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Failed ablation

Does a Successful Catheter Ablation Have Side Benefits? How About a Failed Ablation?

Are there additional dividends from a successful catheter ablation for A-Fib—beyond being back in normal sinus rhythm (NSR)? Research says, yes!

Additional Benefits of Successful Catheter Ablation

“The benefit of catheter ablation extends beyond improving quality of life…If successful, ablation improves life span,” says, lead author Dr. Hamid Ghanbari, an electrophysiologist at U.of Mich. Frankel Cardiovascular Center.

Illustration of RF ablation

His comments are based on a study that examined 10 years of follow-up medical data on over 3,000 adults who received RF catheter for paroxysmal or persistent atrial fibrillation. Researchers found that staying in normal sinus rhythm (NSR) was associated with a 60% reduction in the expected rate of cardiovascular mortality (risk of death from stroke and other cardiovascular events).

In another study (Anselmino), a meta-analysis of 26 studies involved 1,838 A-Fib patients who had undergone a catheter ablation. Post-ablation follow-up averaged 23 months. Examining the patient follow-up data, researchers found a significant 13% improvement in left ventricular ejection fraction (EF), i.e., the heart’s blood pumping efficiency.

In addition, there was a significant reduction in the number of patients who formerly had an ejection fraction of less than 35% (more patients improved their EF ratio out of the life-threatening range). Blood pressure levels were also improved.

Summary of Research Findings: These studies reveal some of the real benefits to patients after a successful catheter ablation that go beyond being in normal sinus rhythm (NSR):

• improved quality of life
• significantly lower risk of cardiac-related mortality
• better heart pumping efficiency for more patients (ejection fraction, EF)
• improved blood pressure levels

You may ask, do these side-benefits depend on the catheter ablation eliminating the patient’s A-Fib?

Ever Wonder If There Are Benefits from a Failed Ablation?

Catheter ablation from Cleveland Clinic

VIDEO: Catheter ablation, Cleveland Clinic

Researchers have studied the follow-up data of failed ablations and found a few ‘side’ benefits.

A clinical trial (Pokushalov) showed that, when ablation fails to eliminate paroxysmal atrial fibrillation, a second try is more successful in returning the patient to sinus rhythm than medication alone; it also slows the progression from paroxysmal A-Fib to persistent A-Fib.

In addition, some patients found their A-Fib symptoms were less intense or shorter in duration. (Might be attributed to an improvement in left ventricular ejection fraction.)

Other patients found they could take certain medications that prior to their ablation had been ineffective.

Summary of Research Findings: These studies reveal some of the real benefits to patients even if their catheter ablation doesn’t return them to normal sinus rhythm:

• second ablation is more successful than medication alone
• second ablation slows progression from paroxysmal to persistent A-Fib
• symptoms were shorter or less intense
• certain medications worked that didn’t work before

A catheter ablation can profoundly change one’s life, even if you need a 2nd ablation.

Conclusion

A catheter ablation can profoundly change one’s life, even if you need a 2nd ablation. 

So, either way, a catheter ablation offers benefits to Atrial Fibrillation patients. Even if you need a second ablation (or a third), know that you may still reap substantial benefits from the previous “failed” ablation.

For more about the benefits of ablation, see Live Longer―Have a Catheter Ablation!

References for this article

FAQs A-Fib Ablations: Improving or is My Ablation a Failure?

 FAQs A-Fib Ablations: Improving or Failure? 

Catheter Ablation

Catheter Ablation

“Since my ablation, my A-Fib feels worse and is more frequent than before, though I do seem to be improving each week. My doctor said I shouldn’t worry, that this is normal. Is my ablation a failure?

It takes about three months to know if your ablation is a success. It takes that long for your heart to heal. For a period of time (which varies from patient to patient) your A-Fib may seem to get worse. Why?

Inflammation: This happens in some people because of the inflammation and trauma to the heart and body tissues caused by the catheter ablation burns and the poking around in your heart during the procedure. These can seem to exacerbate your A-Fib. (An ablation procedure doesn’t create new A-Fib producing areas in your heart, though it may stir up existing A-Fib areas temporarily.)

There is a tendency for ablated heart tissue to heal itself, re-grow the ablated area, reconnect, and start producing A-Fib signals again.

Gaps and Scar Tissue: Another reason you may still have A-Fib is because of gaps in the ablation lines. In the most common A-Fib ablation procedures used today, doctors try to create ablation lines around your pulmonary vein openings to isolate them from the rest of your heart. (A-Fib producing areas are usually found inside your pulmonary vein openings.) But it’s difficult making continuous, perfect ablation lines. Sometimes there are gaps in those lines which let A-Fib signals through. But as your heart heals, these gaps usually fill in gradually with scar tissue that reaches its thickest size at the end of three months.

Milestones: In general, if you’re in sinus rhythm after the third month, the chances are good you’ll stay in sinus rhythm. If you’re in sinus rhythm after the sixth month, the chances of a reoccurrence of A-Fib are even less.

Remember—it isn’t the end of the world if your ablation isn’t a total success. There is a tendency for ablated heart tissue to heal itself, re-grow the ablated area, reconnect, and start producing A-Fib signals again.

Second Ablation: Many people (as many as 15%-25%) have to go in for a ‘touch up’ ablation procedure (including myself). This second ablation is usually, though not always, easier than the first. Often all the doctor has to do is ablate any gaps that haven’t filled in or ablate where there has been re-growth/re-connection. This usually isn’t the doctor’s fault. Heart tissue is very tough and has a tendency to heal itself.

Return to FAQ Catheter Ablations

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