Can multiple ablations (9) cause CHF?

[AFlutter]

Hi, I am a 49 year old female that had an ASD repair in 1989.  I had zero problems until about four years ago, when I visited my regular doctor and he noted my resting HR was 170.  He had me transported to the hospital where I was diagnosed with Atrial flutter.
I have had 9 ablations in 4 years. A pacemaker impantation.   At tsme my ventricular response was in the 300's.  I have counted at least 100 days in the hospital and I still have relief only in the sense that my AFib now comes and goes without having to be addressed in the emergency room, but the fatigue and shortness of breath plagues me every day..  I moved and made an appointment with the local cardiologist and he has just diagnosed me with right side CHF , and we are trying to rule out renal failure.  It is early in the diagnosis, so my echo hasn't been completed.  I have no idea what my current EF is.

[2210485]

If afib ablations are going to cause chf they would most likely cause it early on as opposed to years later. This is due to pulmonary vein stenosis, which MOSTLY manifests shortly after the procedure.

Unfortunately whats more likely here is that this is all part of the same sort of disease process.

Afib, conduction defects such as av nodal blocks, cardiomyopathy and dyssynchrony.. They're all connected to each other, meaning 1 problem just makes the other worse.

In fact the term right sided heart failure in itsself is misleading as 1 side of the heart rarely fails independently, it just may be that 1 side looks worse or presents earlier than another.

Some of these disease processes even explain the logic behind some of the ablations, av nodal ablation (which im betting you had based on your history) for example; is easily justified when you consider the av node is likely to fail on its own under afib burden.

Pulmonary disease can also be at play. As can issues with your pacemaker (perhaps requiring an upgraded unit with additional leads and capabilities).

So in short, yes its possible that an ablation can lead to this.. However its unlikely, and the more time that has passed since your last afib ablation and symptom onset the less likely it is.

You will of course need an echo to try to identify the udnerlying cause. If its pulmonary we treat the lungs, if its an electrixal or muscular thing the pacemaker is going to be the target. If youve been going back into afib this,may require some sort of medical management to try to shore up the ablation line, as a repeat at this point is kind of fruitless.

That said, this sort of difficulty is normal in afib, and sverity varies with every patient. I dont know,if its any comfort but just know that you are not alone in this struggle, nor is what youre going through something abnormal for afib.

Afib is just one of the most god aweful and difficult conditions managed in cardiology.. Its extremely stubborn, technicalky challenging, time consuming and always accompanies or causes a myriad of other issues that inevitably involve the attention of every cardiology subspecialty imaginable.

We hate it; I mean like we really hate this one, and you can be certain that whatever can potentially be done to get it under control will be done. This is something that if treated improperly is only going to come back to haunt us for decades and we try to prevent that as much as possible.

[AFlutter]

Thank you for your thoughtful and thorough answer.  I like you really "hate" this as well.  I'll update layer in January regarding the outcome of th e testing.