Flutter ablation / blood thinners

Considering a second ablation for a newly surfaced flutter after AF ablation a few years ago.

I am concerned it would involve a LAA isolation ( is this true?).

I have had very heavy periods in the past that can be scary when on blood thinners. Don’t like the idea of LAA requiring blood thinners with no options.

Is it a requirement to always isolate the LAA on the 2nd ablation?

No, that's not true at all. Not sure where you got that idea. In fact, there are only a few EPs in the country capable of isolating the LAA so most ablations never touch it even when they should.

The most likely candidate for LAA isolation is someone with longstanding persistent afib who would either be rejected by most EPs for an ablation at all, or would face extremely low odds of success (40% and lower) precisely because their EP doesn't understand the LAA involvement and how to deal with it. And after all that, then only if they visited an EP with the advanced training and experience necessary to deal with the LAA.

It's unlikely you would need any sort of attention to the LAA to fix a late flutter problem. Most flutter ablations are fairly simple, straightforward procedures. (Not all, just most.)

If you don’t have longstanding persistent afib (have instead occasional lone afib) then you are not likely a candidate? I thought if the EP sees afib activity from the LAA that is when it is isolated.

Thank you both for your responses.

This would be for Natale.

I had also thought if he saw any activity in the LAA that it would then be isolated., regardless of being lone paroxysmal or persistent.

Yes, he will ablate the LAA if it's a source of afib whether you're persistent or not, and he won't ablate it if it's not a source. My point was that for a large number (possibly a majority) of persistent patients their LAA is a source, and the reverse is true for paroxysmal patients. That probably explains why ablations have such a miserable success rate with persistent patients (40%, at best). Most EPs don't know how to detect and ablate afib originating in the LAA. Natale's success rate with persistent afib is as good or better than most EPs' success rate with paroxysmal, and this is why. He pioneered LAA isolation.