Had unsuccessful ablation last week. What happened, and what's next? Thoughts and ideas appreciated.

Hi all. Amazing forum here! I spent hours yesterday reading through much of the last 2 years of posts, and learned so much.

I'm 51, very good health and weight. Literally zero health issues, other than persistent afib.

It was diagnosed last November, although it may have started earlier. It is persistent, it never goes away.

I initially saw a cardiologist, he put me on Flecainide 50mg twice a day. Did it for six weeks with no results.

I had a catheter ablation done at Cedars Sinai in Los Angeles last week. In the CT the day before, they found that my left atria was enlarged to around 190ml (they said normal is 70ml. I'm not sure how that translates to the mm measurement that I commonly see).

Before the procedure, the Dr. said that because of that enlargement, chances of success would be reduced.

The good news is the procedure went very smoothly, no problems. The bad news is it didn't work. My afib is the same as it was before.

I don't have much of the details on what they did, although I think I'll try to get that next week. I do know they did a catheter ablation, the total time spent was around 2.75 hours, and they also did 2 cardioversions. I think after the cardioversions I went into NSR for about 1 minute before going back to afib.

Here's some questions:

1) The Dr. said it is still a small possibility that it will work over the next few weeks as scar tissue builds. Is there any hope for that?

2) He didn't put me on any anti-arrhythmia meds. I'm only on Eliquis. Is that normal?

3) I notice that there is very little talk here about surgical ablation (like Mini-Maze), and that instead people tend to have 3 or 4 successive catheter ablations instead. Why is that?

4) Drs. that I spoke with seemed to say catheter ablation has a 50-60% chance of working on the first try, but reading here, it seems that is optimistic. But maybe that just seems that way because posts here aren't a random sample (i.e., people who are successful on the first try probably don't post it on the internet). What do you think the real one-and-done success rate is?

5) How much of a problem is my enlarged LA as far as success for ablation?

As of now, my plan of action is to set an appointment with Dr. Natale for a second ablation.



Edited 1 time(s). Last edit at 06/17/2017 04:59PM by Mac.

One other thing, my blood pressure has always been on the low side. Usually around 95/65 or so.

Hi Mac,

I got your PM a short time ago and replied to you in kind, and so please read my PM reply too for next step. And while, typically, you cannot determine whether or not an index ablation is successful after just one week post ablation, in light of your persistent AFIB and enlarged LA, there is a good chance your procedure at Cedars Sinai was more limited than the more advanced procedure required for long term success with persistent and LSPAF (Long-Standing Persistent AF) ... which very well may be the kind you have if you have been in persistent AFIB for a year or longer non-stop.

An enlarged left atrium does indeed increase the odds for needing more extensive work than is covered by a standard PVI-only isolation of the four pulmonary veins. If you have a copy of your Ablation Report that details exactly what was done during your ablation, then lets discuss over the phone and go from there. There is very much light at the end of this tunnel and don't be focused on a 'one and done' success with persistent and LSPAF .,.. indeed for all AFIB ablation we urge folks to be prepared for a two procedure process overall and just be happy as a clam when it does turn out to be done in one.

The key point is in partnering with the most experienced EP in doing persistent and LSPAF cases that you can possibly arrange for yourself, and by choosing wisely in your next step and going forward, you can rest assured that he or she elite level ablationist will be able to return you to durable NSR in the least amount of total work being required for your degree of AFIB progression.

Take care,

Shannon



Edited 1 time(s). Last edit at 06/17/2017 05:12PM by Shannon.

I agree with Shannon, that success is not always immediate. 2-3 days is not long enough time time to declare failure.
Your next step should be to find out what exactly they did, and get the Ablation Procedure Report.

Mac,

Welcome! Sorry you're here but its a great group and Shannon is an amazing resource.

From the little I know, if you're in persistent afib you'll need to see an EP who is very good at going beyond the pulmonary veins. Those folks are few and far between; Dr. Natale is one and there are others, but typically as a patient you have to figure out who they are and seek them out.

Shannon can give you some great insights along those lines.

All the best -

Clay

Mac

You can't go wrong with Dr Natale. He is the very best in the country as far as I am concern!

My history I was in permanent afib. I hated it and decided I would kill it or it would kill me but I took action. First stop was Cedars Sinai. My first ablation failed there. Next I had a Wolf Mini Maze procedure at Cedars and it gave me my life back for two years then I went back into permanent afib. I was referred by several on this forum and from a Cardiologist at Duke University in NC to check in with Dr Natale. I did and 3 ablations later with Dr Natale I am afib free.

In my humble opinion I think Dr Natale is the best in the country! I am from Southern CA and had my ablations done at the California Pacific Medical Center in San Francisco. Dr Natale is based in Austin Texas. I am not sure how he operates today but when I had my ablations he was in San Francisco for two weeks and I think he also operates out of San Diego.

What he says in followups it takes 6 months after an ablation to measure its success. For me success was immediate. After my first ablation I fell so good despite I was in aflutter which is much easier to deal with than afib.

I wish when I was beginning my battle with afib I would have gone directly to Dr Natale! If I had done this it would have spared me my first ablation attempt and going through with the mini maze procedure I had.

I also suffer from sleep apnea and use a Cpap machine. If you haven been checked out for sleep apnea I would have a sleep test to see if you suffer from that as well.

Dr Natale gave me my life back. I think what makes him so effective he will ablate places in the heart where others EP's won't. That is why I think it is critical for someone in persistent or permanent afib to have the very best EP you can find and as far as I am concern Dr Natale is the very best.

Hope this helps Mac
EC

Very well said EC and welcome to the Forum!

Shannon

Quote
ecblais
I also suffer from sleep apnea and use a Cpap machine. If you haven been checked out for sleep apnea I would have a sleep test to see if you suffer from that as well.

Mac,

This is so important, even if you don't think you have sleep apnea or you don't snore, get a study done. Even my sleep doctor thought I didn't have it, but he ordered an in-home overnight oximiter device be worn and the results showed O2 drops consistent with SA, and then insurance approved an overnight clinical study that confirmed mild SA. I've been using my CPAP for about a month, and have found the adjustment to be relatively easy, and I'm starting to feel the benefits. In conjunction with my Dr. Natale/TCAI ablation, I've laid the groundwork for felling the beast, and I'm getting my life, my old self, back.

Andy

Mac, sorry to hear about your afib after ablation, but they should have had you on a rhythm control drug like Flec for at least 8 weeks, 100mg. 2x a day and a beta blocker as well. I would not get another ablation with that hospital