What is risk for AF ablation causing flutter etc.

Hi all:

Have an upcoming ablation for AF and was wondering:

1) % chance of kicking off new arryhthmia like flutter;

2) Changing an always self terminating paroxymal AF to one that would require cardioversion and be more of a hassel?

Thanks in advance.

I had a PVI in August but they also ablated flutter......seems some here have flutter following an ablation (in the weeks after) not sure of what the% chance is?
I still do not understand why both are now ablated more often ? but I had flutter many times during my afib career.

Who and where is your scheduled ablation?

Tom

I can't answer your question, but do know that paroxysmal AFib gets more serious and becomes persistent AFib without ablation, and I think this can happen in as little time as a year. How fast this happens is dependent on how often and how long you're in AFib.

Diane,

Progression from paroxysmal to persistent/permanent afib is not inevitable for lone afibbers (no underlying heart disease), perhaps 1% to 6%/year. Whether or not it happens depends on several factors including age and the presence of hypertension, heart failure, previous stroke, COPD, aortic stenosis, enlarged left atrium, frequent cardioversions, etc.

[www.afibbers.com]

[www.afibbers.com]

[www.afibbers.com]

[www.afibbers.com]

Hans

DGM,

The 2008 ablation/maze survey [www.afibbers.org] evaluated the results of over 1000 RF ablation procedures for atrial fibrillation. The incidence of post-ablation left atrial flutter/tachycardia was 12% and the incidence of right flutter was 6%.

Hans

My paroxymal afib of 12 years turned persistent while in the throws of a prostate infection. Prior to the infection, I was a lone afibber with episodes once a month or less - so maybe things can change quickly under certain circumstances.

I was ablated over two weeks ago and had tachy for one hour the day after the ablation date and tachy for 6 hours about a week later. The EP said it was flutter, but my own EKG reading indicates atrial tachy (no sawtooth pattern, and some P waves evident). I dropped all the meds one week post ablation which included flecainide, digoxin (never taken) and prilosec (after 2 weeks) and now I feel great... a steady heartrate, no tachy (whether flutter or not). So, I wonder how much post-ablation arrhythmia may be due to an intolerance of the rate and rhythm control drugs that are sometimes prescribed. I also wonder if anyone keeps the stats on percentage of post ablation drugs vs no drugs along with arrhythmia stats of same - would be interesting to ponder. I read a very imprecise and small-sample study that indicated an improvement of ablation success with patients who were put on rate and rhythm control drugs - however, if those drugs tend to mask the results, how can one tell if the ablation is the sole successful element?

Tom

I had my frist AF episode in 1996, this was due to being over medicated with synthroid (too much thyroid hormone), I had episodes only a few times a year then I got them more often, I started taking magnesium and also my EP said to take 1 tab. of propafenone before bedtime (I am vagal). Over the last 6 years or so, my afib episodes are perhaps once every 3 months or perhaps longer, so my AF episodes have not increased but have decreased. It is not inevitable for AF to become more persistent, I can attest to that.

Liz

Tom

I am confused about how long it takes the lesions to form after ablation. Seems to me (touch wood) the effects are nearly immediate for the most part (I had an ablation 2 weeks ago tomorrow)

afhound,
I've read and been told that post-op inflammation plays a part in producing post-ablation arrhythmias as well - I guess that's why the industry standard is to withold judgement on whether the procedure is a success until several months have passed.

Tom

afhound... the lesions are actually burns which heal as scar tissue. My impression has always been that they are in place the minute they are laid down but the healing of those burn sites takes 2 - 3 months and, obviously, there is an inflammatory response as well. I was told that as a result of ablation, the heart remains in a state of irritability for at least that long...sometimes more in some individuals. The AF may stop immediately...mine did... without a ripple until over 3 months later and I have no idea why.

My ablation was 9 years ago and at the time when so many of us were signing up, the technique was much different because then, the sophisticated detection systems were not yet used. Often the Afib was successfully eliminated but sometimes that unmasked an underlying flutter which then required another ablation. Now, with the new techniques and technology, they check many more areas and try to make sure that if flutter is there, they find it and ablate that as well.

Jackie

Thanks all for your responses. In answer to Tom P., my upcoming ablation is with Natale in SF. I've had a 10+/- year history of AF every day-sometimes a few minutes, sometimes a couple hours. Then this year, I've gotten some runs of 10-14 hours (15-20 or so, usually at night). This got me thinking 'time for an ablation'. All self terminating. I've had a very limited, (a few minutes) of 1-1 flutter (not fun) that I tied to the use of prednisone drops in a damaged eye that periodically get's an auto-immune inflamatory response. My concern mirrors the squadron patch motto for Edwards AFB, "In Explorata", another words, "into the unknown." I just don't want to end up with AF that needs cardioverted, or a crappy flutter condition as the result of an attempted 1st ablation.

Hi DGM,

Alas, I know your question and this territory very well. Rest assured though, you've made the most important step you can towards giving yourself the best odds for a good long term outcome by choosing Dr. Natale to do the work.

He is at the forefront of tracking down errant flutter circuits and the other triggers outside the usual areas. So even if you wind up needing a 'touch up' down the road, which is not entirely predictable beforehand, the odds are very high he will have anticipated it from what he discovers during the first ablation and will do his best to insure any additional work will be as targeted and anticipated as possible

For example, with your long history of frequent daily episodes that have become longer in duration this past year combined with the fact that you've had some 1 to 1 flutter as well (all things I experienced too prior to my first extensive ablation with Natale over 4 years ago).. its a real possibility that he might find that your left atrial appendage is either one of, or the, prime trigger sites for initiation of your AFIB/Flutter?

He may then either decide to address it directly during the first ablation as he likely would if it were a significant contributor and certainly if it were the only source of triggering, but depending on what he finds he might also address all the other areas that are active plus PVAI, CS and SVC as well as focal trigger points and CAFE's first as well as do focal ablation within the LAA and then see how you do prior to doing the full LAA isolation.

But even if you do develop some atypical left atrial flutter/tachy after the AFIB ablation the odds are very high your AFIB will be gone and so will the flutter after one more step. And in the event should you require one more ablation, the odds are also very high you will experience a FAR greater amount of NSR between ablations one and two , and that is not only a huge relief compared to daily episodes but it also greatly reduces the odds of your unablated AFIB flipping into persistent AFIB as it sounds like your story may be progressing toward now.

The best way to approach this now that you have made the one major choice that is up to you by choosing the best option around in Dr Natale, just relax now ... your job is well done. Yet also realize that curing this difficult beast can require some patience and additional fortitude and a cooperative and collaborative attitude in partnership with Dr. N. So just go into these next months expecting that you might need two ablations to be truly done, and then be that much more grateful if you turn out to be one and done. That is the best and most pragmatic psychological approach to this whole thing. Then just put one foot in front of the other, trust that you are in the best possible hands, which is literally true in your case, and go for it!

It will all work out and no doubt you will be glad you did in the long run.

Best wishes,
Shannon



Edited 1 time(s). Last edit at 11/02/2012 05:04PM by Shannon.

Thanks Shannon for your post. Very enlightening. Based on history (to much to recite here) and my overly analytical mind, I have a suspicion that the AF is coming from the likely source of the PV's. The limited flutter only kicked off when in fib per my prior post odd ball conditions. We'll see.