"This book is incredibly complete and easy-to-understand for anybody. I certainly recommend it for patients who want to know more about atrial fibrillation than what they will learn from doctors...."

Pierre Jaïs, M.D. Professor of Cardiology, Haut-Lévêque Hospital, Bordeaux, France

"Dear Steve, I saw a patient this morning with your book [in hand] and highlights throughout. She loves it and finds it very useful to help her in dealing with atrial fibrillation."

Dr. Wilber Su Cavanaugh Heart Center, Phoenix, AZ

"Your book [Beat Your A-Fib] is the quintessential most important guide not only for the individual experiencing atrial fibrillation and his family, but also for primary physicians, and cardiologists."

Jane-Alexandra Krehbiel, nurse, blogger and author "Rational Preparedness: A Primer to Preparedness"


"Steve Ryan's summaries of the Boston A-Fib Symposium are terrific. Steve has the ability to synthesize and communicate accurately in clear and simple terms the essence of complex subjects. This is an exceptional skill and a great service to patients with atrial fibrillation."

Dr. Jeremy Ruskin of Mass. General Hospital and Harvard Medical School

"I love your [A-fib.com] website, Patti and Steve! An excellent resource for anybody seeking credible science on atrial fibrillation plus compelling real-life stories from others living with A-Fib. Congratulations…"

Carolyn Thomas, blogger and heart attack survivor; MyHeartSisters.org

"Steve, your website was so helpful. Thank you! After two ablations I am now A-fib free. You are a great help to a lot of people, keep up the good work."

Terry Traver, former A-Fib patient

"If you want to do some research on AF go to A-Fib.com by Steve Ryan, this site was a big help to me, and helped me be free of AF."

Roy Salmon Patient, A-Fib Free; pacemakerclub.com, Sept. 2013

FAQs A-Fib Ablations: Recurrence or Reconnection Explained

 FAQs A-Fib Ablations: Recurrence 

Catheter Ablation

Recurrence after Catheter Ablation

26. “What is ‘recurrence’ or ‘reconnection’? Could you explain it in layman’s terms? (I worry after my ablation, my A-Fib will return.)”

“Recurrence” or “Reconnection” is a general term EPs use to describe any A-Fib that re-occurs after a catheter ablation. In practice, there are four basic types of recurrence or reconnection found primarily when using RF point-by-point ablation:

1. Self-Healing Recurrence/Reconnection. Heart tissue is very tough and resilient. There is a tendency for ablated heart tissue to heal itself, regrow the ablated area, reconnect, and start producing A-Fib signals again. But if this happens, it usually occurs within approximately the first three to six months of the initial PVA(I).

This type of recurrence may happen because the heart tissue was not originally ablated properly, the burn lesion may not have been deep enough (transmural). The EP may not have applied sufficient contact catheter pressure to achieve transmurality and permanent blocking. But with the new Contact Force Sensing catheters, top tier EPs tell me “the use of contact force has definitely reduced the reconnection rates.  It is very unusual to see reconnection these days.”

2. Gap Reconnection. RF point-by-point ablation is not easy to do. It requires manual dexterity, feel and intense concentration to make sure there are no gaps between the RF point-by-point ablations in order to, for example, make a circular lesion line around the opening of a Pulmonary Vein. If a significant gap is left, this can result in recurrence. The A-Fib signal escapes from the Pulmonary Vein through this gap into the rest of the left atrium, thereby producing A-Fib again.

EPs have strategies to find any gaps during and after an ablating an area of tissue. They use a drug like adenosine to try to stimulate A-Fib. They may instead or in addition wait 30 minutes or an hour after the ablation is complete to see if there is any reconnection.

It’s also possible that, after the blanking period when the swelling from point-by-point RF ablations goes down, gaps may appear which were hidden by the swelling of the RF burns—though this is increasingly rare with the use of Contact Force sensing catheters and proper ablation techniques. In this case you will probably need a short touch-up ablation to fix this gap.

(CryoBalloon ablation usually doesn’t produce these types of gaps, because it produces a continuous freezing ablation line around a PV.)

3. Recurrences/Reconnections Due to Pre-Existing Conditions. There are health conditions which tend to cause A-Fib to recur, such as hypertension, obesity, sleep apnea, diabetes, smoking and binge drinking. Controlling these conditions will reduce the risk of recurrence.

For example, let’s say patient “Joe” has A-Fib and sleep apnea, then has a successful A-Fib ablation and is A-Fib free. Because of his sleep apnea, Joe’s A-Fib is more likely to recur than someone without sleep apnea. So much so, that Electrophysiologists (EPs) today are insisting that A-Fib patients with sleep apnea be treated and use devices like a CPAP breathing machine before they can get a catheter ablation. In one study sleep apnea was an independent predictor for catheter ablation failure after a single procedure.

Also, those with long-standing persistent A-Fib, or those with vascular heart disease, or cardiomyopathy are more likely to have a recurrence.

4. “Lone” Recurrence. Around 50% of A-Fib patients have no apparent cause for their A-Fib—called “lone A-Fib” because there’s no other contributing health condition. After a successful catheter ablation, those with lone A-Fib are less likely to have a recurrence. But some lone A-Fib patients do have recurrences.

Your EP may not use the word ‘cure’, but the dictionary defines ‘cure’ as “restoration of health; recovery from disease.

What This Means to Patients

Catheter ablation today is the best hope of a “cure” for A-Fib (Your doctors may not use the word ‘cure’, but the dictionary defines ‘cure’ as “restoration of health; recovery from disease.”) That should be your goal!

Let’s take a worst case scenario after your ablation:

You’re in good health and have no pre-existing medical conditions. Seven years after your ablation you have a “recurrence” of A-Fib.

Think about that for a moment.

You’ve had seven years of a normal heart beat and a normal life! (Only those of us who’ve had symptomatic A-Fib know how wonderful it is to be A-Fib free―even if it’s just for three, five or whatever length of time.)

So what if you have a recurrence. You know what to do. Your EP does a touch-up ablation (which is much easier and faster than your original ablation). That reassuring, isn’t it!

Don’t waste your life worrying about recurrence/reconnection. Live your life as though you are cured for the long term. You probably are.

Last updated: Sunday, October 4, 2015

Return to FAQ Catheter Ablation Catheter Ablation, Pulmonary Vein Isolation/Ablation, CyroBalloon Ablation

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