Single visit ablation without follow up procedure

Anyone out there who have had only ONE successful ablation without a follow up procedure? Does it even
exist and how long have you been in NSR?

You're asking the wrong group. About 75% of paroxysmal patients who seek ablations and about 50% of persistent patients who seek ablations have only one ablation and it's successful.

They don't come here for that very reason. They got their afib treated, it's gone, and they move on with their lives instead of signing up on afib support forums. You really can't judge any treatment by what you encounter here or on any other afib forum.



Edited 1 time(s). Last edit at 05/16/2019 02:15PM by Carey.

I’m on one so far. I’ve had some AF breakthroughs, the longest lasting about 7 hours at the three year post ablation mark. I have not scheduled a second ablation because at this point I see no need. I expect at some point in the future to need a follow up procedure but I am committed to stretching the index procedure as long as I can. I am convinced that this site has helped me to do exactly that and will continue to do so as time goes on.

I made it ten years with my first PVI ablation before everything went totally haywire.

The first several years I had zero issues. Years following was a crap shoot but nothing that made me go running back to my EP asking him to intervene as the break troughs weren't consistent or troublesome. The last year leading up to my latest series of ablations I only had a couple break through events.

There was something obviously brewing there, beyond the PVI, over those years that finally found its way to make itself a nuisance. I often wonder if maybe i should have pursued a second ablation sooner rather than later.

A-fib is a progressive disease. No one should take discouragement at having to face it more than once. The decision to wait is perfectly rational. I’ve made the same.

Natale ablation 12 years ago with smooth sailing after about 90 daysof blanking right after surgery. Apparently mine was pretty straightforward as I had what Hans called Lone Afib at the time, with lots of flutter. I was the first patient to have Natale use the water cooled probe he had a hand in designing.

3 years prior to that I had a right side, flutter only, ablation by a newly trained ablationist in a rural hospital but I don't count that as it didn't last even 3 months and it was not for Afib.

Carey is right about us onetime successes moving on but I think far more of us than anyone thinks still lurk here as who knows when our get out of jail free pass may expire.

Also, it's heartening to see the knowledge base increase over the years along with the improved ways of communicating that to newbies.

Maybe we no longer are all lab rats and studies of one.

Gordon

Hi Gordon,

I recall those days too, as I was just the 11th patient on which Dr Natale used the original irrigated Thermocool catheter when it was not yet fully FDA approved, but was ok’ed for human use by FDA under their investigative clinical trial protocol around 12 yrs ago now. And I haven’t had a single blip of actual AFIB since that index procedure as confirmed on my dual chamber pacer that monitors every single mode switch.

And to add some more insights to the original thread question by Whitehaven, many of Natale’s early patients from late 1998, when PVI ablation first began, through ~2005, when Natale began pioneering a more robust Non-PV trigger detection and ablation protocol.

The purpose of this more advanced process was to better address more advanced AFIB/Flutter cases including beginning to isolate the LAA and CS in select advanced Afibbers who clearly were triggering from these two frontier structures located far away from the four PVs, and prior to this time frame no one ever got LAA or Coronary sinus ablation, to speak of, and thus most ablations were based around an anatomical PVI alone with, at most, an additional posterior wall isolation and an SVC isolation too in select patients.

Now keep in mind, this was the early initial generation AFIB ablation time frame (circa late ‘98 through ~ 2005), and a good many of these patients starting from just after publication of the seminal study from Bordeaux in October of 1998 defined triggers from one or all of the 4 PVs as responsible for approximately 85% of all paroxysmal AFIB cases. Many of these early PVI-only ABL cases did indeed enjoy a long period for freedom from all AF/AT of up to 10 to 12 yrs with a quiet NSR heart.

And by late ‘99 to late 2000, the top elite operators with high volume patient lists were already getting around 70% to 80% success rates in early to middle stage PAF patients with these more basic Anatomical PVI based procedures over an average of 1.4 ablations/per patient.

Natale’s group published about 4 years ago the best long term follow up, so far, from those early years, of over 540 PAF patients from his group during the beginning yrs of his Cleveland Clinic (CC) tenure, representing every PAF case done at CC during the calendar year of 2000 (actually all PAF pts. from December 1999 to early January 2001 at CC).

This was a careful and thorough full ten year follow up, mind you! And Natale’s group had a full 87% success rate from the full ten years of follow up with an average of just 1.4 total ablations done over the full ten year period from this large cohort of over 500 PAF patients. And note, these index ablations were all done way back in the stone age of very early ABL history.

The problem for the field of EP, was that very few operators could come anywhere close to matching such an outcome. And even for Natale, the numbers were a good deal lower in the early days for much more challenging cases when using only anatomical PVI, with maybe posterior wall iso thrown in too, for more advanced PAF, persistent and certainly for LSPAF cases back then.

Natale, Bordeaux, Univ of Penn and a very few others were the only ones then blazing the trail toward addressing more challenging cases effectively ... and no one more so than Andrea Natale who has constantly been at the vanguard of guiding the field forward to improve both safety and efficacy for the most difficult cases as well as the easier afibbers.

However, once Natale and others started to address effectively more advanced cases, not surprisingly this also required a bit more work and demanded a great deal more skill and experience to deliver such good results compared to the m easier very early stage cookie-cutter PAF cases.

Not surprisingly, the more challenging advanced cases with more progressive structural atriopathy having occurred, the solution then often required more work and especially learning to detect and ablate ‘real time discovered’ unique NonPV triggers throughout the left and right atria.

Natale’s group and a growing number of other centers focusing on advanced cases, also discovered that it was not uncommon for more challenging cases of PAF, PersAF and LSPAF, to often need a second ... and less often a third shorter ‘touch up’ procedure ... largely to address Atypical left flutters. And that we have learned are frequently a necessary second step of an advanced ‘expert ablation process’ in order to achieve a truly durable long-term freedom from all AF/AT.

So, we have at least two broadly distinct AFIB ablation pictures.

Those who only ever were exposed to a PVI only (or perhaps with additional LAPW-iso and SVC-iso), who more frequently experienced a decade or longer freedom from AFIB/Flutter that, nevertheless, frequently progressed to needing a very late second follow up ablation after 10 to 12 years of wonderful NSR.

And while some of these very late decade plus recurrences do manifest as AFIB, it is very rare for it to show up as AFIB again, once all four PVs are confirmed isolated for several years or more. Indeed, the vast majority of these very late, after a decade of silence, recurrences manifest as Atypical Left Atrial Flutter... and essentially 100% of these late reappearance of the beast in the form of very late recurrent atypical flutters will wind up requiring an LAA Isolation/Ligation to restore long term NSR again.

Keep in mind, such very late 10 plus year recurrences are NOT a failure of the index ablation! For sure, the patient is still benefiting entirely from the full scope of what that anatomical PVI-only based early ablation was capable of achieving.

After such a decade long successful early PVI any very late recurrence are entirely due to gradual progression of the underlying structural remodeling that continues to evolve (or perhaps ‘devolve’ may be a better term) even after AFIB itself may have been vanquished a decade earlier with the index PVI.

The reason the underlying structural progression could eventually result in Atrial Flutter/Atrial Tachy so many years later, is because what we now know are the last two atrial structures that are capable of sustaining an atrial arrhythmia in the LAA and CS located in those farther frontier reaches of the left and right atria, and that lwere never even looked at, much less ablated, back in the old days of anatomical PVI-only ablations.

We now fully suspect that once a durable PVI is achieved and other Non-PV triggers, such as in the LAA and CS, are durably isolated as well, there should be no further reconnection or manifestation of any atrial arrhythmia ever again. And while we now have about 12 to 13 years of LAA Isolation based freedom from all AT to based that confidence on, plus a lot longer confirmation from the surgical maze experience in which surgical amputation of the LAA or ligation of the LAA by LARIAT or Atriclip add further reassurance that electrically disconnecting the LAA is often the final step in achieving likely permanent freedom from all AT.

As such, from a practical sense, one can assume life-long freedom from all AF/AT may well require either a complete ablation process up front, or accepting that for most Afibbers, a two step process may be the best way to go when the Afibber is able to silence their AFIB early in their AFIB history with a solid PVI plus addressing any low-hanging Non-PV triggers while saving the more advanced stage of LAA/CS isolation for a later date, and only if structural atriopathy progresses many years later resulting in an late atypical left flutter.

In summary, at this stage of the game, it’s fair to say that true lifelong freedom from all AT may require an initial fully successful comprehensive bi-atrial ablation ... or at least an eventual two step process saving the more advanced steps for only when, and if, one ever has a recurrence many years after a fully successful index ABL. Nevertheless, these are only trends we have seen over the last 21 years of AF Ablation experience, and as in all things biological, there will always be some exceptions to these rules of thumb.

And it goes without saying, that this current ideal economy of total work that may be required throughout the full course of a long-lived Afibbers life, requires that they choose from the outset only highly experienced elite level ablation EPs who are consistently able to get 100% durable PVIs in the vast majority of their index ablations in order to minimize the total ABL work one may needs to finally be free of the whole business.

Cheers!
Shannon



Edited 2 time(s). Last edit at 05/16/2019 08:50PM by Shannon.

In answer to Whitehaven's question, here is my story, familiar to those who have been reading the forum for a long time, but maybe encouraging for newer readers.

I had my first ablation in Bordeaux in January 2003 after many years of paroxysmal afib and 18 months of long term persistent afib. I was not a simple case - in those far off days very few EPs would have even attempted my ablation. They isolated all four pulmonary veins, did the roof line, and a line from the left inferior pulmonary vein to the mitral annulus, plus the line in the right atrium. They said that these were all the lines that they knew worked, and that they had done everything it was possible to do.

Afib recurred after three days while I was still in the hospital so they did an immediate second one. They expected to find a gap in one of the lines - Prof. Haïssaguerre said it was like trying to build a dam with round stones so that water couldn’t leak through.

However there was no gap - there was an extremely toxic focus in the coronary sinus which he said was very difficult to find and ablate. Since then I have been in sinus rhythm - over 16 years now. Still seems like some kind of miracle to me.

I probably don’t qualify as one and done, but the Bordeaux team treated it as the same ablation, and there were no extra charges for it.

I still read this forum because I like to keep up with the latest developments. If ever afib recurs I want to be able to make the right decisions.

Gill (female, pronounced 'Jill', in London)

Gill,

As I'm sure you know, I've been here since 2004 and know your story well. I'm very pleased how well it has worked out for you. It truly speaks to finding the best ablationist you can, which you surely did, and let them do their magic.

Continued NSR to you!!!

George

I had my first ablation in Dec. 2012 and am still in NSR. And I do keep lurking back here from time to time. Like Gil, I want to keep up and be prepared.

Marg

11.5 years ago I had my one and only ablation for paroxysmal afib - Not Natale. 11 years of afib prior to the ablation with well over 200 documented episodes. I have had three 2 hr. afib episodes in the last 11.5 years, but that doesn't concern me, at least not yet. No afib meds since the ablation, but I do take Taurine, K and Mg.

Quote
Ken
11.5 years ago I had my one and only ablation for paroxysmal afib - Not Natale. 11 years of afib prior to the ablation with well over 200 documented episodes. I have had three 2 hr. afib episodes in the last 11.5 years, but that doesn't concern me, at least not yet. No afib meds since the ablation, but I do take Taurine, K and Mg.

Ken, How much taurine, K and mag do you take? I bought taurine & hawthorne before getting on meds, but the drs would not approve it & when I had to get on their meds, I stopped taking the other stuff, except of course mag. I might not have needed hawthorne bec I do not have any heart probs (like CHF) other than afib.

As long as you have healthy kidney function, you can take magnesium to bowel tolerance if you wish. Start with 400mg daily and ramp up. Use a highly bioavailable source such as magnesium bisglycinate (amino acid chelated). Avoid the cheap stuff like magnesium oxide or magnesium citrate.

Taurine is safe up to several grams per day. Just don’t go crazy with it.

Potassium should always be sourced dietarily before supplementation unless there is a reason, such as hereditary hypokalemia.

And doctors don’t need to approve your supplements unless there is a reason, like the kidney function I mentioned before. Just tell them what you take and how much.

Madeline,

I didn't fine this web site until a couple of years after my ablation. I was having occasional (few times a month) irregular heart beats for only a few seconds, PAC's, PVC's, Ectopic ?? I started taking 100 mg of Mg twice a day, 270 mg of K once a day and 1000 mg of Taurine once a day. Less than the recommended doses, but it has knocked out the occasional arrhythmias. Why take more?

I am also without a sigmoid colon because of diverticulitis, the water absorbing element of the colon. I take Citrucel twice daily without much liquid to keep "things" glued together which works really well. I am not sure what happens of I increase the Mg. Citrucel with lots of liquid works to free "things" up, but with little liquid, it does the opposite.



Edited 1 time(s). Last edit at 05/21/2019 06:06PM by Ken.

Quote
wolfpack
Taurine is safe up to several grams per day. Just don’t go crazy with it.

;
Wolfpack, If I recall correctly from my reading over a year ago, the taurine might do the same thing that the beta blocker and prescriptions I am on now do. So it would not be something I should do while doing sotalol. I still have bottles of 1000 mg, but stopped them once I started the prescription medicines. I don’t think I took them very long at all.

Taurine is an amino acid, but one that the body doesn't make. As the name suggests, it comes primarily from red meat. It's a useful supplement for folks who are vegetarian/vegan. If you consume meat, however, then I wouldn't put it at the top of the list for supplementation. If you don't want to take it, that's fine.

I'm not aware of a beta-blockade effect from taurine. I use 2g/day myself.

Madeline - FYI about Taurine...

There is a report from about 10 years ago on the use of taurine at this link…
What About Taurine? [www.afibbers.org]


And also Neurosurgeon Russell L. Blaylock, MD offers a report on Taurine in the December 2016 issue of Blaylock Wellness Report. Note the following clip… on the many excellent benefits of taurine….

Taurine deficiencies have been detected in people with several different types of irregular heartbeats, including premature atrial contractions (PACs) premature ventricular contractions (PVCs), and atrial fibrillation.

One study giving 10 – 20 grams of taurine a day reduced PACs by 50 percent and prevented all PVCs. (5) When arginine was added to the dosage, PACs were eliminated altogether.

Taurine reduces these arrhythmias through antioxidant action and by decreasing lipid peroxidation, both of which are major contributors to the damage that occurs from heart attacks and heart failure.

5. Zhao L et al. Drus Res 2013:63(4):185-91


How to Take Taurine
Taurine most often comes in a capsule with doses of either 500 or 1,000 mg. Fortunately it is water soluble, which means you can avoid taking a lot of capsules by emptying the capsules in 2 – 4 ounces of filtered or distilled water.
The dose varies with the condition being treated.
For maintenance, take 1,000 mg three times a day.
For serious illness, the dose may be as high as 4 to 10 grams three times a day.
It is best absorbed on an empty stomach but if you have reactive hypoglycemia, you might have to take it with food.

Taurine is very safe, even in large doses. (end quotes)

Source:
Blaylock Wellness Report - December 2016
Subscription: NewsmaxHealth.comNewsletters

If you would like a copy of the Blaylock 2016 Taurine report, I can send it to you by email. Just let me know.

Jackie

Buying powdered Taurine seems to make sense - Less work, cheaper and just as pure, or moreso.

Doesn't seem to make much sense to buy Taurine powder that's been encapsulated then break it down into powder again.

IMHO, the same applies to magnesium, potassium and other supplements taken in any quantity.
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