1 week ago I had a touch up RF ablation, I thought I would share my experience.
I had my first ablation (a cryo ablation) September 2022. During this first procedure I had all 4 pulmonary veins ablated. At 3 month post ablation, under cardiologist advice I tried to give up the Diltiazem (for rate control) and the Flecainide 100mg/day (for rhythm control). I went into AFib approx 7 days later. Over the past 2 years I have tried numerous times to stop the meds only to slip into AF, 7 to 14 days later. I always revert to NSR within 3-4 hours with PIP flec and bisoprolol.
So I had my touch up RF ablation last Tues at Waikato Hospital (New Zealand). I spoke with the EP post surgery and he was very pleased with how the procedure went, and is very confident he found the area giving the rogue signals.
He explained to me that 3 of the PV's had good circles of scarring from the previous cryo ablation, and he could find no rogue signals in these areas. The PV's are in pairs and he said on each pair the circles of scar tissue should join to form a figure of 8. On the 4th pulmonary vein however the cryo ablation had not been done properly. He said this vein was larger and he could see that the balloon used was too small. The balloon therefore had gone in too far up the vein, so when inflated with the cold freeze substance, the scarring was inside the vein, and not the heart tissue. So using the RF catheter he made a horseshoe shape of burning in the correct area which joined the existing scar tissue on the other PV of the pair.
So here's hoping he got it (2nd attempt). The EP was very confident of a sucessfull outcome.
One week on, and I've had no funny sensations, and have been in NSR the whole time. I feel great. I've been advised to stop the Flecainide at the 1 month post ablation. I am to continue the rate control (Bisoprolol) and the AC (Pradaxa Dibigatran) and have a follow up review at 3 months post procedure.
Note, the EP who did the initial Cryo ablation was a different EP who did my RF last week.
Regards Blake
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KiwiBlake
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Thank you for the detailed post and sounds very positive. Very similar lead up as me, I'm weaning off flecanide 100mg x 2 ready for telephone appointment Aug 20th. My cyro was done June 2022.
There have been 3 appointments since and touch up was mentioned ,so we shall see!
Thanks Wilsond. Here in NZ our public health system is based on the UK NHS. We don't know who is going to do the ablation until the morning of the operation. Looking back at my first one, the EP looked very young, whereas last week, 2nd time, the EP was older and far more experienced. I've subsequently been told he is one of the best in NZ.
That all sounds very encouraging and a great informative post for others in a similar position. They do tell you before cryoablation that an RF touch up may be required but not everyone takes that information in at the time. I was aware of this but hope I won’t need it.
Best wishes and good luck with the recovery, rest up!
It is often quoted on this forum that it can take multiple ablations to 'knock it on the head'. Also everyone's hearts are different, PV's not perfectly round so the cryo balloon not making a complete circle of scarring. With me one being bigger than the others.
Yes, I during my cryoablation I overheard the senior EP explain to the junior he was training that two of my Pulmonary Veins were merged before reaching the heart, so I only have three veins coming into the right atria. Apparently this is not unusual and this a development "quirk".
Like wilsond my cryo was done in June 22 and at the same place. My AF is now stable on 2x50mg Flecainide per day and I haven't been brave enough to start weaning myself off them
I know that hospital very well having lived just outside Hamilton. My daughter was treated there for something. The health system in New Zealand was very good and a great group of people. Have found memories
I think the NZ public health system is fantastic, no complaints from me. I was told my operation last week would have cost the taxpayer $50,000 NZD which is approx £24,000 GBP. I certainly couldn't afford to pay that if I had gone privately. The Dr's and nurses were great.
sounds similar to me. Mt 1st sept 2021 was cryo. Sept 2023 had to have a redo rf. the ep said the left upper PV had reconnected so he did that area. Unfortunately I still have af. But fingers crossed yours is successful.
I recall someone saying on this forum is that some people's hearts heal better than others, which in terms of ablation is a bad thing. If your heart tissue heals too well, rogue signals may come back. What we want is heart tissue that when burnt or frozen, heals poorly, so that lovely scar tissue forms, as it is the scar tissue that stops the rogue electrical signals.
I'm in the Taranaki region, just out of New Plymouth. Taranaki hospital doesn't have a cardiology theatre, hence the need to drive (my wife drove home) 250 km to Hamilton.
I used to be on Diltiazem for rate control. I was switched to Bisoprolol about 18 months ago. What I like about Bisoprolol is that it blocks adrenaline acting on the heart. Stress and anxiety are the main triggers for me. I find the Bisoprolol (2.5mg/day) has a calming effect on me.
BBs did not much for rate control as 186 and 156 control was not good enough.
In 2 hours Diltiazem brought me down from 156 avg (135 at rest) on Bisoprolol to 51 on 120mg AM.
Bisprolol 2.5 PM happily I decreased for BP control.
I'm getting you mixed up with KiwiApha in Kerikeri. near me. Sorry kiwi!
I must tootle down in my Camper to New Plymouth sometime. I've been twice the recent in the dark! And freezing time. The other about 17/18 years on a bus tour from YHA Auckland. Oh much fun.
But I see Mt Taranaki from the rural pace where the 3 pinnacles in the sea (3 sisters). 1 day only on my birthday 16.01. from Moekau ? to see a glimpse of the mountain down in the distance. The following day was a white out. We had a helicopter land in the motorcamp. Delivering hives to the honey area. I was taken by the museum such a treasure.
It should have ended by us arriving at after 5pm and away by 9am like it is opposite the police station at Coromandel. Where mt great grand children are.
You see the big wheelers fighting against having to put air vents to outside!
My SC doesn't run out until December next year.
Recently I did a weekend at Tokorau Bay off on the peninsular to my left. great except for all the farm bikes hooning most of the day at the end of the beach where the site is situated.
Having AF makes me enjoy getting away.
But different from you and caring for my mini schnauzer Jaznow 10 years who was diagnosed with a grade 1 heart murmur without smyptoms, I do not worry about much so adrenalin is not what is triggering my AF. Its a different experience when I have it all the time.
Which is the best park down at New Plymouth?
The camps do not agree to a dog at mud January. but NZMCA do. do they have shade?
It sounds as if you are well on the way to success. I must say I became a little worried when I read the part about the catheter going "too far inside the vein" as it's my understanding that the procedure usually fails as the doctor daren't go too close even to the PV entrances.
The lovely thought is that now this is likely to be the end of your AF! Wonderful.
It is often said that choose an EP who has done thousands of ablations. With my first ablation, I only meet the EP 30 minutes before going into Theatre. He looked very young, so I wonder how many ablations he had done. The EP I had last week looked far more mature, and I have subsequently heard he is recognised as one of the best in NZ. So despite again only meeting him the morning of the procedure, I felt far more at ease. I live rurally, and in a different part of the country (Taranaki is approx 250 km from Waikato). All mine appointments at our local (small) hospital cardiology unit has been with the senior arrhythmia nurse, whom has been very knowledgeable and helpful.
That is something I read all the time, too. To be truthful, I tend to ignore it. It's likely an urban myth that would be impossible to support meaningfully.
I would think that you are in great hands now, as you likely were before. I gather these things are delicate and individual since each heart is different in terms of such things as wall thickness, location of the pulmonary veins and much more. Who would be a doctor doing this kind of thing?
Apparently the scars can heal too. Three of my pulmonary veins had tobe redone coz, on this occasion, I was a great healer!! Typical!! My healing from each ablation was very slow by contrast to most.
I'm 53 years old. I would be perfectly happy to have this done every 10 years given that even scar tissue eventually fades due to the healing process. Now that I have had 2 ablations, the procedure doesn't worry me at all. Given that, hopefully medical science will come up with a new and better permanent fix in the coming 10 to 30 years.
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Pulmonary vein
Post Ablation for Paroxysmal AFIB /A Flutter
Cryo ablation
Double ablation
