Scheduled 4th ablation with mixed emotions

I scheduled my 4th ablation yesterday for July. My first two were unsuccessful in 2009 and led up to an SVT of 220 bpm. I found a specialist who performed Cox Maze procedures and had that done in 2010. The Cox Maze enabled my Afib episodes to correct on their own. I experienced junctional rhythms but was ok. There were periods of time that I had no cardiologist, no EP and no meds (when I started this Afib adventure I was prescribed 5 meds). In 2017 I ended up in the ER with Afib of170 bpm. In 2018 I ended up in the ER again, same bpm. Not sure when but I began to experience bradycardia (2020?) which made me so sick. The EP I had from 2017 til 2022 (not the same as the one who did the ablations) felt there were no interventions for me, and that the bradycardia was the result of having too much tissue burned out. My regular cardiologist felt strongly that I needed some type of intervention and verbalized his belief that the EP was older and probably less interested in surgical treatment and so he referred me to an EP in his practice. I was able to transfer the data from my Medtronic Loop recorder to the new EP and he told me my rate was going down to 40 bpm. We discussed interventions: ablation, meds or a pacemaker. I opted for the pacemaker and received it in August of last year. The EP saw some arrythmias through the PM monitor and prescribed Flecainide a few months ago. I don't tolerate Flecainide well and I haven't had the best of luck with anti-arrythmics. I suspect the EP thinks I am being difficult. We again discussed ablations and he was under the belief that I would not agree to one but I gave in. The reasoning for my hesitation is that the 2nd ablation had complications including a blood clot where they had to wake me halfway through the procedure (I have no memory of it) and then had me evaluated by the head of the Neurology department the next day. I somehow had frozen shoulder in the recovery room and it made it difficult to lie flat with sandbags on my groin for 12 hours. I swore off ablations and found the Maze. I should add that I was recently in the ER due to an episode of Flutter. I have seen many posts on here about Dr, Natale in Austin, TX and wonder if I should schedule a consult? I am a little beside myself with the thought of another ablation.

You have certainly had a hard time and I can understand your mixed feelings about another ablation. You might want to read Carey’s pinned post above about how you can have multiple ablations and still have Afib. He did go to Natale for his last ablation which was very successful. At this point, gathering all the information you can is going to help you with decisions on further treatment, so it would make a lot of sense to have a consult with Natale who probably has more ablation experience than anyone else in the country and specializes in difficult cases where previous procedures have failed. Ablation has come a long way since 2009 and is a much easier experience. I recently had an ablation with Dr. Natale and even though it was complicated, it was quick (about 2 hours on the table) and nothing like sandbags on your groin these days. They insert collagen plugs in the groin punctures, use inflatable pressure bandages if needed and you only need to lie down for 2 hours after your ablation—then they get you up and walking.

If you want to explore a consult with Dr. Natale, the phone number for Texas Cardiac Arrhythmia Institute is 512-544-2342 and the person to speak to is Norma who works with patients from out-of-town who might want to come for a one-trip procedure.

Don't even think of another ablation with any local EP. You're a complex case and way beyond their abilities. Read this post.

Thanks Carey. I did read your post almost as soon as I visited this site and created an account. I couldn't believe someone had been through SIX ablations. I am so glad you shared your experience. And thank you for your advice.