How many ablations is too many?

[chanceflight]

I originally posted this on the arrhythmia alliance forum, but someone suggested I post on this one as well.

I have had bouts of atrial flutter and tachycardia for the last year. So far most medications do not work. It was discovered that there is extensive scarring on my right atrium. Thus far I've had 3 ablations, 2 of which seemed to work for a couple of months before the flutter/tachycardia returned. Now my EP gave the option of meds and a pacemaker (since my rate is very low when in normal rhythm) or a 4th "aggressive" ablation.

Has anyone had 4 or more ablations? What would be the disadvantages of numerous ablations? I would like to be able to fix this once and for all and not be dependent on meds forever.

[ultramarine]

It does seem rather a lot for one condition, did you have only one vein ablated or a few, and what did your scans show on your pulmonary veins, were they normal?. I had this discussion at one stage with my EP before I had my first ablation, as a lot of pauses were captured on my ECG, he told me then that a Pacemaker does not necessarily stop the palpitations, its a different issue.

If you aren't effected by the AF too much but your rhythm is too low then it would seem reasonable to get a pacemaker, all I know is I would need to find out how low it should go before considering a pacemaker, and what other things you can do to add to any further surgery.

[BobD Volunteer]

If you have had three ablations for flutter then these will all have been in the right atrium which explains the scar tissue. From what you say I assume that you have not been diagnosed with atrial fibrillation but only flutter so your left atrium and the four pulmonary veins have not so far been "got at". The two conditions are quite different although flutter can lead to fibrillation which is a very irregular non rhythm not just a fast heart rate. I know of people who have had flutter ablations first and then gone on to have several ablations to stop fibrillation but from your description this is not you.

To come back to your main question, how many is too many? I think this is up to the electrophysiologist who is going to perform the procedure. It is he or she who has to find a way in amongst existing scar tissue and firkle about so if they think it is a good idea and are prepared to try this gives you a good idea what they think. I know of people who have had four or more ablations for atrial fibrillation and gone on to have pace and ablate procedure who still have the feelings of AF even though their ventricle is controlled by the pace maker.

I confess I have not heard before of multiple ablations for flutter as these are usually straight forward and easy to do.

[Icenae]

I have a pacemaker (15 Years). As I was down to 20 beats at times and passing out. I also used to fall asleep as soon as I sat down in evening. Pacemaker is really good. No problems. Still get tachy after 3 ablations for af. But more comfortable. Had big probs after last ablation but settled down now. Just taking bisoprolol beta blocker for tachy which makes me a bit weary but working. E P said might need more ablation but not considering it until cant bear it again. Try the magnesium route (sanjay gupta). Helping me, I am sure. My cardiologist calls it the Continental method!!!

[chanceflight]

Thanks to all for the information. I appreciate it. I did look at Dr. Gupta's videos about magnesium. Very interesting.

The 4th ablation, if done, will be a "substrate" ablation. This I'm told is normally reserved for ventricular arrhythmias, which is a much more serious issue. A substrate ablation will be a much more aggressive approach on my r. atrium to hopefully eliminate any potential channels.