Should I consider a 2nd ablation?

Hi all,

Wanted to get your thoughts on the outcome of my ablation and whether I should consider a second ablation or wait it out. I had my ablation done in September of 2017. Initially afib free the first 9 days and then had daily short episodes for the next few weeks. All went quiet after a month post ablation and other than the strong ectopics all felt good. I have had a few breakthrough events since the blanking period ended however (outlined below) although they seem to be getting further apart. My EP doesn’t think we should rush to going back in as he has had several patients have bumps for up to a year and then go quiet for many years. Note, I am 43 and in good health otherwise.

Breakthroughs (months post ablation)
Month 3: - short 25 minute episode
Month 4: – 90 minute episode
Month 5: ~ 6 hours; reverted with PIP flec 300mg + metoprolol
Month 8: a few super short episodes over a 30 minute period
…
Nothing since month 8 and I am now in month 13

Thanks,
afdude

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afdude
My EP doesn’t think we should rush to going back in as he has had several patients have bumps for up to a year and then go quiet for many years.

Nothing since month 8 and I am now in month 13

Thanks,
afdude

So you're thinking people on this board know more than your EP?

As Jpeters said, we don't know more than your EP.
But we're afibbers and your EP is likely not (or not yet), so maybe we can tell you how we're feeling and living post ablation...
I'm two years from my PVI procedure, and 5.5 months from my recent touch-up. Like you, I was wondering (and still am) if another procedure was to plan, because I'm not yet afib free and still taking meds.
My unsustained short (less than 2 hours and most often less than one) afib episodes were coming twice a week. Once at best. And I often had ectopics.
I phoned my EP one month ago, and we discussed the opportunity of another touch-up, deciding to wait a little more before making a decision.
Since then, my afib episodes are less frequent and the same with ectopics. So for now, I'm sure I'll wait for some time.
I've to say I'm working towards the causes of my afib, and this search seems to give interesting results. As my heart is healthy, it's likely not a heart issue. I'm trying to solve my digestive problems, and since I'm feeling better on this side, my HR is thanking me.
Having less ectopics and afib, I take my flecainide (PIP) less often and I've reduced my betablocker (bisoprolol) to 1.25 mg/day.
So, I'm not surprised reading that some afibbers need a longer blanking period than usual. I may be one of them. And you too.

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Pompon

So, I'm not surprised reading that some afibbers need a longer blanking period than usual. I may be one of them. And you too.

I too greatly appreciate hearing people's personal experiences. What you said is very similar to what his EP told him.

afdude,
You have been afib-free for the last 5 months. Chances are good that you will continue so. Why should you even consider a touch-up at this point in time? It makes sense to wait and hope for the best.

Pompon,
I am so glad to hear that you are improving with regard to afib and ectopics. I hope you will end up being afib-free.
We joined this forum about the same time, and I've been following your progress (and troubles). I had my ablation last April and had my share of anxiety in the blanking period that followed it. Wishing good health to all of us.

Leah

Thank you so much, Leah.
People here are of great help. Doctors don't know how afibbers need for this.

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jpeters


So, I'm not surprised reading that some afibbers need a longer blanking period than usual. I may be one of them. And you too.
I too greatly appreciate hearing people's personal experiences. What you said is very similar to what his EP told him.

I would think that the blanking period would be connected not only to the amount of work done in the heart but specific areas as well. Then factor in individual patient differeces. For instance a basic PVI or flutter ablation blanking period could be 3 months. Then a more comprehensive PVI as DR Natale does maybe 6 months. Then when you get into the coronary sinus and Laa maybe longer?

It's still a developing process and I am certain that one day every ablation procedure will be a one and done.

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rocketritch



It's still a developing process and I am certain that one day every ablation procedure will be a one and done.

Hoping that about cancer too, but we don't even fully understand the causes at this point.

Thanks everyone for your feedback. It's super helpful to hear about other's experiences.

HI all,

So it happened again...but certainly a minor episode in the scheme of things. I made it nearly 5 months since my last episode and am now a full 13 months post ablation. My latest episode didn't have any obvious triggers. I went in and out of afib for 2-3 minutes at a time over a 25 minute period and then it resolved completely (on it's own). My question to the forum is at what point do you consider a touch up? I don't want to do anything in haste but at the same time I do want to rid myself of all afib if possible.

Breakthroughs (months post ablation)
Month 3: - short 25 minute episode
Month 4: – 90 minute episode
Month 5: ~ 6 hours; reverted with PIP flec 300mg + metoprolol
Month 8: a few super short episodes over a 30 minute period
Month 13: multiple short 2-3 min episodes over a 25 minute period.

Are you sure it was afib? Could it have been a run of ectopics - PACs and/or PVCs? Sometimes a run of them can feel like afib but it is not.

Hi MissSunshine, I suppose it is possible although my Kardia recorded "Possible Atrial Fibrillation". It certainly felt just like afib. My heart was skipping around like a fish flopping in my chest with my HR around 170.

I had a 2 week run of what appeared to be affib on my Kardia recorder. I had a cardioversion scheduled but converted on my own a few days before. That was almost a month ago now and I have been in NSR ever since. My 3 month post ablation period will be in 3 days.