Just to ask people who got two, three even four ablations and still in Afib, did you ask your ep why it failed? Why do you keep seeing the same ep and keep doing the same thing over and over again knowing it will fail. There is out there many very skilled ep who got thousands of ablations under their belt and other techniques like Wolf mini maze with very highly skilled cardio thoracic surgeons. Please don’t stick to the same ep who use you as guinea pigs to perfect their skills. The first question I ask the ep is how many ablations you did in a week. I known NHS is different from our system in the US. 95 % of ablation success depend on the skill set of the ep. Don’t be their guinea pigs. If the ep accepts to take your case , it means he/she thinks they can help you living Afib free at least for a while since Afib is a progressive disease. I dont prefer any technique over another one but I care about the success of the technique which supposes to give some freedom from medication for a while and a better QOL. Any thoughts?
Failed ablations: Just to ask people... - Atrial Fibrillati...
Failed ablations
I've had 3 ablations all done by the same EP.
The first one stopped my heart from banging in my chest when I walked up hills. I had no idea that other peoples didn't do that.
The second didn't do much at all. I was then told I wouldn't be offered anymore ablations.
Then my EP designed a new piece of equipment that was put down the throat to the outside of the heart, so that they could see where the rogue signals were coming from. I was invited back for a third ablation and after this one I felt instantly better.
My heart would occasionally drift back into AF and I'd have it cardioverted back into sinus rhythm. Then a few years later, after having two cardioversions in one year, I was told I would not be offered anymore cardioversions. Despite this and now being in constant low rate AF (below 90) I can live a full life and know that I'm never again going to have those hateful AF attacks, hope so anyway.
Why did I keep going back to the same EP, because there were no others anywhere near me and I'd heard good reports re him.
Jean
Just to add, my EP said some people weren't helped or cured by ablations and I was one of them.
Whilst I am sure that there are far more "EPs" in US than here in UK I think it fair to say that due to their very scarcity they probable do more ablations than many of yours do . What I think makes a difference is that many use cryo as a first attempt since it is easier and faster to perform . The very process does , however, make it a little hit and miss since it relies for efficay on nice neat pulmonary viens . As a result, whilst some people have their AF terminated first time many go on to have RF follow up ablations to deal with those areas not available to the balloon.
Like myself. I just had my fourth ablation June 24th now 24 days post extensive ablation. And feeling marvelous. Yes my 4th EP was a well experienced one, finally. I only had to search and find him and his wonderful colleague, Dr. Eric Prystowsky. Here's my 4th ablation report summary:
__________________________________________________________________________________________________
Procedure Performed:
Comprehensive EP study, LA pacing and recording, Trans-septal puncture, Pulmonary vein isolation, non-pulmonary vein afib ablation LV pacing
Atypical Flutter Ablation, mitral annular flutter CTI Flutter Ablation
Vein of Marshall Alcohol Ablation
3D Electro-anatomic mapping (Carto) Intracardiac Echo
Synchronized Cardioversion Medication testing - adenosine Pre-op Wound Classification:
Yes my 1st five local EP's since 2013 could not have done all of this correction to my heart, I just had to drive a couple hrs to Indianapolis for the best.
Doug
Yes, what I meant. Ablation is not just only PVI, there are six or seven other locations which can be sources of the Afib episode on the left and right side (left atrium and right atrium) . An excellent ep knows how to find all of them and ablate all of them in one session. Your ep is one the master ablationist in the US. You picked the right one. Don’t jump the guns and go with the first ep. Do your research and go with the best of the best. Relationship does not count here . It is your life and your heart here. Who cares about the ep. I do care about your life and your heart.
Great topic. Thanks.
I'm also from the US. No ablations yet, but I always ask those questions. 150-300 a year seems to be the sweet spot with 76-80% project success rate.
Sounds like you might have shopped around for ep's like I did. Very easy to do in the States, but not so easy in the UK, as I have learned here. One point for the US.
On the other hand, ep's in the UK and Europe have been ahead of the curve early on with afib ablations, and now are doing Pulse Field which is only available in the US in trial. One point for the UK and Europe here.
Also -- and it may not be your cup of tea -- but many of the ep's in the UK and Europe do PVI's under conscious sedation versus general (GA) and partly because of that, table times are dramatically reduced. Ep's in the States are quoting me 4-6 hours for a PVI under GA while I have heard of dramatically shorter times in the UK, when say Cryo is done under conscious sedation.
The US ep's say they use GA because the patient won't move, but I think it's just the way they were trained and resistant to change even if it doesn't meet the patient's needs and wishes. Not saying I would necessarily hop a plane to the UK to have an ablation, but I wish I could find like minded docs in the US.
As to cryo vs rf, maybe at one point rf was king, but from my own research and talking to several ep's at leading institutions, I would take the cryo balloon first and then RF for touch up later if that didn't work out. Which brings us to your main point about multiple ablations. Sometimes touch ups are necessary even with the best ep's. Even with the WMM, they sometimes end up bringing in an ep to touch up the left and/or the right side. But yes, at some point, reasonable to look at alternate and possibly more aggressive approaches like mini maze or hybrid.
Jim
well said Jim. I'm leaving the WMM or the TTM ablations open, but hopefully they will not be needed. June 24th my fourth ablation was so successful.
Procedure Performed:
Comprehensive EP study, LA pacing and recording, Trans-septal puncture, Pulmonary vein isolation, non-pulmonary vein afib ablation LV pacing
Atypical Flutter Ablation, mitral annular flutter CTI Flutter Ablation
Vein of Marshall Alcohol Ablation
3D Electro-anatomic mapping (Carto) Intracardiac Echo
General and Local.
Synchronized Cardioversion Medication testing - adenosine Pre-op Wound Classification:
Can not ask for anything better than Dr. Patel - newest EP did for me in Indianapolis.
Thanks,
I can breathe so easy and exercise and stopped Flecainide too!.
Doug
I had my first ablation at a top London hospital in 2009 with the same EP who subsequently performed 3 more in 2011, 2013 and 2021. These were all RF, one under GA and 3 under sedation which was preferable.
. The reason why I never sought out a different EP was a case of trust in this particular doctor who is highly regarded and very experienced. I have been a difficult case but hopefully he may have cracked it with my last ablation. I have had a total of 22 'emergency' DCCVs at my local first class hospital and was in danger of becoming reluctantly well known ....
😬
I never saw my 5 ablations as successful or not. They were just building blocks to being out of SR for 1 year, 2 years, whatever. Then after the 5th my heart said , nope not going to comply any more, so Pace and Ablate. Yes, all with the same EP. Why not? We have a good relationship.
US resident, live in Hawaii.
Have been waiting on a long list for an ablation when my occasional events turned into permanent. They bumped me up the list and did the ablation nearly 3 months ago. Other than one 15 minute event 8 days after the operation I've been AFib free. This of course could change any day but I'm hoping I'm done with it.
My first ablation wasn't successful and I suffered side effects. I was very nervous about having a second so it took a couple of years of very bad super ventral tachycardia before I would let it be done again.But a different probably more experienced Dr and it was successful. I think you need someone with experience!Good luck.😊
Thank you SeanJax, I have asked that question to myself numerous times. Let me qualify my comments by stating that I am a relative newbie to this whole afib business.a) An ablation is an incredibly invasive procedure, with oft times debatable "success" rates, or even definitions of "success". It leaves the heart permanently scarred (its aim). Recovery time can sometimes be 6-12 months. A procedure under general anesthesia obviously multiplies the risks for us older folks. Whew, seems like quite a boatload!
b) IN MY OPINION one of the reasons for ablation "failures" is not so much the lack of expertise of the EP, but rather the hearts amazing (and not good) ability to devise alternate and aberrant pathways for the electrical conduction paths that cause the atrial contractions. We know the heart can do this-that's why we're all in afib to begin with! Theories abound as to why this happens, but it does! So if you destroy one little pathway with a blob of scar, no problem (AV node speaking to itself), I'll find a way around it quicker than a whistle. And thus an ablation "failure", and more ablation attempts.
Solutions?? Darned if I know, I'm just an old retiree typing on the keyboard, happily taking my meds, which so far are doing quite well. It would take quite a significant change for me to deviate from that path.
I've had 3 cardioversion same hospital, 3 ablations 3 different hospitals, all worked for on average about 12 mths, then I go back into permanent AF. All medics have been clear there are no guarantees only percentages. Only about 60% successful after 12 months.
I had PVI ablationfirst. Then after my second ablation they said two of them had healed and failed. They redid them amongst other stuff by rf
After my third ablation they said a third pulmonary vein had also healed and redid that and some other singeing.
Now I have af episodes again I would guess the fourth PV scar has healed too. All this happened within 20 months and I cannot face another ablation yet so am trying dronedarone. So part of the reason may be my dastardly little heart's good ability to heal itself! Which is odd coz each ablation needed absolutely months to get over.
Ps first was with a different EP from the next two....
I try to look at if it is RF ablation and then how many ablations are done by the EP in a year. I live in France. The EP I chose for my first ablation with recommandation from my cardiologist does about 600 RF ablations à year. He is quick too. I went in at 9 am and was back in my room at about 11h45. But I am not sure I agree that all arrythmia can be sorted with just one ablation. And not all failures are the fault of the EP. New Rogue signals can pop up somewhere else in the heart at anytime. That is why this forum is very interesting as there are so many different experiences.
I would go to Bordeaux to see Professeur Jais if your ablation fails in the future. You will see how good he is . He was under Professeur Haisseguerre’s wings for a while. The success of the ablation depends on the volume of past ablations, the special talent of the ep, the sophistication of the mapping tool and evidently your underlying disease. How many rogues sources you have. I am not so sure you can choose your ep in France since the social security system changed and I am not aware of all the changes details . I heard you can choose your gynecologist and eyes doctor without referral.
Yes I know about prof. Jais. Was it you who came to Bordeaux from Canada for ablations?Well you can choose your cardiologist ( or any specialist) here and anything to do with the heart is 100% reimbursed. Obviously if the cardioligists fees are above the norm you pay the difference.
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