Before I had my ablation I was told that the success rate was 70%, so for 30% of people it didn't work at all or maybe it didn't work perfectly and they would need one or more procedures.
Presumably that is because not all of the electrical signals were found but maybe not. Maybe it only worked for a time. For people who had ablations in the past, was it that it worked but then the signals found their way around the scarred areas. I don't know what to expect.
Or was it that the equipment was less efficient then. I've read that ten years ago a cardiac ablation took 9-10 hours and they were very jubilant when they got it down to six. I think mine took an hour. Sanjay Gupta who I've got a lot of time for did a video four years ago where he was not at all keen and said it was not natural to burn off bits of the heart and should only be for people whose quality of life was very poor. I will email him and ask if he still feels the same. Personally, I think taking a load of drugs for the rest of my life would have been even more unnatural.
If you've had more than one ablation what was your experience?
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The risk of it not working or only working for a short while so needing it done many times is why I decided not to go ahead, I would rather take pills than permanently fry or freeze bits of my heart !
I'm inclined to agree with you, certainly understand your reasoning. I think it has to be a personal decision depending on how ones QOL is affected.
Myself, I've had 3 ablations and 20 dc cardioversions and really don't want to push my luck by exceeding these figs. I'm back on a list for ablation no 4 but will not be taking this up unless things get really bad.
I agree, when the EP told me immediately only a 70% likely success rate and that I was likely to need a second ablation, my reticence was confirmed and remains avoid it if you can. It is of course a God send for those with very poor QOL/other pill complications.
I wouldn’t have more than two ablations for AF. If they didn’t do the job well enough I would opt for ‘pace and ablate’ if offered because I can’t believe ablations don’t damage the heart in the long run, just in a different way to AF! That is mostly my gut feeling but I have read a cardiologist on here suggesting that ‘pace and ablate’ was a better option in the first place.
Google 'mapping techiniques ablation'. Ignore the 'Google ad's' as they are just trying to reel you in - however there are some gems there on the genunie medicial sites.
Worth an hour or two of your time. If / when I have an ablation I'll want the mapping done - that 70% success rate is likely to be much better and less likely to require a further one. No promises of course but worth a look
Paul
EDIT - some of the articles on my Google recommendation are quite old (some from 2007). May I suggest you research more recent developments regarding ablation mapping. They are not hard to find and I'm sure you'll find them useful for your research.
Good luck - Let me know if you have any problems and I'll send some links. It won't be today though as I need to turn off this computer for the day soon. Working online has it's advantages but sometimes I need to hit the off button !
Goodness they are even working on doing the ablation without catheters. Directing an RF beam to the area around the pulmonary veins in a similar way to how they deal with tumours.
I do wonder if mapping is all it is meant to be. My EP last year was extatic he had found four tachycardias which he ablated. Must have been five or six there as I still have it. lol 😁
Dont cheer me up too much Bob ! He did my 1st ablation with mapping on Saturday..... I was too tired to ask what he found .......Am thinking positive & loafing around
I had 7 ablations and am still taking the tablets too.
My understanding is that in my case there were multiple reconnections. During the 10 years these ablations were performed my quality of life did not improve. Although all the ablations took place at the same hospital I was treated by 4 different EPs due to retirement and promotion.
In that time the technology advanced significantly too.
I did not want pace and ablate as suggested by Buffafly because I feared reaction to the pacemaker because of my severe skin allergies.
It is now 3 years since my last ablation and my quality of life is significantly improved with episodes of AF now a real rarity.
I know for some the ordeal maybe is not worth it but for me I don’t have any regrets.
Is it such an ordeal nowadays? The whole day at the hospital when I had my ablation was fine, I would happily do it again tomorrow. Mind you I did have problems with migraine in the fortnight afterwards but I would put up with that too.
I hope it won't be necessary.
So seven years with six ablations and the seventh one, three years ago was the one that made a difference. Maybe that was because the technology had improved. But you are still taking the tablets, do you need to if the AF is a rarity?
We had a discussion during lock down about potential halving my Flecainide dose. However as I might have needed a cardioversion if it all went wrong again (I have had over 20 cardioversions to date), my EP and I took the view “if it ain’t broke don’t fix it” as the hospital’s anaesthetists were under significant pressure due to the high number of COVID-19 cases at that hospital.
Maybe if all gets better in 2021 we might give it a whirl as we suspect that Flecainide is contributing to my Bradycardia and hence shortness of breath.
Back in 1996 I noticed my heart was skipping a beat so had an ECG at the surgery, the machine was a new addition. It came up with the message that I had had a silent heart attack and the doctor put me on a beta blocker, I think it was atenolol. It brought my blood pressure down and my pulse to about 50. After a week I could hardly function so stopped it. Went to the hospital, ECG, chest x-ray, the works and at the end the cardiologist said that everything was tip-top and there was just this problem with the missed beat and I didn't need to worry about that either. He then drew me a little diagram showing how extra signals were coming from a different part of my heart. I can't remember if he said they were PVCs but that was what I thought they were. Maybe they were PACs. I guess that's where it all started.
I am sitting quietly right now and my heart rate is 42bpm.
I used to be on Bisoprolol but it made my heart rate drop below 40 bpm.
My EP has suggested I would benefit from a pacemaker. However I have had such bad urticaria in the past associated to heart rate monitor electrodes and skin pressure. For example when I had an operation 2 years ago and they wanted me to wear pressure stockings and this lead to 2 weeks of severe skin rashes.
Right now the slow heart rate is bearable not sure what I would do if my heart rate got worse still.
When someone is really seriously unwell with Covid-19 the doctors put them into an induced coma to take over their breathing. It is the Anaesthetists who are responsible for caring for the patient's breathing and as there were so many cases at one time a significant number of the Anaesthetists were totally occupied with keeping those patients alive. At my local hospital over 160 people have sadly died from Covid-19 and it has therefore meant that although it is a centre of excellence for Cardiac care, only urgent cases have been admitted.
It was for this reason that my EP said it was not a good time to experiment with my medication regime.
Were your reconnections in the same area? I have had three ablations. My superior right pulmonary vein kept reconnecting, so it was ablated all three times.
Yes they were in the same area. But with the best will in the world it must be very difficult for the EP to find every rogue electrical connection at one session.
I think we do not really understand just how difficult it is to carry out an ablation.
1. They are working with catheters via your groin and a hole through the middle of the heart.
2. The inside of a heart has more undulations than the rocky mountains if viewed under a microscope.
3. The heart is beating all the time.
4. There have been whole papers published in the issue of how much pressure they use when directing the radio frequency blast from the catheter. My EP is one of the authors of such a study.
So when some get despondent that they are not "cured" first time they should really be amazed that 80% of patients do attain a better quality of life and that such a procedure could be a success at all.
I absolutely agree with your conclusions, especially about the electrophysiologists. Like you I have had the best EPs ( DRs Meleze Hocini and Pierre Jais) in Pessac, France.
I do split hairs with your 80% conclusion because there is a drastic difference between paroxysmal patients and persistent. In my opinion, the true test of an EP is his/her skill in handling persistent patients.
I also feel many members on this forum do not fully grasp the consequences of persistent AF compared to paroxysmal, erroneously grouping them the same. They definitely are not.
I think when I had my first ablation on 11th June 2011, I thought I was going to be 100% cured and lead a normal life again. It did stop my heart from pounding when I walked up hills, but all in all it appeared to make my condition worse.
26th June 2013 I had a second ablation and was full of hope once more, but it did nothing and my AF was now quite extreme and debilitating. At times I could barely walk from my kitchen to the lounge as it made me feel breathless and tired, my life was a struggle.
6th July 2016 I had my third ablation. After this I immediately felt so much better, but AF and flutter have persisted. I'm now in constant AF, which I must say is a lot easier to cope with than paroxysmal. The thing that helped me most was changing my diet to one that didn't include any artificial additives. How I wish someone had told me to do this before having any of the ablations. Would I have listened if they did? I doubt it.
That's interesting. I'm full of hope but I know I could end up disappointed. I expect you are taking the bisoprolol or something to bring your heart rate down. If you are like me, I can understand why being in persistent AFib is easier - you don't have to cope with the low hr when you are in sinus rhythm.
Yes, I take Flecainide and Metoprolol daily. I'd much rather be as I am now than with PAF, it used to make me feel dreadful. Now I can more or less do what I want, have even had some long and hilly walks - just have to take it a little slower, but then I enjoy admiring the views when I'm out.
Had 2 ablations, 1st after 7 years of drugs which left me with very poor QOL, unfortunately made things worse, 2nd stopped AF for 3 years. The thought of being on toxic drugs for rest of my life was not acceptable. Flecainide failed to stop AF & I refused Sotolol & Amiodarone.
I would chance ablation over drugs & all the awful side effects. I can’t take any heart meds now so for me - AF ended after Pacemaker implant.
This is part of my dilemma also I had a Cryoablation for PAF last Dec.Unfortunately for me it was not a success and am now having 2-3 episodes per wk,the latest last evening lasting all night.I took flecainide 100mg straight away,but had to take another in the morning 6am.My problem is that I have to take other meds daily alongside .Bisoprolol 5mg amlodipine5mg doxazosin 1mg linisopril10mg Dabigatran110 mg x2 and a statin in the evening.These sometimes interact and make me feel dizzy. My Cardioligist has written to me ,with the following options,1take Flec every day ,change to Soltalol or undergo a 2nd catheter ablation.I am 76 years of age,reasonably fit,but totally unsure what route to follow.Hearing about multiple ablations,that have failed,especially in my age group,But hate the drugs,any views that might help,appreciated,I know its different for everyone.
When Flec stopped working as a PIP, I took Flec daily - 100mg x 2 daily. That seemed to stop the AF so I continued with that as I didn’t appear to have any side effects at the time but my only other med, at that time, was anticoagulant Dabigatran. When the Flec stopped preventing my AF episodes, which it sometimes does, there seemed no point in continuing to take it so I stopped and although I continued to have AF episodes, the days when I was NSR felt so much better!
I was warned off taking Sotolol as not appropriate for Lone AF ie: no other heart conditions by an eminent EP at the AFA Patient Conference back in 2013, but as you say, everyone reacts differently.
I think the aim is to prevent AF and keep you NSR to improve your QOL and if it does that - great. If it fails or you suffer side effects then something, somewhere needs to be tweaked. When I can to the end of the line I was given choice of - continue with AF epidsodes, Amiodarone (which I really didn’t want and my EP agreed it wasn’t a good option for me as I have other conditions to control and Amiodarone is even more toxic than Flec) or Pace and Ablate (AV node - much quicker procedure than RF ablation of the atria however it means you are more or less Pacemaker Dependant which, because I really was finding the 3/4 week AF very disabling, is what I chose - however I’ve had one very mild AF episode since the PM implant in Oct 2018 so I cancelled the second part of the procedure and I have to say it has been brilliant so far. It doesn’t happen that way for everyone but worked for me.
Best wishes - it is such a difficult call isn’t it? You don’t know if anything will work for you until you try.
Thanks for taking the time and trouble to reply.You have helped me to consider my options.Covid has not helped,as all my follow up appointments were deferred.Lots to think about,Bless you.
I would like to address "in my age group." At 74, I had two ablations. At 76, I had my third. I am now 15 months AF free, granted I do take Propafenone. Plus I was 6 months persistent AF for my first ablation. In other words, I was in a worse condition than you. Plus, I was one of the most complicated cases at the six months persistent stage.
AF begets A; the more AF episodes you get the more you will have. Although you do not say how long the episodes last, 2-3 episodes a week, in most cases, will eventually lead to persistent AF which you want to avoid.
Cryoablation addresses only the pulmonary veins which is the case in paroxysmal AF. But, depending on the structure of your veins, there can be some gaps by which the rogue signals can still get through. A second ablation, radiofrequency (dot by dot), will block the signals. Alternatively, there could have been reconnection in some veins. It is not that your first ablation was not a success; it is that some signals are still getting through.
You can always take meds but you may not be up to or even offered an ablation further on in the short future. In your shoes, I took the ablation route three times for which I paid myself because I went to Pessac, France. I have been more than pleased with my decision. The alternative would have been permanent AF.
Thanks,for taking the time and trouble to reply.I have learned a lot from your input.I have just returned a holter moniter so will be discussing my options at my consultation in October.
I had 3 ablation 2 in 2010 (Dr felt he could get better results) and last one 2017 Because I was caught in AF when at dr appointment. Don’t really and never did have any big issues other than fast heart rate. No meds other than Started taking an anticoagulant at age 65yrs.
I have had 3 ablations, the first in 2009, 2nd in 2011 and the third in 2018. Three times I had the burning ablation not the freezing procedure. The treatment took about 2 hours each time. I am still taking 10mg of bisopralol to keep my heart on an even keel. Not sure I still need such a high dose but the doctor is reluctant to reduce it as I seem to be doing well so far. The drug has no side effects so happy to take it daily. I understand that two ablations is probably par for the course. I was just unlucky. I’m sure the treatment is becoming more successful. I would highly recommend it as living with AF is no fun.
Gosh. Glad you posted this. I was diagnosed in December 2019 and am hoping for ablation. Now I'm reconsidering. Honestly my QOL isn't bad since I changed my diet and lifestyle. My HR increases when I walk uphill but that's normal I think? I just stand still for a bit afterwards till it slows down. I've had 4 episodes since December. Maybe life isn't so bad and I should thank everyone here for the great advice about lifestyle. And, oddly, the pandemic for giving me time to make those changes. Stay well friends!
I was having two or three episodes a week, each lasting 24 to 30 hours. Since my ablation nearly six weeks ago I've had only one lasting 6 hours. I just hope it lasts!
Well that's a QOL benefit right there isn't it? Mine last up to 14 hours but currently I can zap my HR back into NSR with a double dose of pills (recommended by my GP). Fingers crossed for you!
Contrary to most if the anti-ablation answers already posted, I am thoroughly in favour of ablation. My QOL was awful and I couldn’t tolerate the meds they offered. Nor did I fancy taking those awful meds for the rest if my life especially after reading the list of side effects they had and some some of which I experienced. I actually felt worse when taking the meds.
Also, and I suspect this is frequently the case, I had rogue electrical pathways in both the right and left upper chambers of the heart, so ended up having 3 ablations. I haven’t looked back since.
When you consider that there could easily be 75 to 100 rogue patches around the pulmonary veins, you can understand why they can’t get them all in one go.
I greatly appreciate the skill of the entire team who undertook my ablations at the Northern General Hospital in Sheffield and applaud the care and precision they took.
Well that was the problem with my first op, I simply wouldn’t go into SVT because I was sedated and calm.
My history started with just SVT, taking decades to deteriorate and for technology to become sophisticated enough to pick it up and map it carefully. But then with in 6 months of my first ablation for SVT I rapidly went downhill with irregular and irregular hear rythmes and they had no problems at all getting me to go into Afib. Hence the 2nd and 3rd ops to obliterate those pesky rogue cells around the pulmonary veins.
Like many people on this forum I have made lifestyle changes and I am sure that helps too.
it depends what the ablation is for. personally I know of 4 people who have had catheter ablation for SVT and 2 other people for VT my sister also had an ablation for VT 3 years ago she also had mild cardiomyopathy she’s been fine ever since so have the others. With what I read on here it doesn’t have a good success rate for atrial fibrillation I’ve read some people have 4 ablation sand it still doesn’t resolve the problem. I’ve had a few runs of NSVT over the last 12 months I also had an ICD fitted for safety reasons. My cardiologist said I could have an ablation if the VT gets worse he also said ablation for VT as a 90 %
I had two ablations, a cryo PVIfor AFib Jan 29th 2018, and an RF for re entrant atrial flutter Feb 26th 2018.
My EP advised that the flutter was promoted by the flecainide I was taking for the AFib. The diltiazem I was taking to rate control the flecainide was causing me issues: brain fog, poor memory, breathlessness, excercise intolerance, tiredness and less directly weight gain and apathy.
( no longer could be bothered doing some thing s as I was too tired) . I came off all drugs on May 15 2018. I have not taken anything except a few paracetamol since. I got my mental sharpness , memory and drive back. I was able to do easier exercise and regained fitness.
If I get A fib back tommorrow morning I will happily have another ablation tomorrow afternoon to keep off the drugs. I was 57.5 years old when I had the ablations, I had no other co morbitities and was reasonably fit.
My doctor had asked me to go into the surgery and have an ECG when I was in atrial fibrillation, that wasn't hard to do. My heart rate was 159 so the nurse wanted me to see a doctor. The one I saw was not my doctor and, because she felt my hr was too high, she wanted me to double to dose of bisoprolol. She didn't want to hear what I said about the low sinus rhythm rate and, because I thought that even 1.25mg was what was making me feel tired, I asked to see the cardiologist again. I could feel she wasn't very pleased with me.
We have a community cardiology system here and you get to see one of two local doctors who are experienced in heart problems. It's a sort of half way house. When I saw him, he said that the drugs were not the answer and that I was a prime candidate for an ablation. He sent the hospital an 18 week letter and, allowing for the lockdown, I was treated within 18 weeks.
I had PVI some 11 years ago. I was able to come off Flecainide after 8 years. My AF reduced from some 50%/ day to something less than 1%. The technology has improved since eg the catheter tips now fire off in a fixed proximity to the beating atrial wall whereas this was not possible when mine was done. I still have to take Flecainide ( around 20 over the past18 months) It gave me my life back. If I was asked to recommend would do whole heartedly.
I’ve had two ablations and my third is in two weeks. My first only lasted about six months and I had the second in the same year. My second in 2016 was a great success and for two years I was fine then unfortunately I got a nasty flu virus which put me back into permanent AF again. My consultant told me that if this doesn’t work he will do a Pace and ablate which he feels will be suitable for me. I’m hoping that I go back to feeling as good as I did after my second one.
Oh gosh. We are all so different. After being diagnosed with AF I had quite a lot of work done to the valves in my heart and I had an ablation which seemed to work very well. A year later I had a repair to another valve and then 8 months after that another valve repair. This seemed to counteract the good work that the ablation had done and I now find myself with a very irregular heartbeat for which I take medication. The medication makes me feel awful, tired and nauseus and I am constantly breathless. If I thought another ablation would improve my QOL I would be there like a shot. There is nothing worse than waking up in the morning knowing that you are going to feel awful all day and that it will be a struggle to walk far or eat anything.
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