Post-Catheter Ablation Concerns: Atrial Fibrillation Recurrence

Q: Post-Catheter Ablation Concerns: Atrial Fibrillation Recurrence

Hello： It is quite common for patients to experience recurrent atrial arrhythmias within three months after catheter cryoablation for atrial fibrillation, with an incidence of about 40%. <br>This is generally believed to be related to the inflammatory response of the atrial tissu

Post-procedure issues following cardiac catheterization and cryoablation?

Hello, about 12 years ago, I was diagnosed with paroxysmal atrial fibrillation, occurring about 1-2 times every three months.
I took Dronedarone for 10 years, and after 8.5 years, I stopped experiencing episodes, so my doctor agreed to discontinue the medication.
However, at the end of February this year, I suddenly had a recurrence, and by early April, I experienced continuous episodes for 8 days.
The medication could control it, but the last episode lasted about 3 days before it stopped.
I went to the emergency room and stayed for a day, but it was ineffective, and I was sent home to rest.
Feeling anxious, I went to Veterans General Hospital for catheter ablation.
However, I had a recurrence on the day of discharge, and since then, I have had episodes every 2-3 days, each lasting about 7 to 48 hours, which is more severe than before the procedure.
It has now been 3 weeks since my discharge.
During my weekly follow-ups, the doctor says this is a normal phenomenon and has adjusted my medication.
I heard that if episodes last more than 7 days continuously, it indicates permanent atrial fibrillation, which frightens me.
I feel it is getting worse, with longer episode durations, and I am very concerned that the procedure may have failed.
The doctor insists this is normal and that it will stop in about 1-2 months.
During the pre-procedure discussion, they only mentioned occasional short episodes of 1-2 times.
Could you please help me confirm whether my attending physician's judgment is reasonable, or am I actually one of the 20% who experience failure? If it has failed, what other treatment options are available? Previously, when I had episodes, taking 2 Dronedarone would restore normal rhythm within 3-6 hours, but now it is ineffective.
The doctor mentioned that if necessary, I could take 3 tablets at once.
I only tried it once and felt a bit dizzy.
Given my current severe episodes, can I take 3 tablets of Dronedarone at once?

A-Hong, 60~69 year old female. Ask Date: 2021/07/16

Dr. Huang Yinghe reply Cardiology

Hello: It is quite common for patients to experience recurrent atrial arrhythmias within three months after catheter cryoablation for atrial fibrillation, with an incidence of about 40%.
This is generally believed to be related to the inflammatory response of the atrial tissue post-surgery.
During this period, the use of antiarrhythmic medications such as Dronedarone can help reduce the incidence and symptoms.
The maximum recommended dosage is 300 mg (2 tablets) every 8 hours, and taking 3 tablets at once should only be done occasionally.
If you experience discomfort, it is advisable to limit the dosage to no more than 2 tablets.
Please follow your physician's prescription.
When we mention a recurrence rate of 20%, it refers to the long-term recurrence rate after three months, once the atrial tissue has stabilized and healed.
Recent studies have found that patients with early recurrence within three months have a higher long-term recurrence rate, so it is recommended that you continue to be monitored.
If recurrence persists after three months, consideration may be given to repeat surgery or continue the use of antiarrhythmic medications.

Reply Date: 2021/07/16

More Info

Post-catheter ablation concerns, particularly regarding atrial fibrillation (AF) recurrence, can be quite distressing for patients. It’s understandable to feel anxious, especially after undergoing a procedure that you hoped would alleviate your symptoms. Let’s break down your situation and address your concerns.

Firstly, it’s important to understand that catheter ablation is a common procedure used to treat atrial fibrillation, particularly when it becomes symptomatic or frequent. The goal of the procedure is to isolate the pulmonary veins and eliminate the triggers of AF. However, it is not uncommon for patients to experience a recurrence of AF after the procedure, especially in the weeks and months following the ablation.
Your experience of having AF episodes recur shortly after the procedure is not unusual. Many patients report an increase in the frequency of episodes in the weeks following ablation. This phenomenon is sometimes referred to as "post-ablation atrial fibrillation," and it can occur due to several factors, including inflammation from the procedure itself, changes in the heart's electrical pathways, or even stress and anxiety related to the surgery and its outcomes.

Regarding your concern about the duration of your episodes and the fear of them becoming permanent, it’s crucial to note that while persistent AF can occur, it is not an automatic outcome of having longer episodes. Your doctor’s reassurance that this is a normal part of the recovery process is consistent with what many electrophysiologists observe. It can take time for the heart to heal and for the electrical pathways to stabilize after ablation.

As for your medication, it’s essential to follow your doctor’s guidance regarding dosages. While you mentioned that you have taken two or three doses of your medication (likely antiarrhythmic), it’s crucial to consult your physician before adjusting your dosage. Taking more than prescribed can lead to side effects, including dizziness or other complications. If you feel that your current medication regimen is not effective, it’s important to communicate this with your healthcare provider. They may consider adjusting your medication or exploring additional treatment options.

If your episodes continue to be frequent and prolonged, there are several options available. These may include:
1. Medication Adjustment: Your doctor may prescribe different antiarrhythmic medications or adjust the dosages of your current medications to better control your episodes.

2. Repeat Ablation: In some cases, a second ablation procedure may be necessary if the first one did not achieve the desired results.

3. Lifestyle Modifications: Sometimes, lifestyle changes such as reducing caffeine intake, managing stress, and maintaining a healthy weight can help reduce the frequency of AF episodes.

4. Monitoring and Follow-up: Regular follow-up appointments with your cardiologist or electrophysiologist are essential to monitor your condition and make necessary adjustments to your treatment plan.

5. Additional Therapies: Depending on your specific situation, your doctor may discuss other therapies, such as the use of anticoagulants to prevent stroke risk associated with AF.

In conclusion, while your concerns are valid, it’s essential to maintain open communication with your healthcare provider. They are best positioned to evaluate your specific case and provide tailored recommendations. If you feel uncertain about their advice, seeking a second opinion from another electrophysiologist may also provide additional reassurance and options. Remember, recovery from AF ablation can take time, and with appropriate management, many patients find significant improvement in their symptoms.

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