Recurrent Rhythm Problems After Cardiac Ablation

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Submitted by Dr T on May 2, 2014 – 10:57am

I have had 2 ablations to treat afib – after the second ablation last October, after a rough start to the blanking period, things calmed down very nicely.  About three weeks ago, the arrhythmias returned and are now 24-7 (I was paroxysmal)and are not what was traditionally afib like for me (high pulse/very high bp), now when the arrhythmia occurs my pulse is likely to be relatively low (low 100s) and my bp is skewed (120/100).  My EP has moved his practice to another state and I would rather not to go through all the testing again when it may be nothing more than a anomaly of a prolonged blanking period.  Is there anyway to more definitively access what is happening?  During this past month, I have also noticed a marked breathlessness when doing any sort of exertion even walking a short distance.

Electroanatomic map of the posterior left atrium, illustrating the pulmonary veins: right superior pulmonary vein (RSPV), right inferior pulmonary vein (RIPV), left superior pulmonary vein (LSPV), and left inferior pulmonary vein (LIPV). The red circles represent actual discrete radiofrequency applications, predominantly delivered in a circumferential pattern around the pulmonary veins. This ablation strategy can isolate pulmonary vein foci that initiate atrial fibrillation, and/or alter the substrate of the left atrium to inhibit fibrillatory activity due to reentry. Image courtesy of American College of Cardiology Foundation.

Ablations fail occasionally (as often as 20-50%!):

Success rates for curing atrial fibrillation with ablation are as high as 80% for paroxysmal atrial fibrillation in the absence of structural heart disease, and may be as low as 50% or less in patients with persistent atrial fibrillation in the presence of structural heart disease and left atrial enlargement. Repeat procedures are typically needed in 25% or more of patients and result in an increase in these success rates. 1

I am concerned about your symptoms that suggest you may have an arrhythmia complicated by some degree of heart failure. You need to have this checked ASAP with another EP cardiologist!

Hope this helps,

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