Unsuccessful Ablation

[Hyatt65]

I am curious as to a) reasons why a cardiac ablation might turn out to be unsuccessful and b) next steps for treatment.  

I had an ablation for SVT/syncope three months ago but have had two episodes of SVT and syncope this week.  Yesterday I ended up in the ER after passing out three times with a heartrate of 235.  We had thought the ablation was successful, so we are quite surprised this is happening.  I have low blood pressure, and cannot tolerate many typical meds.  Just wondering if another ablation is worth trying, a pacemaker, or something else.  

Many thanks for any help.  

[maggiemag]

Well, in my case, the area was quite large and too close to the AV node.  Whenever they got too close to the node, then I would go into heart block.  So they knew that they would have to put in a pacemaker if they ablated what needed to be ablated.  Because of congenital vessel abnormalities, he already knew that it would've been extremely difficult to put a pacer in, so they abandoned the procedure.  He did tell me all this, though, so I knew it wasn't successful.  I think the one key to a successful ablation is having a VERY experienced EP, and not just someone who is experimenting and learning on you!  I might get another opinion if I were you.

[ireneo]

I agree completely with the other folks. I've had 3 ablations. It zapped out my atrial flutter the first time but my atrial tachy (PSVT) kept coming back. However, they were able to improve it by miles. I still have mini-tachy times (less than a minute) and for the most part they stay around 150-160 with only occasional bursts to 198. Also have PVC's and PAC's but compared to the tachy times I used to have, I'd say I feel pretty good. I now take a low dose of Diltiazem for chest pains I developed a little over a year ago. Whatever. The med really helped with that.

If your doctor offers another ablation and is confident they can give you some relief, try it again. You may never have the perfect heart but you can feel pretty darn good.

[SillyHeart]

An ablation can be unsuccessful for many reasons.  For example, they may not have burned deep enough into the heart tissue to destroy the pathway.  Or, they didn't actually burn the right pathway at all.  Or, you had multiple pathways.

Another ablation is definitely an option.  A pacemaker is not used for SVT.

[sueinns]

Sometimes more than one ablation is required to cure the problem (many posters here have had several).  Although SVT has a 95% success rate, there is still a 5% chance it won't work.  Why is that?  Well, sometimes they don't burn long enough and a segment gets left behind that can continue to cause problems.  This requires re-ablation.  There's also the chance that you could develop the problem in another area but that seems unlikely since you only had it done 3 months ago.

PVC's and Atrial Fibrillation are harder to treat with ablation.  The problem with PVC's is they are sometimes hard to create and you need to be symptomatic during the procedure.  SVT is relatively easy to bring on because it is so sensitive to the drugs they give you.  PVC's can also be multi-focal, meaning they are in more than one spot so ablation success is lessened.

It's been 3 months since I had my ablation for SVT.  I have had the odd dizzy spell (more related to PVC's I think) but no racing.  It sounds like you did not have a successful procedure and another ablation may be worth trying.  A pacemaker would be kind of extreme, depending on the location of the SVT (sometimes it's in an area that if they ablade, a pacemaker is required).

I think a visit to your EP is definitely warranted.