms since. Like you, I was always pretty sure of when I was in AFIB. And I take my BP daily with a device that shows if there is an irregular rhythm. I got no feedback about discontinuing the Eliquis. I don’t have any problems with that drug except that it is pretty expensive.

Great question, and most reasonable. I appreciate that you're actively reading and thinking analytically about what I post.

I was told by my cardiologist that I would be placed on Eliquis for life. I don't recall him explaining the rationale, just that I was now going to have to rely on its efficacy until I die. I have since learned that the cardiology milieu, across the globe, have adopted an assessment model known as CHA2D2S-VASc. Like everything else in medicine and in natural philosophy (AKA 'the sciences'), they modify their models and introduce new ones constantly in an effort to improve the 'predictive validity' of their theories and models. CHA2DS2-VASc has undergone some revisions, and the one I site just here is the latest. The model imparts a score based on several risk factors, after which a total score is derived. Scores above 1.5, generally, are advised to go on a DOAC (Direct Oral Anti-Coagulant, sometimes referred to as NOAC, with N standing for 'novel', because these drugs are all relatively new, and newer ones supersede them or are introduced regularly). I had a score of 1.5, some would argue that it was a solid 2 while I was in AF (atrial fibrillation). So, I was told to accept that, if I wanted to live relatively risk-free from thrombolytic events, I should take Eliquis for life. I believe my score is now under 1.5, and could unilaterally stop taking a DOAC of my own volition and probably, not certainly, not suffer undue risk as a result of a foolish choice. My cardiologist might beg to differ. I haven't asked. I still take the Eliquis.
https://www.mdcalc.com/calc/801/cha2ds2-vasc-score-atrial-fibrillation-stroke-risk
I am on a medical plan up here in Canada, so I normally only pay an annual deduction on my insurance, and then the dispensing fee for each purchase/renewal. I have seen people say that they get their various drugs from online pharmacies in Canada, and that the prices are substantially better. I don't know the details, since they don't particularly interest me, but I hope someone has seen this thread and knows of the details.

Great info in this. Thanks so much for sharing!

hi - in my experience, Mayo is a great data source - see link.