Wait for 3 Months blanking period or not after ablation?

Hi, I wanted to create a thread to collect data and with opinions of patients after ablation.

I had HF Ablation the beginning of the year. Before the ablation I had AF once per Month mildly but after ablation I am had AF every second day. Am now on Flecainideacetate (2x100mg) which helps . The EP offers to redo the Ablation immediately but I am wondering if I should give it more time. Should I least wait the full 3 Months blanking period? (I am in my early 50s and similar AFs in the family but theirs was 'fixed' after first ablation) To answer this I an looking to for similar patients. What was your experience post ablation. Thanks for your help in advance

Have any of you had post ablation problems?

Did they disappear and after how much time?

Did you have Cryo- or HF- ablation (if you know what you had)?

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31 Replies

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  • I have three ablations and each time I have had blips in the blanking period and the frequency and length of the blips is how it has continued after the blanking period. Although the ablations have not been successful it has improved my AF each time.

  • At least progress. My AF got worse after the first AF and after two Months did not improve. I started out with what diagnosed as a healthy heart. Did you take any Flecainideacetate or beta blockers after the ablation?

  • Was on bisophonol and Flecadide to start. Now have Flecadide as a pill in the pocket and have moved onto Nebivolol.

  • Had three RF ablations. First made things worse. Second worked fine for about 9 months and then started getting breakthrough and third stopped AF completely. I still get other arrhythmias but not AF. After two of my ablations I went into atrial tachycardia after about a month-six weeks and had to be cardioverted.

    By the way three months in my opinion is the minimum healing period. I was still getting blips at six months when I tried stopping drugs but these gradually faded away. Again my personal view is that you need to give it time and not rush into things. I had a year between each of my ablations.

  • Bob you are a far more patient man than I am ;-)

    You waited one year between each of your three ablations. Need to ask my doctors more about the time for the scar tissue to form. All in all I feel the medical industry knows far too little yet about the mechanism. They can now test immediately after (during) the ablation if there is isolation. And my test was apparently 100% ok nonetheless I had the problems back worse after a week or so.

    Anyway glad to hear you have it behind you and I do think I want to give it more time to see if the first one really failed. Because if it is that much worse I at wonder if there are other trigger mechanisms at work

  • Update: I am going back in next week. See if it gets better this time.

  • How goes it Bob I'm four months post ablation and had a new sensation tonight , I felt faint and my heart felt like it rocked from side to side! Never felt that before , only for a couple of seconds . Went up to the hospital and my ecg was fine and my bloods are fine! I have a stinking virus, could this just be playing me up?

  • I suspect it is the virus. We always blame our hearts don't we? Any inflammation can upset the balance so try not to worry unless it keep happening. I also very occasionally get a sort of instantaneous zap when it feels like I have been knocked sideways usually if I have been seriously burning the candle at both ends or am carrying a bug.

  • I am staying in bed today and listening to my body, this virus has been coming on and off for a few weeks now. Monday I went to work feeling rough, bad move looking back! Thank for you response!

  • Hi

    I had my ablation in january and like u pre ablation i had af about once a month. I now have af about once a fornight. Im on flecanide pill in the pocket. I also get more frequent dizzy spells. They only last a matter of sevonds but stills scarey. I haven't contacted anyone in nhs as thought i ahould wait my three months and just hope that thi gs will get better after that so roll on april 5th.

    I also am in my early 50s. I had cyro ablation but they only managed to do the 3 veins dur to phrenic nerve palsy. Ill be interested to see your replies.

    The ep followup for me isnt till the end of april so there isnt really a contact point before that and i would have to go through my GP for a referral to be able to change that i would imagine.

    To be honest at the moment i cant help feeling that im wirse off now but i guess im just being negative and hope that another month will make a difference.

    Else xx

  • Hi Else,

    That makes two of us. Although I feel sorry for you, I now feel less alone with the same issue. I have a healthy heart and super low CHADS2 score so doctors gave me a 90% chance. Afterwards they told me I was a super rare case. Clearly they have not been on this forum! Post ablations problems seem more common than I ever imagined and quite a few people seem to be worse off. However also many report improvements after up to 6 Months of waiting. Having spoken with top specialist in the field they still feels it is worth doing the ablation because long term it never gets better by itself and the ablation give you a good chance for long term improvement. And you need the anticoagulants to avoid blood clots during that time.

    I am lucky(!) in a way as I paid for the OP fully myself (£8k) so get a lot of response from the doctors.

    Reading this thread I think I am going to give it more time with Flec (Tambocor) and see what happens. I can still do it any day I like afterall.

    Thank you for sharing your info though.

  • Hi Else,

    Finally three Months passed after second PVI.

    All great now no more events. See full report at the end of this post.

    Just wanted to let you know.

    Hope yours was worked out too. Definitely recommend going back in as soon as an appointment is available for second and even third attempt. I could see from the pictures it gets easier for them each time as they can see on the monitor which parts are still "leaking" current.

    Best wishes to you!

  • Had RF ablation 1 end of Jan last year, 3 weeks of ok, then AF returned much worse. Dr called me back, said can't do another until June/July. Had no 2, no AF but around December had 2 runs of Ectopics which came with AF type symptoms. This coincided with me 'coming off' Bisoprolol. Went back on them, only 1.25mg, been ok since. Now trying without them again. Been ok so far, a week, no ectopics or AF. After AF returned last year they also gave me Flecanaide, 50mg, which I used to take as PIP. Not sure if it helped as AF used to last for 2 to 3 days. Didn't like taking it.

  • Hi,

    Look slike you are on the mend. Same issue with me first week post ablation was fine then slowly started increasing, much worse then before.

    Did you see any improvements during the period between end March (3 Months blanking end) and July when you had your second Ablation?

    Or could you simply not tell due to meds?

    This is my worry when I go off Flecanaide...

  • Only improvement April-July was the length of event did shorten to around 6-24 hours, h/r was usually between 110-160. Used to occur every 2 days or so (I have kept a log). Dr did say it was aggressive, this from the ecg. Whether the meds helped I don't know, the Biso was only 1.25, the 'baby dose' the hospital calls it. My 'normal' h/r is around 60 and I found 2.5 of biso lowered it into the low 40's and this made me feel dizzy. I would take the flec and nothing would happen until several hours later when I would revert to nsr. If I didn't take the flec I would still revert in a similar time scale. So I don't know if they helped.

  • Thanks again for that.

    My RHR is more like 75-80 and Flec does not seem to do much to reduce that. (which came as a surprise much as much does in this disease)

    AFIB rates at 2 x 50mg were in the 150 range just like it was before so had no impact, after increasing dosage to 2 x 100mg dropped to 135 average at rest. So feels less of an impact when it happens.

    PiP with Flec/Tambocor seems to have no effect whatsoever for me (At least not the dosages I am taking)

    My episodes typically last typically 6 to 8 hours the worst one 12 hours and shortest around 4 hours.

    Am writing this in case someone else needs data points to compare.

    P.S. I cannot find any scientific studies on How fast Flec goes into the bloodstream and how long it remains. This is odd given how long this med has been around for.

    Oh well had a good week with only one episode (I had thought that I had pipped it with 2 x 100mg and nothing happened all week only for tody to have a 'normal' episode again. As I have read so often on this forum its a rollercoaster of emotions.

    Thanks everyone who has replied. It helps!

  • Hi, Flecadide won't reduce your resting heart rate it controls the rhythm. Beta blockers such as bisophonol would slow the rate.

  • Thanks for clarifying that. I had read reports that it could reduce RHR for some. So I'm all good. So far 2x100mg flec is holding me up well (fingers crossed)

  • The reports might know more than me! Glad things are holding up.

  • Hertz, I found this on Wikipedia re half-lives for flec: "Peak serum concentrations can be seen 1 to 6 hours after ingestion of an oral dose. While the plasma half-life is about 20 hours, it is quite variable, and can range from 12 to 27 hours. During oral loading with flecainide, a steady state equilibrium is typically achieved in 3 to 5 days."

  • Good morning Hertz. I had cryo ablation in Dec 2011 which kept me AF free for 5 years. Unfortunately now suffering AF at least weekly and awaiting another. Like you I think I would wait before second one. Whichever way I wish you all the best.

  • Thanks for that! How was your post Ablation experience? Did you have increased events or was it healed immediately?

  • I am in a similar situation. I'm 50 years old and other than AF healthy and well. First diagnosed in 2009 with first ablation in 2010. Then +6yrs of - mostly no AF in years 0-3 and then increasing bouts over years 4-6 until late 2016 when I was back to once or twice weekly.

    I had second ablation 3 weeks ago ( Feb 9). As with the people above in my 3rd week I'm getting AF on average every second night (I have vagal AF) and it certainly feels at this stage that the second ablation has done more harm than good. If I can hold my nerve my plan is to give it a few months and hope things settle down.

    In terms of meds I'm on 2x 100mg Flec. plus an extra PIP. Seems excessive when reading these posts.

    Anyway it's good to know that I'm not the only one in this position.

    PS. Does anyone have a good source of information on vagal AF? I have seen the Sanjay Gupta videos.

  • Hi There,

    Thanks for your response. 2x100mg seems to be more the norm than excessive so you should not be worried. The minimum dosage for 70kg body weight is 2x50mg (i.e. 2 x half a pill) anyway. Most patients seem to respond well at 2 x 100mg

    It was the same for me tried 2 x 50mg for a week with no result. Then increased to 100mg and all was well. I am surprised that Flec is not given as standard (except if there is contraindication naturally)

    From what I have seen so far: keep your nerve! As you can see you are *definitely* not alone, I'm going through the same for now. Seems to get better over time for most patients.

  • UPDATE: So the episodes never disappeared again and that is *with* 2*100mg Flec. Without Flec its too often for comfort. Going back in for a second try. I was yet again told it should immediately be better afterwards. However they usually get patients much worse so they feel better if they improve to the level I started with. I am beginning to doubt the basis of the hospital statistics. Will post here in 2 weeks time with an update. Thanks everyone who responded

    UPDATE: 2nd try after 3 Month was successful (See full report below). No further episodes

  • Now this has my interest!!

  • Final update:

    So in the end the situation was not sustainable.

    Without Flec I had multiple events per week and a lot more severe than after the first PVI

    After 3 months immediately went in for second PVI and was "lucky" that Afib happened during the actual procedure so the isolation success was immediately visible.

    Felt better immediately after the treatment and now three Months later had no further events and see myself as cured -for now-. Yes I know it can always come back but enjoying life while it lasts :-)

    Interestingly after the second PVI I did get Flec prescribed 2 weeks 2x100 then 2 weeks 2 x 50 then nothing, which was not prescribed after the first treatment (naturally anticoagulant for the whole 3 Month blanking period) .

    With the knowledge I now have I don't think the Flec after treatment makes any difference to the actual condition nor outcome except maybe more comfort for the patient.

    I have nice pictures from the screens during the treatment where you can see the computer visualization of the non-isolated areas around the left pulmonary veins which were successfully isolated after the second attempt. I can no understand why its difficult to get it 100% right the first time around because you work from nothing.

    Once they go in a second time it becomes much clearer which areas were not perfectly isolated. In fact knowing what I now know I am surprised there is such a high success rate on first attempt. The full isolation is only achieved after a few weeks when the scar tissue forms so its hard to say during the first treatment if it was successful or not. Second time around it becomes much easier.

    Also it is now clearer to me what manual skills come into play and just how much that influences your chances of success. One day robots will do this with near 100% success rate and eliminate the hit and miss of humans. No disrespect here but just a fact of life. My second procedure was conducted by one of the leaders in this field, and the information flow alone was quite different.

    So if you landed here because you are concerned your first one did not work out it is likely that you are correct. The good news is second time around you have much better chances and third one even more.

    Also there are still very different procedures in play. Some still use balloons other create a scar barrier around both PVs in one big circle wit spot welds.

    We still need a lot more large scale studies and maybe some post doc stumbles on this site and starts a survey.

    Until then I wish you all best of luck with your treatments.

    Keep the faith they *can* and *will* get you healthy again even if it takes (a few) more treatment(s)

  • I am , had my ablation in march , but my heart has played up a bit the last couple of days. Was perfect for three months. Fingers crossed it's just blips.

  • arggg now you are worrying me ;-)

    No actually I have become so super sensitive if I have a carbonated drink I feel like Afib when its not. Hope its nothing serious for you. How long since you stopped taking Flec or other meds?

  • Still taking flecainide twice daily 50 mil. I have had a stinking virus for a couple of weeks now , don't think this is helping.

  • Hmmm, surprised you are still on flec so long after the Ablation.

    I was told to stop after 4 weeks (unless I have more events)

    I purchased a Holter EKG monitor on eBay (About £50 for a second hand 3-lead model PC-80b) so was measuring the events over long periods. Do you have any way of recording an EKG yourself?

    You can easily see if its something or not on the EKG. As I mentioned I became hyper sensitive after developing AFIB so not trusted my own judgement and started recording. The contact pads are super cheap on eBay as well (a few £ for a pack of 50)

    I would recommend anyone who develops afib to

    1) Learn to read an EKG (loads of basic and even advanced courses on the web. Its not rocket science) and

    2) get yourself a cheap 3 lead monitor.

    Even as a lay person you can identify a nice smooth NSR vs. an Afib event: distances between the "peaks" (aka QRS complex in med speak) are either the same over long periods or start varying.

    Google is your friend. Learn as much as you can on the subject and measure yourself. You will find discussions with your specialist will take on a whole different dimension if you are well informed. Its your life after all.

    All the best and hope you get rid of that virus soon!

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