Afibs again 5 months after 1st ablation

HI,
I have a question about afib after ablation.

1. If I still encounter occasional Afib 5 months after ablation. Does that mean my ablation is not successful?
2. Feel faster heart rate, KardiaMobile tested, Afib. Should I quit alcohol completely?


Thank you very much

That’s what it meant for me. I had a second ablation 9 months after the first. Just had my 3 month post second ablation with EP yesterday. I have not felt even a little flutter after the second ablation. EP gave me the go ahead yesterday to start coming off of meds. Done with Xarelto now and tapering off of flecainide and metropolol.

As far as alcohol, I have not totally abstained but have dramatically cut back. I know it is best to totally cut it out but I honestly have not linked it as a trigger for me.

Generally, yes, and it's quite unlucky. However, I hope your care-givers made sure you understood that a first ablation only has about a 75% success rate, and my EP claimed it was closer to 70%. Subsequent ablations enjoy about 80% success rate. Of course, this varies between EPs whose skill isn't the same from person-to-person.

The general empirical trend is as follows: most of us have some unsettled heart rhythm in the two months following an ablation. However, those who have the odd hiccup in the first three or four weeks, and who then enter a quite phase and on until the first year has lapsed, do better than those whose hearts behave in the first three to six weeks, and who then begin to experience some arrhythmia episodes after the 'blanking period' has expired. It seem that you must be in the latter case. I was there as well, and there are many others who post here at least infrequently if not regularly.

Alcohol is widely condemned in this community as a trigger. It might not be for everyone, but enough people swear that even small amounts set their hearts off that it's sort of an accepted wisdom to just say no. There is very little evidence that caffeine is a trigger, but again, some swear that even a whiff of coffee sets them off.

There are other triggers: worry, anxiety, financial woes, relationship problems, obesity and stomach distension (such as eating too much), poor sleep, excessive exercise, hypokalemia (low potassium levels), even disorders and diseases that raise inflammation.

Others might have differing opinions about this, but an ablation is meant to stem the distribution around the endothelium inside the atrial wall. The idea is that ablated tissue simply won't propagate or pass on the unwanted electrical stimuli. If you have had an ablation, and any time during the next 12 months you get arrhythmia, your ablation has not completely blocked the paths of the spurious signals. You may indeed have a whack of healed lesions and scarring left from the first effort, but it has not formed an effective stockade or dam around the point where the signals enter the atrium and spread around it. Somewhere, there is a gap. A skilled EP will find it and seal it off on a second go.

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gloaming
I hope your care-givers made sure you understood that a first ablation only has about a 75% success rate, and my EP claimed it was closer to 70%. Subsequent ablations enjoy about 80% success rate.

Gloaming, how is "success rate" defined? Does this mean 75% people are AFib free after the first ablation? Free for how long? one year? 5 years? 10 years?

Sorry for the duplicate post, I don't know how to delete it



Edited 1 time(s). Last edit at 03/22/2023 09:15PM by Yuxi.

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Yuxi
Gloaming, how is "success rate" defined?

The generally accepted definition is one year free of sustained atrial arrhythmias without the use of antiarrhythmic or rate control drugs.

Be careful. I've seen more than one published study that counted patients relying on antiarrhythmic drugs as "successful."

Thank you for the clarification, Carey!

Quote
gloaming
Generally, yes, and it's quite unlucky. However, I hope your care-givers made sure you understood that a first ablation only has about a 75% success rate, and my EP claimed it was closer to 70%. Subsequent ablations enjoy about 80% success rate. Of course, this varies between EPs whose skill isn't the same from person-to-person.

The general empirical trend is as follows: most of us have some unsettled heart rhythm in the two months following an ablation. However, those who have the odd hiccup in the first three or four weeks, and who then enter a quite phase and on until the first year has lapsed, do better than those whose hearts behave in the first three to six weeks, and who then begin to experience some arrhythmia episodes after the 'blanking period' has expired. It seem that you must be in the latter case. I was there as well, and there are many others who post here at least infrequently if not regularly.

Alcohol is widely condemned in this community as a trigger. It might not be for everyone, but enough people swear that even small amounts set their hearts off that it's sort of an accepted wisdom to just say no. There is very little evidence that caffeine is a trigger, but again, some swear that even a whiff of coffee sets them off.

There are other triggers: worry, anxiety, financial woes, relationship problems, obesity and stomach distension (such as eating too much), poor sleep, excessive exercise, hypokalemia (low potassium levels), even disorders and diseases that raise inflammation.

Others might have differing opinions about this, but an ablation is meant to stem the distribution around the endothelium inside the atrial wall. The idea is that ablated tissue simply won't propagate or pass on the unwanted electrical stimuli. If you have had an ablation, and any time during the next 12 months you get arrhythmia, your ablation has not completely blocked the paths of the spurious signals. You may indeed have a whack of healed lesions and scarring left from the first effort, but it has not formed an effective stockade or dam around the point where the signals enter the atrium and spread around it. Somewhere, there is a gap. A skilled EP will find it and seal it off on a second go.

Hi Gloaming, Thank you very much. Your input is very helpful. Lewis



Edited 1 time(s). Last edit at 03/23/2023 03:11AM by Lewis.

Everyone is different. Perhaps you were dehydrated or drinking or consuming too much sugar as examples? We’re you tested for sleep apnea? I had a good run and by accident ate a can if anchovies (high salt) instead of sardines and went into Afib.

Interestingly I asked ChatGPT about the definition of a successful ablation, here is the answer :



====ChatGPT=====


A successful atrial fibrillation ablation is a procedure in which the abnormal heart rhythm known as atrial fibrillation (AFib) is eliminated or significantly reduced in a patient through the use of catheter ablation. This is typically achieved by creating scar tissue in the heart's atria (upper chambers), which disrupts the electrical signals that cause the irregular heartbeats associated with AFib.

In general, a successful AFib ablation is characterized by the following:

1.Restoration of normal sinus rhythm: The patient's heart rhythm returns to a normal, regular pattern.

2.Reduction in AFib episodes: The frequency and duration of AFib episodes are significantly reduced or eliminated entirely.

3.Improvement in symptoms: The patient experiences a significant improvement in their symptoms, such as palpitations, shortness of breath, and fatigue.

4.Reduction in medications: The patient is able to reduce or eliminate their use of medications to control their heart rhythm or rate.

5.Low risk of complications: The procedure is performed safely with a low risk of complications, such as bleeding or stroke.

It is important to note that the success of an AFib ablation can vary depending on the patient's individual circumstances, such as their age, overall health, and the severity of their AFib. Your doctor will be able to provide more specific information on what to expect from the procedure based on your individual case.

Thinking critically, AF is simply a signal run rampant inside the atrial wall because there is an issuing location that is not normally present, or active. When a person experiences repeated or persistent bouts of AF, it's a sign that there are unimpeded, unoccluded, and uncontained electrical impulses moving over the atrial endothelium. If one submits to an ablation, the intent is to impede, occlude, and/or to contain those impulses. If one recommences even occasional fibrillation in the weeks and months following an ablation, it must, de facto, mean that the procedure was NOT SUCCESSFUL in impeding, occluding, and/or containing the unwanted signal. If you perform an engine rebuild because it has been burning too much oil, and after three weeks it begins to burn oil again.........................................................

It must be understood, and accepted, that in the very few weeks following an ablation, some unsettled rhythms are often experienced. And believe me, they ARE unsettling. At least to me. My first time, I felt that my gracious EP had goofed, and it turned out that I was right. I was in the local ER twice in the six weeks following. My second ablation was six weeks ago, and I was once again in the ER, this time after two weeks had passed in NSR. Happily, and after some hand-holding by the outreach nurse who assured me that I had a successful second ablation due to the length of time before I had the eight hour glitch, I have been in calm NSR ever since. I'm about to go off metoprolol, and have been tapering since Wednesday. But, if one has a good and confidence-building run for five-eight weeks after ablation, but then some arrhythmia begins again, it means that the lesions have healed, settled down, and that signal can once again cross a small gap. Small gap = unsuccessful ablation.



Edited 1 time(s). Last edit at 03/28/2023 03:05AM by gloaming.

The most likely issue for Lewis is that the ablation did not stop all the "uncontained electrical impulses." However, my second ablation (first one was good for 13 years), seemed to be unsuccessful as afib started again well past the "blanking period".

Ablation on Jan. 6, 2020, and on Eliquis and Flecainide for one month. Then all was good until April:

7 episodes of afib between April 4 and Aug. 4, all stopped with Flecainide, "pill in a pocket" in a few hours. Then:

No more afib since Aug. 4, 2020. That's 2.5 years with zero afib and no meds. Could the blanking period be as long as 7 months? Not likely, but what other explanation is there?

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Ken
Could the blanking period be as long as 7 months? Not likely, but what other explanation is there?

For you it apparently was. Unusual but not unheard of.