Ablation # 2

Hi everyone,

Jeff from from California here. Confirmed for a Radiofrequency ablation on October 14. By way of background, I was diagnosed with AFIB during November 2015. I am a fit and healthy 60 year old with no other heart problems or significant medical issues. I had my first cryoablation in March 2016 following a course of treatment with meds. I Was considered an excellent candidate and my EP felt the procedure went very well. Experienced significant ectopic heart beats and coughing during 3 month blanking period which dissipated the following month. Went off meds after 3 months (except Pradaxa) to assess success of procedure and immediately went into AFIB which was captured while wearing an event monitor. Went back on meds (Flec, Metropolol) for three months and once again experienced AFIB like symptoms when I went off the meds again at 6 months. As a result my EP felt a second ablation (this time RF) was the best course of action to "touch up" and would further enhance my odds of success which he estimated at 80 percent Nevertheless, my expectations, while hopeful, are more moderated this time around given my negative experience with the first ablation. Three questions:

Can anyone explain the rationale for an RF ablation following a cryoablation?

Should I be prepared for another round of ugly side effects post ablation which may or not be different from the last time around?

If this works, is it possible that the ablation could hold my AFIB at bay for years, maybe till I hit 70 or older until I may need another procedure?

Thanks much

Jeff

13 Replies

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  • Hello Jeff

    You should look on a repeat ablation as adding to the work carried out the first time.

    It is not a case of your first ablation not working persue although you will read that for some success can be achieved at the first attempt. For others such as me it may need additional RF ablation.

    Regarding after effects they too differ from occasion to occasion and person to person. I tend to get over each procedure by resting maybe more than you are told on discharge.

    Best wishes for 14 October.

    Pete

  • I've had a cryoablation which I am led to believe, only isolates the pulmonary veins. Any other sources of AF will still be active and this is where the 2nd ablation comes in ie the radio frequency one, which can then be used to target these other sources, which you clearly have.

  • Hi Jeff

    Your experience is not so different from mine. It's so frustrating. Small consolation, but you are not alone.

    If you have confidence in your EP cardiologist ask him or her to answer your questions. If not, then find someone else. BUT remember that the success rate for first ablation is nowhere near 100%. In my case the second procedure simply showed that there was no electrical transmission from the pulmonary vessels to the atria.

    The pulmonary vessels are the most common but not the only source of rogue signals. If they are originating elsewhere then pulmonary vein ablation will not be successful.

    Hopefully your second ablation will go well. Hope for the best and be prepared for the possibility that it will not work. If not then push for alternatives. Unfortunately, the surgical options are more invasive. But with minimally invasive techniques are worth considering. This is where I ended up and 9 months later I'm in NSR with the occasional ectopic. Off all heart medications. Touch wood that it stays that way.

    Good luck

    Ian

  • Very common for people to have multiple procedures. Reason for RF is that it's pin prick so can pick up all the bits where veins are irregular or where AF is breaking through because of healing. In essence cryo uses a little umbrella which is pressed against each point where each vein enters the heart. However if there is some irregularity where it presses that small bit may not have been ablated.

    There are many who have had multiple ablations so I'll let them say about symptoms.

    Always difficult to tell about duration. Some have had years AF free after ablations. However don't forget that catheter ablations have essentially only been done for just over 15 years and equipments and techniques have improved. HUL site didn't exist even 5 years ago and in any event most, but not all, of those who achieve success drift away because the forum is no longer relevant.

  • You asked about the difference - the cryoablation uses a small balloon so that it cover the whole entrance of the vein in one hit whereas the RF ablation uses a small wire attached to a catheter which the EP manipulates around the area that show rogue electrical pathways on the mapping system.

    If you EP is now using the RF method I would deduce that it is to 'fill in' areas which may have been missed by the balloon.

    The former uses heat rather than cold but you may very well find that the side effects will not be as severe as I believe the cough is more common with the cryoablation. I was back working after 10 days or so after my first RF ablation, albeit part time.

    If successful, the treatment could well last for years or even your lifetime, but as far as I understand there are no guarantees. Depends upon many factors, skill of EP, your healing ability as you don't want the scar tissue he creates to heal which can happen, lifestyle subsequent to ablation for instance anyone with sleep apnea needs to have that successfully treated as this is the most significant reason for AF returning after successful ablation.

    I have 3 not 4 pulmonary veins so a cryoablation wouldn't work for me as one vein is in my EP's words 'huge'. I had to have a second ablation which held very well for over 2 years. I recently had irregular rhythm episode but I suspect that this has been brought on my meds that I take for another condition which is known to cause arrhythmias.

    Good luck, hope that you have a great outcome and many healthy, active, fit years.

    Best wishes CD

  • Cryo ablation is a useful tool where the rogue impulses are coming from the four pulmonary veins. It can not deal with any other sites in the atrium since it relies on a small balloon being threaded into the entrances of the four veins and then a freezing gas pumped in.

    Radio frequency uses a hot tipped catheter which can do much more by making dot scars so a line can be drawn across the atrium to block other impulses. Yes it take much longer which is why cryo is often tried first.

    For a much more full explanation go to AF Association main website and down load tehe booklet on ablation.

  • my daughter's father in law has lumbar spondylosis and after 1 try of rfa treatment, it was unsuccessful in taking away the chronic pain. any suggestion?

  • I had no side effects whatsoever from my one & only ablation (I believe it was RF), some 3 months + ago, so good luck.

  • Hello I've had two ablations (cryo and RF) in the last 12 months and the jury is still out - have had 3 long episodes since the second ablation on 9 May. I saw my EP about 3 weeks ago and he's going to review me again in 3 months. He was very sure that both procedures had gone well and it was possible that the problem lies elsewhere than in the pulmonary veins. Am still on full meds but most of the time am ok, just never know when AF is going to occur. I'm still optimistic that it has worked! We all heal and respond differently. I am lucky that I lead a pretty normal life - just get tired easily and some irritating side effects but so many have much worse to cope with. Best wishes,

  • Jeff...sorry you are going through this all over again :( Luckily you are a strong athlete whose body is used to going beyond the limits....approach your procedure as your latest athletic event!!

    We will all be waitng for you at the finish line cheering!!!!!!!!

    geegee :)

    by the way I am 4months post cryoablation and get my heart monitor this Friday...wearing for a month.....fingers crossed!

  • Thanks all for your comments, very helpful. Will keep you posted.

  • This one will will work because Cryoablation is way different than RF. The EP will be able to stimulate your AF and be able to ablate the exact thing that's causing the problem! I am praying for you and hoping for the very best when that time comes! I know I would be nervous too, and you can keep in touch and keep us posted! This is such a touchy annoying horrible thing! My hope is that this will do the trick for your life, you are in the prime of your life right now so think positive...this has got to be the ticket! Cheers and BEST of luck!

  • Thanks PattiJay for your prayers and encouragement. Will keep you posted

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