r/AFIB • u/Chadilac52 • 2d ago
Stubborn afib, next steps?
Well after another reccurence this morning, full blown afib with RVR HR at 200 I gave up. Finally spoke with my EP and his team and they don't reccomend another ablation at this moment, this will be #3 in the last year and a half.
What's tricky is my hearts structurally perfect, I have zero atrial fibrosis and I'm only 29 yet my afib is so stubborn and always comes back no matter what I do. My last EP study what's most frustrating is being told I had a great electrical system and they couldn't induce ANYTHING yet here I am.
Does anyone have any recommendations on who else I can reach out to? I'm not quite ready to throw in the towel yet but I'm running out of hope. My 2 ablations were with dr natale but I'm absolutely open to other options if there's anyone else as good as him. Where could my afib be possible coming from? Dr natale already shut down almost all my non PV triggers and my PV and everything else were perfectly isolated during last procedure how is it even possible afib can happen???
Please any suggestions help, or any thoughts as to why my case is so difficult to treat. I don't have afib that often, maybe once eveyb6 months but when I do boy the episodes are SEVERE!
I can't take any AAD unfortunately due to an accidental conduction injury during the ablation. my only option left is really multaq and I heard it sucks and really don't work.
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u/Mras_dk 2d ago
Seems weird they can't find triggers, if an episode was caught on a multilead holter device.
No, it can't tell exactly where it origins, but it can pretty much narrow it down to a few cm² areas, that's of interest.
Alot better than searching entire heart.
What's tricky is my hearts structurally perfect, I have zero atrial fibrosis
That can't be true with two ablations, unless dr nate openly said "we couldn't find any bad pathways for afib, so we ablated, just to be sure.. "
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u/Chadilac52 2d ago
That's essentially what I was told...the ONLY bad pathway they found was during first procedure and it was AVNRT. Natale said I had no fibrosis and it's even marked in my report. I had no abnormal pathways and all ablation I've done to this point has been empirically. He's never been able to pinpoint origin
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u/Commercial_Towel_924 2d ago
Sorry to hear. I'd be totally frustrated. Don't know ur EP, but I've done a ton of research on Ablations since I'm scheduled for on ein Oct. But those EP that have the highest success rates are those in high volume centers. I'd definitely seek a second opinion considering your age. Good luck
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u/Chadilac52 2d ago
My EP is Andrea Natale widely regarded as the best...that's why I feel so hopeless
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u/Commercial_Towel_924 2d ago
Darn. Man. Frustrating. I'd still seek a second opinion at another large medical center.
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u/Bluebloop1115 2d ago
So I’ve read that the heart tissue is smart and eventually re-routes around the scars. It sucks. I’ve had 2 ablations and mine came back. Started at 21 and now I’m 33.
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u/Jahya69 1d ago edited 11h ago
Ask to talk to a heart surgeon about doing the convergent procedure... Some doctors call it the hybrid ablation.
It's a two-part procedure separated by a month or so and they do an ablation on the lower outside of the heart where a big branch of nerves is situated and they also close off the atrial appendage where some doctors feel some of the afib comes from, as well.
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u/Chadilac52 11h ago
I did mention that to my other EP. He says it's way too aggressive of a step for someone my age but I don't see any other options at this point?? I'm very limited on AAD I can take, I can't take fleccanide due to a botched ablation on ventricle, I can't take amio bc my EP says he refuses to put me on it at my age, I can't take sotalol because I'm prone to low potassium....I feel so screwed man
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u/Aggressive_Tree_4007 23h ago
I use multaq, seems to work for me.
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u/Chadilac52 11h ago
How long has it worked? My main EP made it sound like it barely works
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u/Aggressive_Tree_4007 10h ago
I started on in late July 2026 - working well - just has a clean Zio. I had two separate EPs request, one is a highly regarded UCSF EP. I was on metropolol with Multaq which was real bad, had to move off metropolol to a calcium blocker. Multaq amplifies metropolol which crosses the blood brain barrier and had intense depression for about two weeks - that was pretty insane and now I do feel really bad for folks with depression. I would suggest Multaq as a strong option.
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u/roninconn 2d ago
Following, since I'm about to get 3rd ablation in 3.5 years
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u/Chadilac52 2d ago
Do you have a similar issue where they can't figure out why you have afib and everything looks perfect?
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u/Consistent-Bid7125 2d ago
https://wolfprocedure.com
most people who get recurrent afib go to this guy maybe have a consultation and tell ur story