Significance of a Single Late Afib Occurrence after Ablation

[mjames1]

It's 11 months since my first PVI afib ablation. I've only had a single afib episode at month six, which terminated 3 hours after PIP Flecainide.

I would be more than happy with just one afib episode a year, however the concern is will the frequency increase?

Anyone have a similar late occurrence after their ablation? If so, how did things work out from there? The literature is sparse on this.

Jim

[Paulbounce]

Hi Jim.

We are all different. It could continue like this or you may need a 'top up' at some point - only time can tell.

Good luck anyway.

Paul

[Buzby62]

The 64 thousand dollar question Jim.

Hope you find the answer and don’t have any more episodes.

Good luck.

[Hidden]

I was free of AFib for 5 years after ablation for paroxysmal AFib. I had a second ablation after developing persistent atrial flutter/ fibrillation. This was unsuccessful. I have accepted permanent AFib.

Unless you are confident your episodes are always symptomatic, including at night, do think an IPL might help predict the possibility of further dysrhythmias?

[mjames1 in reply to Hidden]

Good point but I'm pretty confident I know when I'm in afib or flutter plus not concerned with very short sub-clinical events that a loop recorder may pick up. As for anything longer than a minute or so, pretty sure I know when I'm in afib or flutter and never picked it up when I did overnight monitoring, nor has the Apple Watch picked up anything on afib burden monitoring.

Jim

[trevs7]

Hi Jim,

I was in the same position as you. I had a 12-hour episode 5-months after my 1st ablation (used PIP Flecainide), then a short 2-hour episode 2-weeks later. I held off having another ablation until I had another one 10-months later lasting for 9-hours, and then another 2-weeks after lasting for a few seconds. I did have a 2nd ablation 4-weeks ago as I thought it was my best hope of stopping future episodes.

I'm not sure I have done the right thing though, as I still don't know if I will have anymore episodes.

Like you, if I only have one or two a year, then I will probably live with it and only go forward with more ablations if things become worse/more symptomatic.

Hope this helps a little.

Kind regards,

Trev

[mjames1 in reply to trevs7]

Thanks Trev. All the best luck with the second one.

Jim

[Lenlec]

sorry to hear. Hope it’s one off

[CDreamer]

Living with uncertainty is part of the process, before and after ablation.

[DKBX]

Been through five ablations, lost track of the number of DCCVs, tried every rate and rhythm control drug in the pharmacopoeia … and still the beast returns.

Ultimately headed to pace and ablate, I imagine. Just accept the inevitable but hope for the best. Good luck.

[OldJane]

according to my EP they may - or they may not, at least for years. I had an ablation nearly 4 years ago, one episode a year (brief, an hour or two) then last year two, one was 6 hours. He scheduled me for a touch up thinking the monster was creeping past, but nothing since September so holding off. Good luck

[mjames1 in reply to OldJane]

Personally, I'd be OK with one or two a year. Were you aware of any common triggers to these episodes?

Jim

[OldJane in reply to mjames1]

No. Previous triggers had been vagus - alcohol, deep sleep. But not these. EP says triggers identified at start of Af journey will morph and in the end will not be relevant to track.

[OzJames]

hi Jim i know little about ablations but could the AF episode just be part of the blanking period people talk about. If that’s a possibility then you might not get another for years… are you on any meds at the moment

[mjames1 in reply to OzJames]

Thanks. I was three months out of the blanking period, but of course it can vary by individual. I very occasionally take some Flecainide and diltiazem if there's a lot of ectopic activity. That's because they can sometimes trigger an episode.

Jim

[OzJames]

I find the Vitd3 and magnesium help my ectopics, reduced to nearly not noticeable after 12 months. Anyway hope you stay in Sinus for a good number of years!

[Snowgirl65]

I've had 3 very short ones since my third ablation in December 2022. I worry about that too, i.e. if these will continue or have they formed a new pathway in my heart. My EP confirmed recently that no, they didn't. I just need to stay away from my known triggers, i.e. sugar in the form of cookies and cakes, and stress.

[mjames1 in reply to Snowgirl65]

Thanks. Do you remember the dates of the three events or about how long they occurred after the third ablation?

Jim

[Snowgirl65 in reply to mjames1]

Jim, I checked a-fib diary. I had one episode 8 months after my ablation. That one lasted two hours (triggered by a hornet sting). The next one was 5 months later (or 13 months after ablation) which lasted 10 minutes (triggered by eating tons of sugary cookies). I'm hoping that if I stay away from cookies and hornets, I'll be fine from now on.🙂

[mjames1 in reply to Snowgirl65]

I'm hoping that if I stay away from cookies and hornets, I'll be fine from now on.

😄 Not sure which of the two will be harder to avoid.

So my trigger was a short tachycardia with heartburn on top of it.

I can't avoid the tachycardia episodes without another ablation, however I am treating the heartburn more aggressively with daily PPI's and PIP Rennies 😄

But your story is reassuring in that one or two late occurrences doesn't mean we've gone back to aquare zero.

Jim

[Snowgirl65 in reply to mjames1]

I guess we all know our triggers! I was reassured by my EP that even though I had those short episodes, my heart hasn't remodeled itself.