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