Why do so many need a second ablation?

Do we know why the need for a second ablation is so common? Is it because the EP/team made errors the first time and suggest we should find a different EP? thanks

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bneedell
Do we know why the need for a second ablation is so common? Is it because the EP/team made errors the first time and suggest we should find a different EP? thanks

Yes and no.
There are EPs only ablating "easy" areas. Okay for many patients, but there are difficult cases. They may require more than one procedure to have it done, even with a top grade EP.
Don't forget this sickness is evolutive, which adds to the odds having to get back to the lab, months of years later.

The top tier EP may ablate all firing areas during the procedure and make your afib fenced in (monkey cage) so you maybe afib free. But afib can develop elsewhere in one’s heart, so additional ablation(s) due to age, atrial remodeling, genetic disposition, health etc may require another ablation if new firing sites elsewhere occurs. That’s why we all in remission because there is no afib cure. You just hope for a long successful remission.

First ablation lasted 13 years. Second one going on two. Will there be a third? If I live another 20 years, there well could be.

Thanks to all who have responded...I am curious about when a second afib ablation is needed shortly after a first one due to recurrence, or atrial flutter/ PACs, etc.

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bneedell
Thanks to all who have responded...I am curious about when a second afib ablation is needed shortly after a first one due to recurrence, or atrial flutter/ PACs, etc.

I don’t think generally there is a cause. Everyone is different and a lot of people have long remissions after an ablation while others don’t

Re: I am curious about when a second afib ablation is needed shortly after a first one due to recurrence, or atrial flutter/ PACs, etc.

bneedell --

Check this link for the details of my ablations... the first for Afib, and then, years later - the second for A-flutter that included LAA isolation and then a touch-up, 7 months later.

[www.afibbers.org]

PS - Happy to report that my heart remains calm, thanks to Dr. Natale!

Jackie

When the EP's workload is heavy, they'll 'work the percentages.' If it fails, they'll do a more thorough job the second go, and that is normally all it takes...hence the higher success rate for the second ablation. In my case, just days ago, I was advised by the fellow that I had one recorded instance of flutter, and that they might tackle that while I was under. The EP, himself, later told me that he had not seen flutter in my record, and that once there is flutter, it stays fluttering. Accordingly, my procedure was going to be simple and relatively short.

As for why the procedure might not stop the ectopic activity the first time, the answer is that the continuing enlargement of the lesions did not close off the pathway of the spurious signal. The lesions continue to 'grow' for some time, as does the concomitant inflammation. The EP only makes so many burns, not 40 or more around each PV. The idea/hope is that the result when things settle down will block any potential paths for the signal. In about 20% of all catheter ablation surgery, there remains one or two more suitable paths for the signal, and that leads to continued unwanted beats. As a previous responder said, if years go by with significant activity, the heart remodels itself, and this must be dealt with as well.