2 ablations and Touchup with Natale - still active

Greetings all….
I have had 2 “full” ablations by Natale -first was to the usual areas for afib, second was to isolate the LAA (I had flutter after ablation number 1). Then had a watchman put in this last summer (he also did a short Touchup due to some tachycardia that started about 6 months after ablation number 2). So we are now 6 months since my watchman and short Touchup, and I am having a ton of premature beats. Just finished a 7 day halter to provide more detail, but it’s multiple hours a day of pac’s/pvc’s….it doesn’t create any sustained arrhythmias - yet - it’s just nsr with supra-ventricular ectopics…and I feel every one of them.

I know I can medicate with flecanide for the time being for relief, but anybody else still dealing with this stuff after 3 ablations? Any suggestions from the group? Thanks for any suggestions!

Cindy L

Dr. Natale's track record is excellent, but even he can miss something, or have something develop/evolve in his patients and he has to take another look. I think you should be carefully mapped to determine where the spurious signaling is getting through to the atrial endothelium, and from there the 'cure', such as is it, should be somewhat straightforward.

At least one of our hosts here has had six ablations, and like you, he lived with uncertainty and troubling arrhythmia for several years in between. After Dr. Natale's last kick at his can, he has been free of ectopy for several years running.

It's disappointing, and probably unnerving. Would be for me, anyway. Best to get on Dr. N's list again. I would guess he'd be curious, if not keen, to see what went wrong, or what he missed.

After three? Try five. I'm the guy with six, and Natale was the one to put an end to that ridiculous series of failures six years ago. I agree with gloaming. Get back on Natale's list. I doubt it's something he missed. More likely it's new ectopic sources that have appeared after the touch-up procedure. Afib is a progressive disease so it's prone to doing things like that.

He has an excellent track record. But perhaps there could even be a <> 1% chance that ablations are not successful for a rare patient ..no matter how many ablations one has. Perhaps repeatedly new sources keep appearing could be the result of genetic disposition and not a failure in the ablation…and that could be the reason why new sources keep popping up no matter how many ablations are done.

Well that was the reason I was told happened to me. Ablation #2 was just supposed to be a short touchup and a LAA ablation and he told me that he was shocked how the mapping lit up like a Christmas tree with new sources.

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Cindy L
Greetings all….
I have had 2 “full” ablations by Natale -first was to the usual areas for afib, second was to isolate the LAA (I had flutter after ablation number 1). Then had a watchman put in this last summer (he also did a short Touchup due to some tachycardia that started about 6 months after ablation number 2). So we are now 6 months since my watchman and short Touchup, and I am having a ton of premature beats. Just finished a 7 day halter to provide more detail, but it’s multiple hours a day of pac’s/pvc’s….it doesn’t create any sustained arrhythmias - yet - it’s just nsr with supra-ventricular ectopics…and I feel every one of them.

I know I can medicate with flecanide for the time being for relief, but anybody else still dealing with this stuff after 3 ablations? Any suggestions from the group? Thanks for any suggestions!

Cindy L

Had Maze procedure 2 yrs ago during mitral valve repair and while apparently it solved my AFib, it left me me lots of daily PACs that drove me absolutely nuts. Only 25 mg of Met and 100mg of Flex, both taken twice daily, would give me relief. Then the meds started lowering my HR and BP too much so out of desperation reached out to Natale and had my first ablation with him last month (2nd ablation overall). 40 days later and so far I kept experiencing same annoying PACs in between my meds dosages. Don't want to jinx it but in the last few days it's been remarkably better, but the real test will be in 4 weeks when I am off the meds. Time will tell, but this journey is frustrating as hell, that's for sure.

That's unsettling, Carey. Are you saying that it's not uncommon to get Afib back after getting a LAA ablation, a flutter ablation and then a Watchman, all with Dr. Natale? That's my afib experience too....it's been 9 years since the 2nd ablation (flutter), and all has been quiet. Hoping it stays that way forever.....Barb

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tobherd
That's unsettling, Carey. Are you saying that it's not uncommon to get Afib back after getting a LAA ablation, a flutter ablation and then a Watchman, all with Dr. Natale? That's my afib experience too....it's been 9 years since the 2nd ablation (flutter), and all has been quiet. Hoping it stays that way forever.....Barb

It's uncommon, but it can happen. If it's been more than a year since your ablation and afib reappears, it has nothing to do with the quality of the ablation you had or who performed it. It's because a new source of afib has developed somewhere in your heart that's outside the area(s) isolated by the ablation.

By the way, the Watchman has nothing to do with it. A Watchman doesn't prevent afib. It just protects you from strokes even if you stop taking an anticoagulant.