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2nd ablation

Posted by MichaelW 
2nd ablation
January 09, 2019 11:38AM

I was diagnosed with Afib in Jan 2016. I was 54 at the time. I have always had a desk job but am pretty active, mainly bicycling. I was riding about 80miles a week when the afib symptoms begain.

However, I also enjoyed my craft beers, and my diet was not very good. It was very low on fruits and veggies and was mainly carbs.

I have Kaiser insurance and have been happy with the care I have received so far. They put me on beta blocker and I did have a few more episodes during 2016 but was mostly fine. Then in 2017 I started having more afib attacks that would last 12 to 36 hours. They started me on 100mg Flecainide a day which seemed to increase the frequency of the attacks but shorten them. So we went up to 200mg a day and I did well on that for about a year. During 2017 I cut way back on alchohol and began to eat better.

Then in mid 2018 my symptoms began to worsen again so I had a cryo-ballon ablation at Kaiser LA in July 2018. It went well, but they left me on 200mg flecainide, beta blocker, and warfarin. By late 2018 my symptoms began to worsen again and that’s when my EP switched me to Dronedarone (Dec 2, 2018). Once I was “loaded” up on that it seemed to work pretty well and I didn’t have any significant side effects except my energy level is not very good.

We also made a tentative appt for 2nd ablation on Feb 25 that he said we could postpone if I am doing well enough. As of today I am doing pretty well as long as I eat well and refrain from all alchohol, sugary foods etc.

My question is should I request to have the 2nd ablation anyway even if doing well? Will the ablation be more effective if I am in afib at the time of the procedure, because I may not be? I have been having irreg heartbeat episodes every few days that last for a few hours, but they are fairly mild and my just be a lot of PACs. I have had the horrible afib attacks where I am out of breath and almost feel like i will pass out in the past but not in the last year or so thank God.

BTW my heart goes out to all who have this condition. It has severly affected my life in a negative way.

Edited 2 time(s). Last edit at 01/09/2019 12:36PM by MichaelW.
Re: 2nd ablation
January 09, 2019 01:11PM
Good day. I recently had my second in 10 years ablation with Dr. Natale. My attacks usually lasted 5 - 7 hours but my longest was 16 hours. It sounds yours are even worse. My Afib returned last (2018) year and i had just 3 episodes which lasted 1 - 2 hours each before i opted for 2 ablation cause i just do not want to deal with it. So if I were in your shoes I would opt for the 2 ablation for sure. However I would not go just to anybody but ask the maestro himself ( Dr.Natale) to perform the 2 ablation. Yes you will spend extra on airline tickets + hotel + possibly car rental but it well worth it. I understand that currently you are in NSR because of anti arrhythmic medication however those medication tend to stop working after a while. So again yes If I were you I would definitely opt for the second ablation but it is just my opinion.
Re: 2nd ablation
January 09, 2019 02:23PM
From what you describe, it sounds like a failed cryo-ablation. We like to define ablation success, whether it be cryo or RF (radiofrequency), as freedom from atrial arrhythmia for a period of one year or longer without the use of any anti-arrhythmic medication. By those standards, your index ablation did not work. This could be for a couple of reasons: 1) The cryo-ablation did not succeed in fully isolating the pulmonary veins, or 2) There are other sources of ectopy in your left atrium that cannot be ablated by a cryo-balloon. The second point is perhaps the most salient here, as it is important to understand that cryo-ablation is limited to vein isolation (PVI) only. RF ablation is not. If you do in fact have triggers outside of your pulmonary veins then you can have 100 cryo-ablations and it won't matter.

I suggest you find another practitioner who uses RF catheters and also works on areas in the left atrium other than the "boilerplate" PVI. You should get yourself to the most experienced operator you can afford. I don't know to what extent Kaiser complicates that, as I don't have that particular insurance myself but I hope it doesn't make things too difficult.

Bottom line, in my opinion, not another cryo.
Re: 2nd ablation
January 09, 2019 03:54PM
I totally agree with wolfpack. And if you can afford to go to Austin then that would be the place to go.
Re: 2nd ablation
January 09, 2019 09:54PM
Do not do another cryo ablation. As wolfpack pointed out, it would be a waste of time. You need to find out what sort of ablation they're suggesting (cryo vs. RF) and you need to find out how many ablations the doctor has performed. If the answer is less than hundreds, preferably thousands, just say no. You're not dealing with someone who has the experience necessary to do successful afib ablations (and your first one was definitely not successful).

The answer is as simple as dartisskis suggested above, but unfortunately you have Kaiser, which means you're locked into their choices of who you can see. They virtually never approve procedures by any doctor outside their system.

If I were you and doing well on Multaq (dronedarone), I would just wait and see. I absolutely would not do another ablation yet. If and when you're no longer doing so well, I would drop Kaiser, buy a non-HMO insurance policy, and book an appointment with someone who knows how to do an ablation.
Re: 2nd ablation
January 19, 2019 06:37PM
Thank you to all who responded. I will quiz my EP before any more decisions are made.
Re: 2nd ablation
January 24, 2019 03:21AM
Sorry to here you are having issues.

Had my first RF ablation in 2009. My second (January 2018) was done with Cryo by the same EP after my afib returned to the state it was leading to my first ablation. The Cryo ablation lasted less than 3 months and my afib seemed to be worse than it was before. Cryo ablation really limits the EP as to what areas can be addressed and my issues fell well beyond what cryo would allow. Knowing what I know now I would never have allowed my first EP to use Cryo on me. Especially after having such good success with the RF the first time around.

I to was on flecanide for a time. I used it as a PIP in the years following my first ablation until it stopped working for me. This was also what lead to the Cryo ablation. When that failed flecanide only worked for a short period of time. I was then put on ticosyn which sort of worked for me but didnt keep me in rhythm all the time.

I had my third (RF) ablation (July 2018) done by Dr. Natale in Austin. I had a pretty rough go of it afterwards due to some other issues but at this point in time it appears to have been successful.
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