Second Ablation Procedure

[cynewulf]

Hello-

Four weeks ago I had a radiofrequency catheter ablation procedure for Wolff-Parkinson-White Syndrome.  The cardiologist had to make about 20 burns inside my left ventricle to stop my arrythmia.  Unfortunately, as I was lying there immediately after this, my heart began another episode of svt, indicating a second accessory pathway.

After further study, the cardiologist pinpointed the problem area, this time inside my left atrium.  He tried to reach it with the ablation tool but was unsuccessful.

I stayed overnight in the hospital and was discharged the next day.  Within 8 hours I went into another episode of svt and had to go back to the hospital.  The cardiologist told me that I should begin taking fleccainade 100 mg/day and atenolol 12.5 mg/day for now.  I could try another ablation that would require piercing a vein to reach the atrium.  He could do it, but doesn't have the 3-d imaging equipment he would like.  The medication I am on makes my heart slower and makes me tired.

I am at a loss as to how to proceed.  Are second ablations successful, is there a lot of risk?  Do the side effects of medication fade over time?  What about sudden death from WPW?  Are there places that specialize in unusual ablations?  Thank you.

[Cleveland Clinic]

cynewulf,

Sorry for the delay in answering.  

Im not sure what you mean by piercing a vein to reach the atrium.  Im assuming you mean a transeptal approach to the atrium, which is done commonly in some electrophysiology labs.  
As far as the mapping software, that is going to be operator specific.  It is important to remember that it isnt necessarily the tools the physician uses, but his or her experience with those tools that leads to success or failure.  It may be helpful to seek a second opinion with a physician that already has the resources to accomplish your procedure.

It is not completely uncommon to have more than one pathway.  A second ablation really carries no more risk then the first unless a different technique is used. The approach and risk should be explained to you before the procedure.

Some people grow accustomed to the side effects of medications over time.  Some people don't.  This is clearly why a lot of people are perfectly fine taking their medications and do not wish to have any procedures.  

The incidence of SCD in WPW is small and probably not really elevated above the general population.  

Tertiary and academic referal centers are your best bet for departments that do a lot of complex and unusual cases.  We have a huge volume here with good success.  

good luck

[WPWGuy]

Hi.  I was wondering which direction your first accessory pathway was conducting in, whether it was along the left wall, and how you know you have a second pathway, as opposed to your original path.

I also wondered whether the imaging machine you refer to (that the doctor lacks) is the one used for mapping voltages in 3D, or whether it is one used for guidance during the "transceptal" piercing.

[WPWGuy]

One more thought.  How do you know that what you experienced after the ablation was SVT and not something else?

[cynewulf]

I believe the path was ventricle to atrium.  Upper right wall of left atrium was the location, which was confirmed during the ep study.

I think the 3D imager is for guidance during a transseptal entry.

The episode after the ablation sent me back to the hospital.  The ER folks got an ekg reading that my cardiologist examined, and it was svt.

[WPWGuy]

Your situation sounds familiar. I had one ablation for WPW/SVT, same direction (called concealed pathway) as yours, but on the left or outer wall of the left atria.  Doc attempted to ablate in the atria first and when that failed went "transaortically" through the aortic bicuspid valve and made the burn in the left ventrical.

Unlike you, I did not have SVT after ablation, but have experienced short runs of atrial tachycardia, and short runs of ventricular tachycardia. I am carefully considering whether it would be worth doing a second attempt to eliminate the issue in the left atrium. That could eventually lead to a transeptal puncture.  I am still researching the risks and benefits of doing this.

[jobob52 ford]

Hi, I haven't been to this site since HANKSTAR was 86'd. It just doesn't seem the same.
Anyway, I also had accessory pathway(WPW), causing VT and also would slip into A-Fib, was maxed out on flecinide and 25mg of atenolol and still kept breaking out -having to go to ER every other week for 12mg of adenosin.
I went for three ablation procedures, the third being at the Cleveland Clinic. I live on the west coast. There were many burns made during the first two procedures, in fact at one point they were ready to burn right on top of sinus node because that is where they kept seeing the signal. Duh. Man, Am so glad they didn't. At the Clinic, they went transeptal, made one burn and that was that. Done deal! It was the shortest procedure.
I haven't had any VT, A-fib a fwe times, untill I relized caffine was the culprit. Now I just have an occasional pac, not lasting long enough to feel it when I feel pulse on wrist.
Don't be afraid of transeptal, just be sure you're at a knowledgeable facility.
Good Luck, Bob

[WPWGuy]

Bob, thanks.   Based on the comments you posted in the past, I did visit the clinic and do the ground work for having the transeptal, in case things start to go extra bad.  In the mean time, I am taking my time and giving it due care.  BUT,  its nice to hear from somebody who has already been there and done that with good success.  Very encouraging.  Thanks.

[wmac]

Hey please tell me more about your VT! I also have nsvt, is yours nsvt or vt? I live in Idaho you said you live on the west coast where? I just had a ep study and they could not induce my vt. So of course I did not get fixed. I had a 90% of being fixed! I went to the University of Utah. Please tell me more, either here on email me at ***@**** thanks so much
wmac