Looking like 2nd ablation failed...

I had my first ablation in August 2018 and had my first reoccurrence of afib 30 days later, at which point my EP suspected the PV reconnected. Indeed, I had about 15 episodes of AF over the next year, though slowing in frequency over time.

In November of 2019 I had my second ablation, and then seven weeks later had my first instance of afib. Again, my EP suspects the right PV has reconnected. During the ablation, he had confirmed the prior reconnection, thoroughly isolated it again, and couldn't find any other non-PV triggers.

I continued taking 50mg Flecainide twice daily + 12.5mg Metoprolol after the ablation, though gradually began to taper Flecainide; AF occurred when I was down to 25mg twice daily. I'm going to resume the 50mg Flecainide for now.

I see some studies saying that AF episodes can occur up to 90 days after an ablation, with it still ending up being successful. Maybe I've still got a shot. But either way, I'll probably wait at least another year before considering another ablation.

I asked my EP if Natale's approach would be any different, and he didn't think so, though he was happy to give me a referral; they're friends and colleagues.

Is it even worth trying another ablation? It seems quite possible my stubborn right PV could just reconnect yet again. Has anyone here had a similar experience?

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MarkF786
Has anyone here had a similar experience?

Oh yeah, in spades. Three failed ablations by the same EP with the same results as you -- reconnections a few months later. You can read my entire saga here.

Give it at least another couple of months before you make any decisions, but if you still need flecainide in, say, March then I would do two things:

1) Do NOT allow your current EP to do another ablation. I don't care how much you like and respect him. Just don't because he doesn't have the technique and skills down yet. You can continue your relationship with him for ongoing maintenance.

2) Do take him up on his offer of a referral to Natale. You don't need to wait a full year, just a few months. It is still possible your heart could settle down.

I didn’t even have to wait a few months. I was immediately scheduled for the end of the month when Natale is in CA.

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Carey
1) Do NOT allow your current EP to do another ablation. I don't care how much you like and respect him. Just don't because he doesn't have the technique and skills down yet. You can continue your relationship with him for ongoing maintenance.

2) Do take him up on his offer of a referral to Natale. You don't need to wait a full year, just a few months. It is still possible your heart could settle down.

Thanks for the reply, Carey and Susan.

One thing I'd note is my EP is one of the top afib ablationists at University of Pennsylvania hospital, which is one of the top EP labs in the country. Shannon has recommended him by name a few times on this forum, and has said he is one of the best in the country when we've spoken on the phone. It seems Natale is universally recognized as the best ablationist potentially in the world, but it seems shocking (and maybe even depressing) that only he has the ability to ablate an otherwise seemingly simple case of paroxysmal afib.

Don't get me wrong; I indeed plan to go to Natale the next time (and second guess if I should have this time), though I've got to be fair to my current EP that's he's no amateur, and even Natale has to do repeat ablations.

The reason for potentially waiting a year is largely due to factors with work and insurance, more so than any medical reasons.

Thanks again.

Mark

If it was the EP it sounds like then I'm quite surprised. It could be you're not the simple case you thought you were.

You're not simple. We've all been there, you need to see Natale. Sorry to be so blunt. I've been down the "oh it must have reconnected" and wasted 2.5 years of my life and 3 abaltions before Natale fixed. Get the 1st appointment your insurance will allow.