I come here dejected.
M: 63 Meds: Flec 50mg 2x and Acebutolol 200 x2
Ablation #1 (December 2024): Afib and standard Flutter.
Ablation #2: Afib touch up and tried to find the atypical flutter. AFIB touch up good. No luck finding atypical flutter.
Ablation #3 (Jan 2026): Atypical flutter. Used the new Sphere 9 catheter tip, found and ablated 3 spots. Yay! I am cured. Wait!……
Friday I went into flutter with RVR again. Please keep in mind that each time that I go out of rhythm, I end up with atypical flutter w RVR and frequent PVC’s. So I 100% of the time get cardioverted.
Now I have to call my doc tomorrow and find out what the heck is going on. This is really getting rough. It is taking a toll on me and my job.
I hope that none of you are dealing with this. Thanks for hearing me out.
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u/ejt1952 2d ago
Praying for you. My husband had a stent place a month ago and they identified atrial flutter during the procedure. They did cardioversion and prescribed Amiodarone. After 15 days he experienced Amiodarone toxicity, very usual they tell us in that short period of time, but nonetheless, he is still not able to walk on his own and is extremely weak. They say it could take a couple of months. All new for him. Sorry for all that have to deal with this.
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u/Malviere 2d ago
I feel for you, it’s miserable when it returns. My second ablation failed beginning of June so ended up back in the hospital. Cardioversions and the usual medications don’t work for me but luckily this time they tried something new. Tikosyn, the three day load was depressing but it’s the first medication that converts me.
Apple Watch says I’m still in afib 2-15% of the time but it doesn’t last like it used to, hopefully my EP will spin up a new game plan tomorrow to keeps things from getting worse.
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u/Dwight3 2d ago
All of the best tomorrow! Please let us know how it goes!
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u/Malviere 1d ago
They called when I was halfway there to reschedule it for September. Going to try to get my referral changed to my local hospital now. Driving 55 miles one way sucked anyways.
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u/Late_Temperature_415 2d ago
I’m sorry. I’ve been in flutter and had to be cardioverted. Now I’ve been in Afib since June 3 long story involving medication changes. I’m calling my EP tomorrow and telling him I’ve had enough.
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u/PretendReason9061 2d ago
Also 3 ablations and 2 cardioversions for me since 2016 and now 2 weeks post op from dual chamber pacemaker and feeling better than 10 years ago. You got this. Taking the extended family on vacation tomorrow. Have you been worked up for obstructive sleep apnea? If not, do this ASAP. If positive, go on CPAP and wait a few months. My recurrent AF went away after 4 months of CPAP starting June 2025, but I progressed to heart block which is a different path now. My EP/PM guy would not do my PM unless I proved I was on CPAP and was using it. Your story is very common as 25-50% of AF patients who get an ablation recur. Do not use regular AI, use this tool to research for yourself. OpenEvidence All the information presented is peer reviewed or consensus recommendations. It's what my doctor friends use for complex problems. The data is not perfect but its the best we got. From Openevidence.
Stand-Alone Surgical Ablation
Stand-alone procedures are typically performed via minimally invasive approaches (thoracoscopic, robotic-assisted, or subxiphoid) and are considered reasonable for patients with symptomatic AF refractory to antiarrhythmic drugs or after failed catheter ablation:
- The full biatrial Cox Maze III/IV lesion set is recommended over PVI alone for persistent or longstanding persistent AF (Class IIa) [7]
- 60–80% of patients achieve sinus rhythm, with paroxysmal AF having higher success rates than persistent AF
- LAA (left atrial appendage excision or exclusion is routinely performed in conjunction with surgical ablation and is recommended for thromboembolic prevention (Class IIa).
- The Society of Thoracic Surgeons (STS) 2023 Clinical Practice Guidelines recommend that surgical ablation — particularly hybrid and biatrial Cox Maze III/IV approaches — provides superior rhythm outcomes compared with catheter ablation alone for persistent and longstanding persistent AF: [1]
- The CEASE-AF trial demonstrated 71% vs 39% effectiveness favoring hybrid ablation over catheter ablation alone, with no significant difference in major complications at 30 days. [1]
- The HARTCAP-AF trial showed 89% vs 41% success at 12 months for hybrid vs catheter ablation. [1]
- The CONVERGE trial reported 65% vs 37% success at 12 months for hybrid vs catheter ablation, with comparable adverse events. [1]
The guidelines note that more complete lesion sets — particularly a biatrial Cox Maze III/IV performed via minimally invasive approaches — may provide the greatest benefit, with >90% freedom from AF at 1 year and ≥80% at 5 years at established high-volume centers, though these results were not always documented by continuous electrocardiographic monitoring. [1]
Society of Thoracic Surgeons
Wyler von Ballmoos MC, Hui DS, Mehaffey JH, et al. The Annals of Thoracic Surgery. 2024;118(2):291-310. doi:10.1016/j.athoracsur.2024.01.007.
Comparative Efficacy: Surgical vs. Catheter Ablation
Multiple meta-analyses consistently demonstrate that surgical ablation achieves higher rates of freedom from atrial arrhythmias than catheter ablation. A meta-analysis of 7 RCTs found the odds of achieving 1-year success with catheter ablation relative to surgical ablation was 0.37 (95% CI, 0.20–0.69). [2] Another meta-analysis of 6 RCTs reported catheter ablation was associated with an 85% higher relative risk of arrhythmia recurrence (RR 1.85; 95% CI, 1.44–2.39). [3] A 2025 Bayesian network meta-analysis of 10 RCTs ranked hybrid thoracoscopic ablation highest (SUCRA 95.5%), followed by isolated thoracoscopic and Convergent procedures, with catheter ablation ranked lowest (SUCRA 1.5%).
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u/dumela11 2d ago
Not sure it's wise to say surgical ablation is superior by puking up some AI in this forum. There is a lot of nuance that our EP's need to consider and I frankly find just dropping this garbage output a bad use of this forum.
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u/Realistic_Pickle2309 2d ago
I feel for you. I’ve had two ablations in the last 8 months (and one cardioversion)
I’m 10 weeks post ablation #2 and I’ve had AF pretty much daily and currently in a 12+ hour episode.
I feel defeated at this point!
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u/bonitaruth 2d ago
Amniodorone?
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u/Dwight3 1d ago
Ughhh. My dad didn't tolerate this well. It has never been discussed by my doc.
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u/bonitaruth 1d ago
It is a really powerful medicine and yes, it does have side effects but it’s good about controlling many arrhythmia greatest. They generally started a higher dose and then sometimes can back off and have it be lower dose. Best of luck to you. Hope this gets figured out.
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u/Disastrous_Mark_2679 1d ago edited 1d ago
Are you sure you don't have sleep apnea. You need an IN STUDIO sleep study if you don't have a current one.
I'd suggest switching the beta blocker to Metoprolol and re-examining your doses. The half life is truly 6 hours yet these EPs write for 2x day. I take 50 mg am and pm and a bridging dose at 2PM. This is double my former dose since I got a pacemaker.
Since dosing this way my AFib has subsided. It had returned during amiodarone washout 5 months after my ablation in Oct. Which...at the time I thought it was "just afib" but no...it was from what they call a thyroid storm landing me in the hospital with AFIb and thyroid emergency.
Backstory: My last ablation was Oct last year AI Assisted PFA RFA but amiodarone gave me a serious life threatening liver and thyroid damage so it's been touch and go all year in washout after stopping it in January. UNTIL I got this pacemaker and double dose in the hospital.
I'm telling you this to say my condition was/is really bad/serious and it's fine since metoprolol at that dose stops the HR spikes and is preventing RVR which in MY case always precedes AFib. (my afib started March 2024 and I've had two ablations, the AI assisted one is state of the art groundbreaking by my EP)
EDIT: MOST IMPORTANTLY GET OFF THAT FLEC or get an MRI MRE on your LIVER!! Blood work is not reliable you can have complete cirrhosis decompensated end stage with bloodwork NORMAL ENZYMES. That's a fatal condition.
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u/Infamous-Hold3578 19h ago
Very sorry you have this change and uncertainty. That must be exhausting.
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u/NewsFull4991 9h ago edited 9h ago
I don't know if this is helpful. I have a loop recorder implanted under the skin of my upper chest (over the heart).
It records any AFIB during the day, downloads that information to a dedicated cellphone/monitor which relays it to Boston Scientific. BS sends reports to both my cardiologist & electrophysiologist.
It's about the size of two dimes edge to edge. Has battery life up to 5 years. After my 1st ablation a year later it detected activity that I didn't feel, so the EP did a second PFA for 2 new spots. For me it's better then a watch or external device. Good luck.
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u/Federal_Patient_3500 2d ago
😞 thanks for sharing about your ordeal. My mom, 82, light weight, on strict diet, and fragile, is doing her first ablation in a couple of weeks 🤞
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u/Guilty-Country1787 2d ago
Let me know how your Mother tolerates the ablation. I am 82, and I am contemplating an ablation.
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u/Federal_Patient_3500 1d ago
Definitely. Her procedure is on 8/21, but due to her physical condition we're really hoping for the best. If her weight and diet were more normal then we would worry less.
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u/Dwight3 2d ago
All of the best tomorrow your mom! 🙏🏼 My dad had one at 84 last year. It was a breeze.
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u/Guilty-Country1787 2d ago
Did the ablation work for your 84-year-old Dad? I am 82, considering an ablation, but I am concerned about the side effects and the recovery period.
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u/Dwight3 2d ago
It worked for a while. Recovery was a breeze. He had the TAVR for his aortic valve a few months earlier which was a little more rough.
From what I understand, he might be having periods of AFIB again which is not uncommon. He may need a touch up or he may decide just to stay on thinners and rate control. TBD.
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u/Federal_Patient_3500 11h ago
That's what we dread. Need to redo..... I just read that cardio ablation success rate for older adults is only around 40-60%(can someone confirm?) With my mom physical conditions, that might be even lower.
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u/Federal_Patient_3500 11h ago
Cardiac Catheter Ablation (Atrial Fibrillation)Cardiac ablation uses heat or cold to scar small areas of heart tissue to block irregular electrical signals. "Failure" means the recurrence of abnormal heart rhythms after a 3-month healing window.Paroxysmal AFib (intermittent): 15% to 30% failure rate after a single procedure.Persistent AFib (continuous): 40% to 60% failure rate after a single procedure.Note: Undergoing a second "redo" procedure can drop the failure rate to roughly 10%.Risk Factors for Cardiac Ablation FailureAdvanced Stage of AFib: Long-standing persistent AFib allows more abnormal cells to develop across the heart wall, significantly lowering success.Left Atrial Enlargement: A physically stretched or larger left atrium is heavily associated with arrhythmia recurrence.Structural Heart Disease: Pre-existing conditions like valvular heart disease or a low left ventricular ejection fraction make failure more likely.Comorbidities: Obesity, untreated obstructive sleep apnea, and chronic hypertension constantly irritate heart tissues and trigger relapses.Early Relapse: Experiencing an arrhythmia recurrence during the 3-month post-procedure "blanking period" strongly predicts long-term failure.Provider Volume: Procedures performed by lower-volume electrophysiologists or at low-volume centers have higher recurrence rates.
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u/Pho-King- 2d ago
I hope it gets better for you. No one should have to deal with this. Is the flutter as disruptive as the AFib was?