Second cardiac ablation attempt

[Helloits]

Hi there,

I am a 31M fit and healthy and suffer from a high frequency of left ventricle premature ventricular contractions (PVCs) with a ~18% burden. They are coming from a small area near the LF papillary muscle . I had an ablation under a very skilled EP in London who successfully ablated the problematic area of the heart using radiofrequency ablation. I was PVC free for 2 hours before they slowly resumed back to normal. 5 months on and no difference and they are back in full force. Very frustrating as you can imagine.

I have a second ablation coming up at the end of this month with the same surgeon, although the only worry I have is, what if the same thing happens again and what will they do differently to improve the long term success rate of the next procedure. He said they will map the area more thoroughly and maybe us cyroablation (freezing), instead of heating like they did the first time. But it would be interesting to hear people's thoughts on this.

Can anyone provide any reassurance here that the second ablation will work. Does anyone have a similar story?

Thank you.

[MeganMN]

I don't have PVCs, but PACs and Atrial Tachycardia. I had an ablation in 2021 and mine came back a year and a half later. I had two more attempted ablations and they couldn't induce the rhythm. I just had a second successful ablation and they had to ablate a much bigger area. So far so good. Its hard, though, to have to have so many procedures for just a normal heartbeat.

[AspiringVet]

Hey there, following this thread to see how you get on as I am in a very similar situation. 25F had an ablation nearly 3 months ago for 15% PVC burden, coming from a similar location in the LV around papillary muscle of the mitral valve. Electrophysiologist was very pleased and said they had ablated a lot. Fortunately, they got my burden down to 8% but I was still very symptomatic and not feeling well at all. I was started on dapagliflozin as my pump function is marginally impaired. Since then my burden is down to 4%, which theoretically should be fine but I’m still not feeling right so I’m off for a second ablation. My cardiologist is reluctant to use other anti-arrhythmics like amiodarone or sotalol due to my impaired pump function. Although, she has said if the second ablation is unsuccessful that’s what we’ll try. I have heard of people having upwards of 4 and 5 ablations, so I suppose having 2 is not that unusual - you’d just prefer that didn’t have to be the case! All that is to say that maybe you’d be looking at additional ablations or those more serious anti-arrhythmic drugs, if you haven’t already?

[Helloits in reply to AspiringVet]

Hey, thanks for the reply. It's nice to hear somebody in a similar situation, it's easy to feel alone in this. A 4% burden definitely sounds manageable and I would dream of that amount. The only time when my burden has been that low is when I was taking amiodarone for about 6 months. This worked wonders and is the only thing that has worked for me. However I was taken off these as they can have nasty side affects, although I didn't have any any side affects when on them. They have put me on Sotalol instead which helps a bit but is nowhere near as good as Amiodarone. Sotalol also makes me feel drowsy and reduces my exercise capability. Do you know if the EP used radiofrequency or cryoablation? Have you found any natural solutions to reduce your burden? Looking forward to hearing back from you.

[MoundMan]

Not as savvy with vocabulary. Have undergone 3 ablations. Latest August '23. Each time was guided back into sinus rhythm. Also there've been 4 cardioversions. Latest this March. My situation is likely unlike almost everyone else. Slow afib has been norm since early childhood. It's what my heart knows. Over decades. Only since my late 60's have symptoms been really noticeable. Affecting quality of life. During 2nd ablation, heart attempted to return to slow afib. Currently in sinus. Big difference in energy level. Thus, my thought is, 'Go for it'.

[EX_PVC]

Hi,

I had occasional PVCs since when I was 18. They became unbarebly frequent in 2003 (20.000 per day, almost every day, mainly at rest, improving with exercise). I underwent my first catherer ablation in 2006, for a month or so they seem improved, but then they fully relapsed. With the same questions you are asking yourself, I underwent a second procedure in 2010 (4 years later), same arrithmologist, different hospital in Milano.

The second went well, after a couple of weeks of "irritation" various arrhitmias, I am now 99% PVCs free since then, which il 14 years!

The difference between the first and the second procedure, according to the doc, was that he burned much more tissue, went deeper and completed with extra areas which were not proven to be originating the arrhitmia but "often involved".

In conclusion, I was so happy to have tried, and I am now 52, cyclinc addict with 6000 km/year, I don't take a single pill.

Good luck!

[Helloits in reply to EX_PVC]

Thank you for the reply. That's really encouraging and I hope I have the same outcome after my second ablation. I will let you know how I get on. Thanks again.