My failed ablation

I had my ablation 3 months ago done by a very experienced and highly reccomended EP. I was sent home on Coumadin and Multaq that was to be my post-ablation drug for 3 months for the blanking period or healing period that follows ablation. A week later I went back into afib and was told this was normal and I was cardioverted and sent back home on the Multaq regimen. Another week goes by and I am back in Afib (possibly from MSG). Well I then called in that this Multaq was not working for me and suggested that I had some success with Flecainide and Metaprolol, I was told to try that, I did and after taking the Met. and 45 Min. later the Flec I self converted for the first time ever, so I felt this was a big improvement over getting cardioverted, maybe the ablation was working. So all went smoothly over the next few weeks without even a missed beat using the Flec. and Met. combo. then came the 8 week mark where I got off the drugs except for Coumadin. I had 6 days of NSR with a few missed beats and then afib again. I tried the PIP with Flec again and it worked with a 200 mg dose however it took 16 hrs. 3 days later, Thanksgiving morning, back in afib and the PIP method did not work this time. I won't be able to contact the EP until Monday because of the holiday. I have been using the essential trio of drugs throughout my year long afib ordeal and have been cardiovereted at least 8 times counting the ablation. While I was in for the ablation I was told some people might need a "touch up" ablation afterwards. I am assuming at this point that my ablation has been a total failure but have not received official notice as of yet, my final appt. and tests were to be this upcoming Friday. Another ablation? stay on Flec.? permanent afib on Pradaxa? Maze procedure with keyhole incisions and excising the left atrial appendage? these are all options I have been considering, I really dont feel too bad in afib, I just get tired and winded faster. I would appreciate some suggestions. Thanks for your input, I always get good insight on this forum.

Tom - that's very unfortunate and certainly disappointing. Perhaps there were too many hidden drivers. Touch ups are common when it's difficult to ablate all of the drivers with a conservative approach. Some EPs are more agressive and get the ****done with one procedure. Many people require two and sometimes, more. Touch ups make it sound more benign, but it really is a second procedure.

I know initially when you visited here, you had tinnitis and we discussed the link to a magnesium deficiency. If you have not been able to maximize IC magnesium and also the needed potassium for rhythm stabilization, that could still be a major problem that ablation won't correct. How much and of what type magnesium and potassium are you taking on a regular basis? Any other heart support nutrients... such as suggested in The Strategy?

As far as having your atrial appendage removed, do plenty of research on the function of that before considering removal. It's there for a purpose.

Jackie

Tom, sorry to hear of your failed 1st ablation. I posted a link earlier this year about repeat ablations for people with more complex AF. Here it is again.

[www.venicearrhythmias.org]

IMO, you goal should be to regain NSR and stay in it, for reasons that have been discussed elsewhere:

[www.bmj.com]

The general approaches at this point would be to make sure you have exhausted the potential of the approaches short of ablation and to gather more information by asking your EP and possibly a TTM surgeon some questions:

1) Maximize the supplement approach, as suggested by Jackie. This would involve testing of K and intracellular Mg to make sure they are at levels that would have the desired effects -- or taking the doses she recommends in her Strategies paper (...starting on p 22):

[www.afibbers.org]

2) If there is room for improvement in your use of supplements, this improvement could make your PIP approach more likely to succeed. You can experiment with PIP drugs and dosages, and try chewing the medication or mixing it with water to help absorption.

3) Experimenting with increased doses of various medications for daily use is also an option. As you probably know, medications that were ineffective previous to a CA can become effective post CA.

I think that doctors vary on when and under what circumstances they would recommend a second interventional procedure, such as ablation or surgery.

Assuming that the previous steps do not reduce your AF burden to a safe and tolerable level, the question would be what to do next and when -- which would depend somewhat on the work that was done by your EP, and what he things he might accomplish by a second procedure. He can of course go back in and find that your PVs have reconnected, and that re-isolating them will have lasting effects. He can also make additional lines or ablate more tissue (taking care of CFAE's) -- if he has not already done what he can in this regard. You can ask about these things when you see him.

Your mention of surgery is interesting because it suggests that this possibility is now on people's radar screen, as a possible alternative to a second CA, and one that has the *potential* for a complete and lasting cure -- although this has yet to be shown by long-term followup.
You can also ask your EP about this approach, although he may be skeptical because the TTM surgery is so new.

To me, the choice between a second ablation by an experienced EP and TTM is a difficult one. Consulting with practitioners of each may bring out some advantages or disadvantages in your specific case -- so I guess this is what I would recommend (ideally).

The other approach that has the potential for adding some information relevant to your situation is that of Dr Marrouche, who uses MRI to determine the amount of remodeling-induced change in the heart tissue and have developed a staging system for predicting the likelihood of CA success. If a CA were predicted to fail, perhaps surgery would be a better bet? The TTM surgeon you consult might have an opinion on this.

Jackie brings up another point that seems to have disappeared from serious consideration. There seem to be important reasons why the LAA appendage should not be removed, but I never see this brought up by surgeons, who appear to offer LAA removal as an advantage of their approach over CA.

[www.bmj.com]

New devices for isolating/clamping the LAA are being evaluated with no mention that I can see of the possible drawbacks of such a strategy.

[www.stopafib.org]

-- Dick

Tom,

I'm so sorry to hear this. I believe you had the same EP that my husband used in Akron. Mike has had two ablations and both have failed although he is much improved.

Debbie

Jackie, I have been using about 2 teaspoons of Now Potassium Gluconate (7g.) spaced out through the day, 1 Now Taurine 1000 g. at lunch, 2 to 3 Bluebonnet Chelated Mag. 200 mg. each depending on tolerance, Jarrow Ribose 2g. in morning, 1 E 400, 1 CoQ10, 2 Triple Str. Fish Oil, 50 mg. Zinc and D-3 1000 IU. I was hesitant to take more supps. after the ablation. I believe that the tinnitus is caused by the Beta Blockers because the symptoms subsided a little in the pre-ablation elimination of the rate control meds.

Thank you all for your concern and input, there is some great information here that I can use to plot my next course of action.

Tom C.

Hi Tom,

I can relate to your frustration with the failed ablation. My first ablation was also a total failure. I went into Afib as I left the hospital, and continued to have intermittent bouts of the beast for another two years. I really believe that the ablation was a failure because the EP was not skilled enough, even though he had done many, many ablations.

The second ablation was done by Dr. Sergio Pinski at the Cleveland Clinic in Weston, FL and was a total success. I have been free of Afib now for 3 1/2 years. I know your decision is a tough one, but if I were in your shoes I would opt for a second ablation done by someone in the caliber of Dr. Natale and/or Dr. Pinski.

Wishing you the best,
Marian

Tom:

My blanking period was 4 months. Technically it's 3 months, but obviously everyone is different.
After my 90 day blanking mark, I was still having afib pretty bad and I even emailed my EP and was not a happy camper. Then a month later, viola, the afib ceased.
6 months later I'm still in sweet NSR with ocassional ectopics and bursts of afib that no last more than a few seconds. But it's always from drinking red wine or eating heavy foods or if my Herpes simplex flares up.
I'm still on 75 mg of flec. and 12.5 mg of Metropolol and 6grams of Doctor's Best Mag and 1 gram of Taurine. I find that I don't need to supplement with potasium. In fact, when I do my afib flares up, so to each their own.
Hang in there, blanking periods are relative.
My Ep worked on me for 10 hours, so perhaps the intensity of the ablation, too makes a difference.

chris

Tom:

Sorry. After reviewing my message to you, I realized I stated that I take 6 grams of Mag. a day. I don't; I take 600 mgs.

Chris

Resercher,
Thank you for such a great article. I listened to it before when you first posted it. There was such a lot of useful information in it I was wondering if it was possible to print it. I am not a very techy person so I would be grateful for any advice .

MargaretC

Chris, are you taking those doses of Flec and BB 2X a day? Is there any possibility you might try to wean off of the meds in the near future?

Thanks Tom C

Tom, I have had three ablations all of which started out great, but none have lasted a year. I will say my A Fib when I have it is for shorter times and less troubling than pre ablation. I take Tikosyn 500mcg. twice a day which is the highest dose you can take. As long as I take my supplements as I should and don't over indulge in either too much food or sweets (like I did Thanksgiving) I remain in NSR. It is a narrow tightrope we walk to stay in NSR. Ir the Tikosyn stops working, as it has in the past, I am not sure what I will do. Intend to discuss this with my EP when I see him in Feb.
Best wishes to you as you struggle with this.
Cynthia

Cynthia - have you had your Cardiac or High Sensitivity C-reactive protein measured? Jackie

Margaret, I don't have a transcript of the video presentation. I also just realized that the video link doesn't work anymore. I was a really useful presentation for people with complex AF requiring multiple iterative procedures.

Yes I have, but I don't think my internist checks it yearly. I am due for my annual physical early next year. Do I need to make sure it is done this year?
Cynthia

Cynthia... since you are still having afib, I'd want to know the level of cardiac inflammation going on and your cardiologist ought to as well... I just had mine done and had to pay out of pocket because Medicare doesn't cover it. How absurd...something this valuable and they don't pay.

Jackie

Hey Everybody, self converted on 300 mg. Flec and 25mg Metaprolol after 4 days afib., it took 14 hrs., well its a starting point and sure beats cardioversion. I will stay on Flec for the time being then start to cut back to see what works.

Thanks again for all your support

Researcher,

Its a shame that its not available anymore. Thanks for trying

Margaret

Congrats Tom-glad to hear you converted. Don't be too hasty on cutting back on your Flec-you need time to heal again after the stress your heart just endured. Best wishes for continued NSR for you

Tom:

My goal is to be completely off the meds. However, with the nutrient and drug combination I'm on and how it seems to be giving me the blessed NSR I've wanted, I can't say I really know when I'll change my dose.
Quite honestly, at the dosage I'm on right now, I have zero side effects, and I feel great. The Mag. really calms the nerves and, I believe, keeps my heart in good shape.

Chris

Hi Chris:
I am taking 75 Mg of Flecainide and 50 Mg of Lopressor (Metoprolol) a day. I am interested in learning more about how much potassium and magnesium should be taken as supplement. I heard these supplements are very important for heart rhythm but currently I only take a multivitamin.

Chris: A correction to my previous post: I am taking 75 Mg of Flecainide and 25 Mg of Lopressor (Metoprolol) twice a day. I am interested in learning more about how much potassium and magnesium should be taken as supplement. I heard these supplements are very important for heart rhythm but currently I only take a multivitamin.

I saw another video of a 3rd procedure done by Jais. Although it is an advertisement by Philips, the lesson is that some patients require electrogram guided ablation to track down the offending circuit. Anatomically guided ablation works often enough that EPs will do just that for the 1st procedure. The video is very technical compared to the talk by Ernst that I referred to earlier.

[eplabdigest.com]

Carrie and Chris, I am taking 100mg. of Flec and 12 mg. of Metaprolol, 2X a day. I was taking 25mg. of Met.2x and was told I could cut back to 12. I really notice the difference, not as tired etc. and I am still safe against 1:1 conduction, a dangerous condition. I was told that when cutting back on the Met. you cannot try lowering your dose of Flec at the same time as that might bring on afib. you lower to the minimum dose of Met. give it a week or two then lower the Flec.

I just tried the video link brought forward by Researcher and it worked for me. Just like having an ablation. If at first you don't succed, try ,try again.

Adrian