[www.heartrhythmjournal.com]

“With time, these endocardial nerve endings can regenerate, or alternate pathways for GP innervation can form.”


How is this different than a regular failed ablation where regeneration can occur?

I believe they are describing the same process. A simple PVI done well should....SHOULD...result in a prolonged free-from-AF period if the focus or re-entrant happens to be in the PV ostia. Unfortunately for some of us, the focus is somewhere else, the Vein of Marshall, the LAA, the coronary sinus, or even in the septum itself. At least, the new one may be in one or more of those places if it isn't a re-establishing of the old pathway through neurogenesis or neural self-repair. They do talk about the diff between a simple PVI repeat and one where it is the secondary target where a ganglionic plexus ablation had been the previous procedure. It turns out to not be statistically better.

Perhaps someone else will have a different handle on this article.

It's pretty simple, really: Destroyed nerves cells can regenerate, but destroyed myocardial cells cannot. Although heart cells do divide in younger people, the replacement is very slow and incomplete (~3%) and that process slows to a stop as we age. That's why adults with heart damage due to heart attack can't fully recover.

So translate that to an ablation. If an ablation fails, it's usually because a source of afib wasn't found and isolated, but it can also be because the burns were inadequate and didn't fully destroy the tissue, so the tissue can heal and when it does afib resumes. That's what happened to my first three ablations. When I compared the first EP's burn times with Natale's, I saw that Natale's were significantly longer.