Back 10 years after an ablation

Greetings all:
I had an ablation with David Callans at Penn almost 10 years ago, with no afib since, until four months ago. I had been having high-stress related BP and other anxiety issues related to changing jobs and ultimately retiring, and had one episode that was ended with Corvert. Have been in contact with Vivek Reddy in NYC, and he is willing to perform an additional ablation when I am ready. Have felt absolutely fine until about a week ago, when increasingly lengthy bouts of PACs have started to occur. So I have several questions:
1 - does anyone have experience with Reddy? His reputation seems good, and Callans highly recommended him
2 - any sense of whether or not the PACs are in fact a precursor to full afib?
3 - any sense of whether or not afib 10 years after an ablation is simply a breakthrough in the ablated tissue, or more damage having occurred to my heart since?

All feedback welcome-

1 - no, but someone here will
2 - yes, PACs are often precursors to AF
3 - after 10 years I'd figure there's been some progression of the disease rather than a breakthrough of the original ablation lines. Don't be discouraged. AF is progressive and it's entirely normal to expect it to come back. 10 years from an index ablation is VERY good.

Vivek has a great reputation. Excellent choice.

I agree with wolfpack on everything else. You've had one episode requiring intervention to stop, and now with increased PACs I'd say a repeat of that episode is in your future. No way is it a failure of the original ablation. You've developed a new source of ectopics outside the areas isolated in the first ablation. Should be an easy job for Reddy to fix.

So it looks as if the consensus is that the next ablation is inevitable: would it make sense just to schedule it and get it done? Or wait to see what happens with the ectopics?

Not an easy decision, but if it were me I'd probably give it some time and see how it goes since you've only had one actual episode. There's always an outside chance it was a one-off thing that won't happen again. But once the next one occurs, I'd be on the phone scheduling the procedure the next morning.

Yup that was actually my plan....I'm downing taurine and magnesium like there's no tomorrow. Thanks so much for your feedback. I was on this site a great deal over ten years ago when my afib started: an episode a year for three years, then once every six months, then once a month - which was when I did a bunch of research and decided to go to Penn and Callans. My ablation was cut short because I reacted badly to the Fentanyl, developing chest wall rigidity that caused him to stop before he could ablate the area that is responsible for flutter - just did the pulmonary veins - so all things considered 10 years is not a bad run. And this episode was definitely associated with off the charts stress, so maybe I can buy myself some time. By the way I can't say enough good thing about David Callans if anybody is interested: did a superb job and is known for his incredible humanity and compassion

I also agree with Wolfpack . I also have a similar story.

Index ablation in 2009. Around 5 years afib free. The following years I would have anywhere from zero to several events a year Witt no ryhme or reason.
By December 2017 my events were becoming more frequent and I actually hit the deck. Then in January I whet into perminant Afib and had my second ablation with the same EP. Thii ablation was basically just a redo of the PVI where there where breaks in the scar tissue.

It was also at this time I returned to this site seeking advice which led me to Austin and Dr. Natale for a 3rd ablation since the previous one did not address the underlying issues causing my afib which came back in three months.

Best of luck to you.

Thanks for the response. For the last two days the PACs have calmed down significantly, and I saw from looking at my posts that I was here a year ago, with the same issue, and they calmed down then...fingers crossed. It is amazing how much ablations have evolved in the past decade: I have not yet wrapped my mind around the different catheters, imaging and cooling techniques that have been introduced. Will have many questions for Reddy.
The most bothersome thing about my ablation afterwards was the increased heart rate, which stayed up for almost a year. Reddy's assistant said that would most probably happen this time as well: are there things that people can do to relieve that, or shorten that?

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Callydex
The most bothersome thing about my ablation afterwards was the increased heart rate, which stayed up for almost a year. Reddy's assistant said that would most probably happen this time as well: are there things that people can do to relieve that, or shorten that?

Nope. An increased resting HR following ablation is just about the most predictable, consistent effect there is. 100% of the people I know of who've had ablations have reported it. And yeah, it tends to last a surprisingly long time, upwards of a year. But it's not that bad. It's usually just an increase of 10-20 bpm. I never found it noticeable unless I checked my pulse.

50 bpm at rest before ablation. Now 70 bpm and I'm seven months passed my last touch-up.

I started at 65 and went to about 89 for a year. Bummer It's great now. When and with whom was your ablation? All still good?

Had successful ablation 11.5 years ago. Three breakthroughs, two last year and one a couple of years before that. No meds, episodes ended on their own in a couple of hours. Not an issue for me, not a big deal until A LOT more episodes show up. MG, K and Taurine essentially stopped the occasional PVCs when I started taking them about 10 years ago. Stress, both mental and physical seemed to be an issue with two of three afib episodes. The other, just started late one evening and was gone sometime during sleep.

Quote
Callydex
The most bothersome thing about my ablation afterwards was the increased heart rate, which stayed up for almost a year. Reddy's assistant said that would most probably happen this time as well: are there things that people can do to relieve that, or shorten that?

My recollection is that the HR increase is a hallmark of successful ablutions and has to do with ablation of vagus nerve tissue.

{edit} Shannon goes into more detail here <[www.afibbers.org]



Edited 2 time(s). Last edit at 07/20/2019 08:49AM by GeorgeN.

Yes Goerge thanks - I do remember that now. It is all coming back to me, unfortunately. My PACs have totally disappeared for now: maybe I'll luck out like Ken and this really will have been a one-off....

My HR after PVI last August was only up 5-10bpm and settled back to pre-ablation after 6 months or so. Now at bedtime it’s 48 and in the morning about 54.

Good to hear - I should be so lucky. PACs quiet today, in spite of horrendous heat, sweating, and (I am sure) loss of electrolytes/minerals in spite of best efforts

Why not have Callans do re do???