Considering 2nd Ablation Surgery

Hello,

Was wondering who has had a 2nd Ablation? I had my 1st surgery
about a year and a couple of months ago. We have been trying to get me on Medications that will keep me from going into Atrial Fib. Seems like all we have tried have failed to keep me from Fib events and the side effects are hard for me to tolerate. Am currently on Sotalol 120 mgs in am and pm. Feel like the walking dead and have back and shoulder pain. I have a Pacemaker put in around the same time and have finally got that regulated. Paced at 60 beats per minute and had the test turned off. My Dr. has been willing to work with me on medications but it seems all he wanted to do is give me more medications on top of what I am currently taking.

Now I have an appointment to talk with him about a possible 2nd Ablation. Would Love some input from you that know, what to look out for or discuss. Also would love to hear from someone that has chosen to do this surgery again and it was successful. I am having a heck of a time with these heart medications. Need to see some hope out there. Have been pretty low energy and (I will admit it) depressed. Going for counselling now and hope to get some help there.

You all have been so kind and helpful to me, Thanks, Mary Ann

10 Comments

Afib ablations

by golden_snitch - 2014-09-19 04:09:22

Hi Mary Ann!

I'm sorry to hear that your first ablation didn't do the trick.

I'm not an Afib patient, but I have had multiple catheter ablations for different atrial arrhythmias. What I do, however, know about Afib ablations - I guess you mean the so called "Pulmonary Vein Isolations" - is that the first procedure is successful in a limited number of cases. I think the success rate after just one attempt is something around 40%-60%. After a second or even third procedure, success rates are higher, about 70%-80%.

The EP department where I'm being seen at is doing more than 1000 Afib ablations per year (2500 ablations/year all together). My EP professor there said, that they always inform patients before the first procedure, that they might need a second and probably also third procedure, before they are Afib-free or at least see an improvement. And in some patients it really only is an improvement and not a cure; improvement in the sense that in these patients the Afib episodes occur less often and/or have a shorter duration or that they respond to drugs again, which were no longer successful before the ablations.

So, if I were you, I'd definitely give it a second try.

Inga

Feel like trying

by scarheart - 2014-09-19 04:09:46

Hello Inga,

Thank you so very much for your prompt reply! I believe it is worth another try. Not quite so afraid to go ahead.

I will let you know how it goes when I have this surgery done. Mary Ann

Input Appreciated

by scarheart - 2014-09-20 05:09:42

Dear Alma Annie,

Interesting about the sinus node burning...something to talk about with my EP.

Glad that you can tolerate Metoprolol. There are very few drugs that I seem to tolerate. This is the main reason I will be having a second Ablation. Do your Hiccups happen at night? Mine sure are.

Thanks for your input, Mary Ann

2nd ablation

by Alma Annie - 2014-09-20 05:09:44

It was after my 1st ablation that I had to have my pm, but all was not good and I continued to have all sorts of problems with heart rhythm. A year later EP suggested another ablation. This time he could really destroy sinus node as I had the pm, so he did. I have felt really good since and most of my rhythm symptoms have disappeared.
I am still on Metoprolol, and without it my heart goes into 'hiccups', otherwise I am ok.
Hope all goes well for you.
Alma Annie

I'm fine!

by golden_snitch - 2014-09-21 02:09:02

Hey,

one sometimes has to be careful in forums like this. I know that people only mean well, but sometimes information shared here are wrong. My cardios/EPs are smiling at patient forums, they say there is so much half-knowledge or non knowledge shared here that patients do each other more harm than good. I'm absolutely in favour of online patient support groups, but I do understand my doctors' concerns in this regard. So, I just cannot keep calm when I read comments with incorrect information.

Yes, I have had loads of rhythm issues. Actually, my EP professor invited me to a talk he gave yesterday, and asked me to tell a bit from the patient perspective. We ended up telling the different parts of my story together, and I realized once again how much I've really had to deal with. But I'm fine now, thanks for asking. Rhythm is quite stable ever since the AV-node ablation, and I do not need antiarrhythmic drugs any longer. Pacemaker is working well, too, so at the moment I have nothing to complain about :-)

Wishing you good luck for your second Afib ablation! A friend of mine had three Afib ablations, and is doing fine now.

Inga

No!

by golden_snitch - 2014-09-21 06:09:30

Sorry, but a sinus node ablation to treat Afib does NOT help at all.

Physiologically speaking it is impossible that a sinus node ablation helps with Afib. The sinus node is the natural pacemaker of the heart. It sits in the upper right corner of the right atrium, is able to autonomically produce electrical signals (no other nerv etc. tells it to beat), and dictates the pace at that your heart is beating. When you are in Afib, the sinus node cannot do anything, and it's most importantly not causing your Afib. Afib is usually originating in the pulmonary veins in the left atrium. A sinus node ablation for Afib would only make sense, if the sinus node was a part of the problem, but it isn't!

Now, what is sometimes done in Afib patients in whom all other therapies have failed, is an AV-NODE ablation. The AV-node sits at the junction of atria and ventricles, and it's responsible for passing the electrical signals, coming from the atria, on to the ventricles. In very fast atrial arrhythmias, such as Afib, the AV-node does not pass every signal on to the ventricles, but passes them on in a very irregular pattern. This leads to the irregular rhythm you go into when you have Afib. It can be too fast, too slow, or in the normal range, but it's always irregular. Now, when you ablate the AV-node, you induce a complete heart block; the AV-node no longer passes any signals on to the ventricles. A pacemaker then takes over this job. When the atria are fibrillating, the pacemaker ignores what they are doing, and just paces the ventricles at an appropriate and steady rate. When the atria are in sinus rhythm, the pacemaker tracks this rhythm and makes the ventricles beat in the same rhythm. But usually, Afib patients who get an AV-node ablation are in permanent or nearly permanent Afib, so that the pacemaker just stimulates the ventricles.

Alma Annie, I still don't know what your diagnosis is. We have talked about this before. If indeed a sinus node ablation did the trick for you, you had a sinus node issue and not atrial fibrillation. Sinus node ablations are only done to treat permanent sinus tachycardia (which I had). They do not make any sense for other arrhythmias.

Inga

ablation.

by Alma Annie - 2014-09-21 08:09:33

Now I am confused. You see my EP is not a communicator.
My history is this:- I had had several bouts of AFib. Before I could have any investigations, I had an MI, which also involved proven coronary artery spasms. After being discharged from hospital and on the insistence of a son, I saw his cardio/EP friend, who immediately re-hospitalised me after tests as he said I had cardiomyopathy and only half heart working. After 8 days he let me go home, but 2 weeks later my ECG was all wrong again. He tried me on loads of meds, but nothing really worked. He decided on a sinus node ablation (that is what I was told) I had to come off all drugs so AFib was coming and going too much so I was hospitalised until procedure He only just touched the spot and HR went from 200 t0 23, so he stopped. 2 days later he put in a pm as HR was all over the place, and too low.

For the next year I continued to have erratic heartbeat and chest pain so he decided on another ablation. He told me he had virtually destroyed the Sinus node but that was ok as I had the pm, and I am now 100% paced in atrium but only about 1-2% in venticle. It cleared up most of my symptoms.
So that is all I know. I suppose I could always ring up the clinic and ask them to tell me, but I always feel that they are so busy.
Any advice would be welcome as I want to know!
Alma Annie

AV-Node Ablation

by scarheart - 2014-09-21 12:09:11

Hello Inga,

Thanks for explaining this all to me. No, my A Fib. is not constant! Probably don't need that kind of Ablation. Sorry that you have had so many rhythm issues to deal with.

So How are you doing now? Mary Ann

No idea

by golden_snitch - 2014-09-22 07:09:15

Hi Alma Annie!

Again, a sinus node ablation will not make any difference to the Afib as the Afib originates in a completely different area in your heart, far away from the sinus node. If the sinus node ablations did the trick for you, then you had problems with sinus tachycardia before. But from what you describe, with the heartbeat being all over the place and being erratic, it sounds like you had Afib.

So, I have no idea what your diagnosis was and what the EP did, but what you have been told makes no sense at all. It just doesn't work, you cannot treat Afib by ablating the sinus node. Ask any other EP and you'll be told that the sinus node has absolutely nothing to do with Afib. So, if you want to understand what you had and how it was treated, get the reports from the hospital.

Another thing that does not make any sense is that you say you are paced 100% in the atria, and in one of your other postings here you mention, that you have the rate response switched off. That does not work out either. If the sinus node doesn't function any longer, the pacemaker needs to adjust your heart rate when you move around or exercise. With the rate response off, and 100% stimulation in the atria, you'd be running around with the base rate of 50 all the time.

Inga

ablation.

by Alma Annie - 2014-09-23 05:09:17

Talked to my knowledgable 3rd son. He explained what happened. It was a bit complicated, but you were right Inga and it turned out to be sinus tachy. Apparently there were a few other things. Cardio /EP apparently is brilliant at his job, (he was almost begged to return to South Australia from Europe to teach other EP's) but does not feel the need to communicate with his patients. Son said who would you rather have,someone to save your life or someone with a good bedside manner!! Thank you for your advice. Next time I go to clinic I will ask for all my details. Anyway my 2nd ablation seemed to put things right.
I will be away for the next few weeks so will be unable to view pm club.
Alma Annie

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