Short episodes of atrial tachycardia after second ablation

[mwcf]

Hi all,

62 yr old male, good health generally, AF history 24 years, no comorbities/CHADS 0, PVI ablation 2018 Bordeaux and then further ablation (Marshall Vein, additional lines, RSPV touch-up) earlier this year again at Bordeaux. Second ablation further to episode of persistent AF (interspersed with atrial tachycardia) that started on 25/10/22 and lasted until ablation No2 on 03/01/23 (was in AF at start of procedure, then went from AF to AT after Marshall Vein alcoholisation with the AT then being terminated with an LA posterior wall/roof line).

Now 11 weeks on after ablation 2 and some slight issues this last 2 weeks comprising 3 short (1 to 2 minutes) episodes of atrial tachycardia at 120-130BPM. They do self-convert quite quickly and I can make conversion back to NSR quicker by bearing down/straining.

I appreciate that its not yet 3 months, but still a bit discouraging.

Has anyone else experienced anything similar and, if so, did it sort itself out by 6 to 12 months or did the episodes become more frequent and/or longer in duration leading to a 3rd ablation ?

To be honest here, I used to think that the blanking period was 2 to 3 months and that we tell ourselves it's longer - like 6 or even 12 months - to make ourselves feel better/give ourselves hope that the ablation has worked despite adverse issues in the first few months. The thing that DOES NOW make me think it really can take 6 to 12 months for everything to settle, is that its frequently the case for ablations to result in a higher resting HR that almost always takes 6 to 12 months to settle back to pre-ablation levels. If it takes that long for one's resting HR to recover then surely it's taking 6 to 12 months for the whole electrophysiological and ANS landscape to settle down. I've noticed my own resting HR is 10-15% higher after my recent 2nd ablation - on related note a couple of flights of stairs will now post-ablation up HR from 70 to 100 whereas pre-ablation 2 flights would only raise HR from 60 to 75.

I'd probably go a third ablation but probably no more than that as I wouldn't particularly want to keep chasing different atrial tachycardias from scar tissue around for evermore. I am prepared for pace and ablate at some point but was hoping to get north of 70 first !

Any and all comments very welcome.

Best to all here on this AF/AT journey !

Mike

[mjames1]

I have heard some ep's term anything after three months the "wishful thinking period" as opposed to the blanking period. That said, it really depends on how much of a burden you are left with and if it's worth another ablation to fix. My ep told me there was only a 60% chance of zero episodes within six months, however there was a very good chance that my afib burden would be decreased 90-95%. The latter I would take gladly. As to scarring, if you did go ahead with another, I've read little or no scarring with the newer pulse field ablation (PSA). Bordeaux, I believe was one of the first to offer it.

Jim

[MikeyF in reply to mjames1]

Thanks Jim, I had PFA at Bordeaux for the bulk of my second ablation. Only had RF for the RA typical flutter line they did at the same time.

Time limits in EP-land are a very arbitrary and ‘convenient’ thing. Eg., so a 25 sec salvo of AF/AT is not sustained arrhythmia but a 35 sec one is ?!

Plus we’re all unique experiments of one anyway. Generalisations are just that.

[BobD Volunteer]

Three months is defintely the minimum period as we explain in our fact sheet on recovery. Many people are still improving at nine mnths or a year.

I had ATach approx three months after my third ablation for AF which was successfully cardioverted. But ten years later it came back and eventually required its own ablation.

[MikeyF in reply to BobD]

Noted thank you Bob, but I’ve had 3 x 1 or 2 minute AT episodes in two weeks so not sure DCCV would be worth trying if it only lasted a few days.