Failed second ablation

[bluebird100]

I had a second ablation 2 weeks ago and towards the end of it I went into AF when given a drug to slow my heart down . The EP said this indicated that my AF is coming not from the pulmonary veins but from the right side of my heart. Yesterday I had a 12 hour AF episode. My EP said that he is certain now that my AF is coming from the right side and is concerned about doing a third ablation because on this side there are many vital heart components including nerves that control breathing etc. I am feeling really low about all this and wondered if anyone else had been through this she whether they could advise please? I am feeling that I have lost the opportunity to have at least a temporary solution to my AF. My questions are: is a third too risky based on what the EP has said ? And is a third ablation on the right side likely to fail anyway given that he won’t be able to ablate areas too close to vital nerves etc?

[Kaz747]

I guess it depends exactly where the triggers are. I have 3 ablations in less than 2 years - 2 for SVT in my right atrium and one for atrial flutter in my right atrium as well a PVI in my left atrium for AF so my heart has undergone a lot of burns. It’s only 5 weeks since I had my last procedure (AFlutter & AF) and I have a lot of inflammation and ongoing arrhythmias and it’s too early to tell if it will be okay but my EP said they did a lot of testing after the burns so hopefully he doesn’t have to go back in again. Did they do a comprehensive mapping procedure when they did your ablation?

[bluebird100 in reply to Kaz747]

Yes but EP said he is sure that AF is coming from right side but doesn’t know where exactly. He said he is limited what he can ablate on this side and seemed very pessimistic of success and worried about the risks.

[bluebird100]

Although he didn’t say he wouldn’t do another one

[Kaz747 in reply to bluebird100]

I guess it depends on what equipment they have access to and what experience they have.

[bluebird100 in reply to Kaz747]

Thank you for replying. I am being treated at Glenfield hospital in Leicester. My EP has always been incredibly professional and personable but do you think there would be anything to gain from going private?

[Kaz747 in reply to bluebird100]

I can’t really comment as I’m in Australia.

[Mogold7tamm in reply to Kaz747]

Hi, Kaz, I'm in Australia too, good to meet another Aussie!!

[Kaz747 in reply to Mogold7tamm]

Hello - I see from your other posts that you are in South Australia- I’m in Perth 👋

[Mogold7tamm in reply to Kaz747]

Hi, I'm in the Adelaide Hills, on my own, eight days post op, and wobbly as a jelly, but undaunted!! Cheers, Shirley.

[Kaz747 in reply to Mogold7tamm]

Good to hear. I’m 5 weeks post my third ablation. Having a few dramas but trying to stay positive x

[Hidden in reply to bluebird100]

I would be cautious about going private at the moment as it is said they tend to avoid procedures which are difficult or problematic (there was an article a few years back in the Guardian from a GP detailing how private providers often dumped patients on the NHS if they think it is risky to do a procedure). And a friend of mine who is the son of a GP confirmed this- his father said that very often the equipment in private hospitals is not as good as that in the NHS. Its ok imo to seek private healthcare in some areas, but perhaps not in this.If you do decide to see somebody privately then I suggest you make plain that you want his *opinion* on whether it is safe or not, but that you are not join to ask him to carry out the procedure.

[BobD Volunteer]

Flutter not fibrillation usually comes from the right side. That is if you consider your right and left not his!!!

[bluebird100 in reply to BobD]

Thanks for replying. Yes my right side. EP was clear that it was AF coming from the right side. Basically because he is sure that he has isolated the pulmonary veins and that when he gave me a drug at the end of the ablation that raised my heart rate and I did not go into AF but then gave one to slow my heart rate abs i went into AF he feels it must be coming from the right side. He tried to isolate some areas on the right but not many.

[Jlaine in reply to bluebird100]

Gosh its discouraging to hear so many people need several ablasions!! Especially when you get general anesthesia each time which isnt good as we get older!! Best of luck! I hope this will work and be your last!!

[bluebird100 in reply to Jlaine]

Thank you.

[heartmatters1 in reply to Jlaine]

Not all ablations are performed under GA. I have been offered mine with sedation - I wasn’t even given a choice 😰

[Jlaine in reply to heartmatters1]

Oh jell no for me!! I have a bad back and after coming out of general anesthesia I was in horrific pain. Would never have been able probably to tolerate it with sedation?? But your right you can have sedation But most have GA. Remember to give your aation 6 maths to form scar tissue then perhaps things will be good??!!

[Dinodog]

Hi bluebird-

Very sorry you are going through this. I’m in the states so not quite sure how your healthcare works. I can say that if your EP is telling you he isn’t comfortable going into the right side, he simply doesn’t have the skill set to do what it takes. This is not at all uncommon when things get more complicated. I don’t know who to go to there, but am sure someone on this forum can tell you who the most experienced and successful ablationists are in England. I’d really suggest seeing someone who has done thousands of complicated ablations- these are the docs, and there are a limited number, who can fix your problem. Traveling is absolutely worth it as you will spend more time and money being out of work sick, uncomfortable etc. otherwise. I’m hoping I understand correctly and that you can still see other docs in the U.K. That aren’t in your local area but still covered under your plan. The top people I speak of generally have a wait to get in- that is a good sign. Bordeaux has one of the top centers in the world but I have no idea what the costs are there- it may be listed on this board if you do a search. You may not have to go private but may have to travel a bit to find someone who can fix you up. I had to travel a bit to another state for one of these docs, and it was well worth the inconvenience. I certainly realize costs can be prohibitive for many and we all have limited options based on our plans and resources. Keep your chin up you will get through this and feel better- try not to let it all get you down I know how hard it is. Best wishes!!

[bluebird100 in reply to Dinodog]

Thank you for your reply and encouraging remarks. Over here we have a national health service which is free at the point of access and although a wonderful service it limits your choice of moving to different EP’s in different areas. So if I was going to try to access a top EP I woul probably have to pay out if my own pocket as I don’t have private health insurance to cover this. But if I have to take out a loan or remortgage my house I think I would do so if I had a good chance of being symptom free for a good period of time.

[fallingtopieces in reply to bluebird100]

I was thinking of exactly what has already been said: see another EP for a second opinion. Perhaps you could find an (recommended if poss) experienced EP who works both privately and for the NHS, then pay for a private initial appointment with him, then hopefully if another ablation takes place it could be on the NHS. Acquire copies of your medical notes to take with you.

Pat

[Hidden in reply to bluebird100]

I’m not sure that is true. I live in Yorkshire but asked to be referred to Moorfield’s hospital in London for cataract extraction on the NHS.

My understanding is that in England we are all entitled to ask for an “out of area” referral, to any hospital in England, on the NHS.

[cuore in reply to bluebird100]

I agree with Dinodog to travel to go to a top EP. I had two ablations, both in Bordeaux, very complicated, but I am in sinus rhythm now. The first ablation was also on the right side of the heart. So, definitely get a second opinion and not trust this EP exclusively.

[Dodie117]

Ask for a second opinion. I had mine in St Thomas’ in London in 2013. Af and flutter free since then.

I saw Mark O’Neill who I believe trained in Bordeaux.

[bluebird100]

Thank you for your reply. Can i ask did you have to go private to do this?

[Barb1]

Yes, I agree about a 2nd opinion. Someone who has loads of experience. I certainly wouldn't stay with an EP who was unsure.

[bluebird100 in reply to Barb1]

Thanks for your reply.

[songbird74]

Check he has 3d imaging as I believe this helps a lot in identifying where to ablate. I went privately to Birmingham and was very happy with them.

[bluebird100 in reply to songbird74]

Thank you .. I will ask.

[Jc24]

I just had my 4th ablation. It was at the Cleveland Clinic and the procedure was extremely long as they mapped my heart. It’s been 24 days and the only problem I have had is the optic migraine caused by the transseptal puncture. The last few days have been free of those and I have started walking again. I’ve had no heart issues and feel like it was worth doing. The only med I take is the blood thinner because of my family history.

[bluebird100 in reply to Jc24]

I Hope this one works for you. Good to know that it’s possible to keep trying to find a solution. My EP said he might do a third but if that one failed I would need to stay on meds and hope for the best.

[Brizzy5000]

Hi I had ablation for A flutter right side and A fib left side by a Dr Barman at Bristol Heart Institute in May he was excellent and so far so good.