What is the longest you've been afib-free after an ablation?

Hello to everyone. I'm considering getting an ablation due to my worsening afib. But after reading this forum, it seems there are so many failed ablations or cases of afib getting worse after an ablation.

Has anyone here had a successful ablation that lasted more than 5 years?

Thank you

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Maria23
Hello to everyone. I'm considering getting an ablation due to my worsening afib. But after reading this forum, it seems there are so many failed ablations or cases of afib getting worse after an ablation.

Has anyone here had a successful ablation that lasted more than 5 years?

Thank you

You have to rephrase your question. How many successful after the index first ablation or how many are successful after more than one ablation, and if so how many ablations did it take before they were in afib remission —to get the whole picture.

It will be six years for me this coming August. We have others here who've gone much longer than that.

And it's important to keep in mind that a forum like is heavily biased toward people who have not resolved their afib. It's not at all a random sample. The people who have one ablation and it's fully successful don't come here to post about it. They go about their lives and forget about afib. Statistically, about 70-75% of all ablations are successful on the first try. That's been found in many studies and it includes ablations done by elite doctors, good doctors, and mediocre doctors. If you look at only elite doctors, the number is typically over 90%.



Edited 2 time(s). Last edit at 04/23/2023 06:23PM by Carey.

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Maria23
Hello to everyone. I'm considering getting an ablation due to my worsening afib. But after reading this forum, it seems there are so many failed ablations or cases of afib getting worse after an ablation.

The statistics on failed and successful ablations vary enormously according to who does the ablation. A few of the ‘top tier” EPs who perform ablations have success rates over 90%, I’ve seen posted here, while the national average for success on a first ablation is about 70%. The most important lesson I have learned here is, when seeking an ablation, travel to one of the best. It may be inconvenient in the short term but so worth it long term, and since these top tier ablationists have a lot of out-of-state patients, they usually have a system for accommodating their needs.

Thank you for your answer and congratulations on your ablation.

When you say "about 70-75% of all ablations are successful on the first try", what is the definition of success? 1 year afib free? 5 years afib free?

One year. Some EPs want part of the year to be on anti-arrhythmic drugs, especially and mostly during the 'blanking period' of 8 weeks post-op. That's when one's heart is most irritable and unsettled, and when one is likely to have breakthrough episodes of AF. Those are normal, and they diminish rapidly if the operation is a success. Ideally, once the wearing of a Holter monitor at around the 10 week mark shows no recurrent AF, you can go off meds. In fact, the wisdom and idea is to go off meds a couple of weeks, ideally, BEFORE the Holter monitor so that one's true heart rhythm can be assessed un-corrected. But, if it looks all clear, you will be advised or told to continue taking the anti-coagulant for life, even if at a markedly reduced dosage, but there's no further need for anti-arrhythmics and rate control like metotprolol.

I am one of those first-time failures. It was very disappointing, and the heart seemed to fall naturally back into a very cranky state within weeks. But, the EP said he'd be pleased to have a second chance, and he got it. Happily, I am about to wear the Holter on May 10th, and have been off metoprolol for four weeks. My HR is elevated, running between 65 and 75 while awake and still, but it's fixed in wonderful normal sinus rhythm.

Don't let the scary statistic worry you or dissuade you from the mechanic's wrench. These guys and gals are really keen, well-trained, and they are oriented to doing good by you. Imagine what it's like doing 15 of these a week knowing that four of them are likely to have to come back, even if all indications before removing the unconscious patient from the operatory are that the operation is a success. They test the heart, properly called 'challenging', before they release you using a chemical meant to stress the heart. If it doesn't show AF, then the reasonable assumption is that the work is done...properly. Yet, 30% have to come back for more work. And they'll do it, and you'll still shake their hand when they come bedside and report how the second go went. Mine did, and I'm grateful for his work.

Remember, some unfortunates, like Carey, had to have six or more ablations, even taking the trouble to try to improve their odds by seeking new practitioners whose credentials and references said it would be an improvement. They're here, much better off, and off all but a half-dose of apixaban or equivalent.

This isn't a used car business.



Edited 1 time(s). Last edit at 04/23/2023 06:56PM by gloaming.

I’m highly skeptical that 70% of afib cases in the US are resolved after one ablation.

At least if “resolved” means afib free for a year or more.

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Maria23
When you say "about 70-75% of all ablations are successful on the first try", what is the definition of success? 1 year afib free? 5 years afib free?

The definition is one year free of atrial arrhythmias without the use of antiarrhythmic drugs.

One thing you need to keep in mind is that afib is a progressive disease. If you're free of afib and off drugs for a year, then the ablation is complete. The scars created are permanent, will never go away, and those sources of afib will never bother you again. However, new sources can develop in the future. When you hear about people developing afib again 5, 10, whatever years later, that's what happened. A successful ablation 1+ years old does not fail.

So you might say, "But if I hadn't had an ablation what would it matter if new sources develop? I'd still just have afib." The answer is you wouldn't have had those years of freedom from afib and -- most importantly -- "afib begets afib." The longer you stay in it, the more likely it becomes you will stay in it persistently. There is no benefit to living with afib unless you're asymptomatic and you're okay with living with permanent afib for the rest of your life. And once you go persistent, it becomes much more difficult to ablate, difficult to the point that average EPs simply don't have the skills to do so, and many won't even try.

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Mac
I’m highly skeptical that 70% of afib cases in the US are resolved after one ablation.

At least if “resolved” means afib free for a year or more.

There are a number of large studies showing exactly that.

As has already been stated, people come to these forums and to apneaboard.com to get help. People who can play tennis and go camping after an ablation don't need to be here. They don't wanna be here!

Just doing some paper napkin figuring, your average EP performs between 4-12 of these each week. Within six months all they would be doing is repeats if the success rate were less than about 55%. Someone else would have to be doing the first-time patients, and farming their failures out to the first batch of EPs resigned to doing touchups. Also, given the risk of catheter ablation, which is a big deal, if routine these days, I don't see how the insurers would suffer a failure rate like that in such a procedure. What does an ablation run, about $15K a pop? With discharge the same day in most cases? No, it has to be substantially better than 55%.

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gloaming
What does an ablation run, about $15K a pop?

Cash price in the US is about $150-180K, but the price negotiated by Medicare and insurance companies is typically about 20 cents on the dollar, so they end up paying about $20-40K. But if you're some wealthy dude coming to the US for an ablation and paying out of pocket, you'll be paying the $150K+.

As for number per week, someone like Natale might do 12 in a week, but the average EP is much closer to the lower range of 3-4, or even less. The guy who did my first ablations did maybe 1 per week, and he was head of the EP department at a large teaching hospital.

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Daisy

Hello to everyone. I'm considering getting an ablation due to my worsening afib. But after reading this forum, it seems there are so many failed ablations or cases of afib getting worse after an ablation.

The statistics on failed and successful ablations vary enormously according to who does the ablation. A few of the ‘top tier” EPs who perform ablations have success rates over 90%, .

10% will not be successful according to your statistics after multiple ablations. There will be those who fall through the cracks. Natale told me he never quoted success rates (I love his honesty) to his patients and he sees frustrated patients thinking it’s a done deal by using the best…so I think it’s subjective on what you read.

I had the best EP and unfortunately after 3 failed ablations he set a new goal of future ablations (plural) until I was stable for life on drugs. The problem is for me drugs were not successful long term and my flutter after each ablation got worst. I never had flutter pre ablation(s) and for some here flutter could be the result from the scar tissue ablation burns.

I think it’s patient to patient who maybe succeeded and who can’t after either a singular or multi ablations. Obviously the more trained EPs will get better success rates. It comes down to skills luck and faith.

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Carey
It will be six years for me this coming August. We have others here who've gone much longer than that.

.

But you had over 5-6? It wasn’t a one and done success story. How many patients would consider an ablation knowing it’s possible they may need 6? Each ablation burns healthy cardiac tissue and comes with its own aftermath baggage such as flutter or a pacemaker if the EP heats up the sinus node. The patient scheduled before my ablation and myself ended up with pacemakers. That’s why I urge those considered an ablation to get the pulse (no heat) and not the BBQ RF ablation technique.
[www.afibbers.org]

Some of the EPs have reputations of being good to excellent backgrounds and top hospitals. It depends on karma and luck if the EP is having a good day or not.

My first ablation, 6 weeks. Not done by Dr. Andrea Natale and the incredible staff at St. David's/TCAI in Austin.

My 2nd ablation just about 2 months later by Dr. Andrea Natale and the incredible staff at St. David's/TCAI in Austin, is coming up on 6 years free of any known arrhythmias of a duration longer than :30, and free of all anti-arrhythmics. I'm still in awe and overflowing with gratitude. I feel very fortunate.

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susan.d
But you had over 5-6? It wasn’t a one and done success story. How many patients would consider an ablation knowing it’s possible they may need 6?

It was five, and that's what makes the success of #6 far more remarkable than a one-and-done. I was an extremely complex case with multiple flutter circuits and afib and scar tissue from previous ablations. In fact, prior to seeing Natale I thought the only option left for me was an AV node ablation.

If people listen to the advice given here, there's no chance they'll need six. I've written at length about how that happened and how not to make the same mistake I made. It's a pinned topic so not hard to find.

First ablation lasted 13 years, then afib back and a second ablation. Now 3 years afib free and hoping for many more.

It would be useful to have some factual evidence of how people behaved differently after a successful ablation vs. an unsuccessful one. It's a confounding factor, obviously, because if people get what should be successful ablations, say running 90%, but some go on to eat more sensibly, have other comorbidities fixed, get more sleep, get more exercise, have healthier relationships, or lose bad ones, etc, etc,, I can't help but wonder if it's something WE'RE doing and not something they're (the EPs) are doing wrong, or failing to do.

Maybe the modest success rate, if it could charitably be described as such, just means its early days grappling with AF, and that we'll get much better inside of a couple of decades.

I did nothing different.

I don't think lifestyle changes are going to make much difference in the success of an ablation. See my monkey cage analogy for why. What lifestyle changes can do, however, is make a big difference in your health going forward. You stop exercising, get fat, get diabetes -- your risk of developing other cardiac problems increases. It probably also increases the risk of progression of your afib to areas outside the ablation "cage" but I don't know that with certainty.

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Carey

The definition is one year free of atrial arrhythmias without the use of antiarrhythmic drugs.


Carey, some websites list oral diltiazem as an antiarrhythmic drug and others do not. If someone is one year free of arrhythmias, but still on diltiazem, would you consider that a successful ablation?

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Pixie
websites list oral diltiazem as an antiarrhythmic drug and others do not. If someone is one year free of arrhythmias, but still on diltiazem, would you consider that a successful ablation?

Diltiazem is in a class of medications called calcium-channel blockers. In the afib world, these meds would be rate control drugs, not a rhythm control drugs. I assume you may be on it for blood pressure treatment? In my world, this would be a successful ablation, as the diltiazem is not going to keep you from going into afib.

Thanks for your response, George. I was told by a prior EP that it was for rate control during AFIB episodes. I was using metoprolol with it. Dr. Natale kept me on the dialtiazam. One of his APNPs told me he thought it was for rate control, but now I don’t know.

It's a rate control drug, not an antiarrhythmic, so yes, I would consider your ablation successful.

If you don't need it for hypertension and don't need it for rate control, why are you still taking it? You should ask.

Thanks Carey, for responding. I will definitely be asking.

Hello, Maria and Welcome.

My first AF event was in 1995 at age 59. Not long after that, I found this great website by founder, Hans Larsen. My goal was to reverse AF w/o ablation, but as the years went by, the events became more frequent.

In 2003, I decided to have an ablation… so on 11/12/03…I had my first ablation.

That lasted until 5/8/12 when I began having A-flutter events that initially converted with PIP meds but then stopped – so I had ablation #2 for flutter on 8/11/14… followed by a touchup #3 in April 2015. In addition to the flutter ablation, the Left Atrial Appendage was also isolated and I was prescribed a half dose of Eliquis TID for life. I take no other meds.

So… today… 8 years later, I remain in NSR.

Jackie

Thank you, AB Page. Happy for your 6 years.

13 years is impressive, Ken! Thanks

Thank you, Jackie, and congratulations on your calm heart.

May I ask who performed your ablations?

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Maria23
May I ask who performed your ablations?

In case Jackie doesn't log back on soon and see your question - Dr. Natale performed all of hers (the first at Cleveland Clinic in 2003 and the other two in Austin). I joined here about a year after her first and have followed her and Dr. N since. Here is a search of her ablation posts if you want to read more: [www.afibbers.org]

First - Thanks George for your assist. I appreciate it.
Jackie

Maria 23 - Yes, as George points out, Dr. Natale did all three.
The first , when he was with the Cleveland Clinic in Ohio and for
the other two, I flew to Austin, TX.

Going back in my non-cardiac health history, I had numerous
health issues that were poorly diagnosed by several different
doctors coupled with disastrous treatment results and ongoing issues....
so when I learned of Dr. Natale's expertise and the fact he was in Ohio,
I didn't waste a second making the appointment.

Best yet, I have never regretted my decision and I've always thought of
Dr. Natale as my hero. So kind, compassionate and so highly skilled.
I am truly blessed.

Sincerely,
Jackie

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Jackie
Best yet, I have never regretted my decision and I've always thought of
Dr. Natale as my hero. So kind, compassionate and so highly skilled.
I am truly blessed.

Thanks for posting that today, Jackie—I’ll be in his hands tomorrow morning!



Edited 1 time(s). Last edit at 04/25/2023 07:10PM by Daisy.

Best of luck to you, Daisy! I’ll be going there in a few weeks also, and will keep Jackie’s words in mind. Keep us posted.

~ Linda

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Maria23
Thank you, AB Page. Happy for your 6 years.

You're welcome Maria. While my words carry no influence, my story is like so many others, connected to Dr. Natale through the selfless acts performed by Shannon.

Best to you as you develop your course of treatment with your EP.



Edited 1 time(s). Last edit at 04/26/2023 08:44AM by AB Page.

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LLA
Best of luck to you, Daisy! I’ll be going there in a few weeks also, and will keep Jackie’s words in mind. Keep us posted.

I was first up this morning, now settled in my room after a delicious grilled salmon and asparagus lunch. Dr. Natale stopped in about 4 pm for a quick visit before his last procedure of the day. I really appreciated his update—a tiny bit of touch up ablation, and a successful Watchman implant—yay! I’ll post a thread about tomorrow after he does rounds if there is anything interesting to add. 😊

Awesome, Daisy!! Here's to an unencumbered future for you.

Best of luck Daisy! Having Natale implant my Watchman was one of my best decisions I’ve made.

Read the comments on this page labeled: how to have multiple ablations and still have afib. That explains it all. It has over 4,000 views!

My ablation lasted 10 years. Had a second " touch up" 4 years ago. Will likely need another "touch up" in the near future.

Paroxysmal a-fib started in 2006. Went 9 years without taking any drugs because I only had about one a-fib episode a year.

In early 2015 my a-fib became a regular thing so I had a March 2015 index ablation by Dr. Natale.

(went almost 8 years with ZERO a-fib and no drugs or lifestyle changes)

January 2023 - LAA ablation with Dr. Natale

(had a few atrial flutter breakthroughs during the 3-month blanking period)

April 2023 - 7-minute touch up ablation with Dr. Natale & Watchman implant put in

(now I wait to see how many years I'll get of a-fib/flutter freedom!)

Travis

P.S. You can read in great detail about all of my a-fib ablations and my journey with a-fib on my blog: www.livingwithatrialfibrillation.com

Travis, thanks for sharing your blog. Can you explain what is index ablation?

“Index ablation” is one’s first time getting an ablation. Your first ablation.

I have been afib free since my Natalie ablation in Thousand Oaks CA in August of 2017. I had afib from around 2010 - 2017 and it was getting pretty bad and impossible to live with. Like Elizabeth mine was from too high of a Free T4 from too much Synthroid after my thyroidectomy in 2009.

Totally changed my lifestyle and keep my Free T4 at the low end of the scale. Have also been following Steve Carrs protocol.

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greyhoundgal
Have also been following Steve Carrs protocol.

Here is a search on Steve Carrs protocol here for those who are interested. His most current version. Steve has done a very systematic analysis of the variables impacting his case.

Hello Carey
Would you be able to point me to a survey showing 75% success rate: no Afib after 5 years, no medications, single procedure.

My figures are more like 50% success rate.
Thank you. Saul

I agree. My research leads me to believe that just 50% (and possibly lower) of single catheter ablations are completely successful after five years, with no anti-arrhythmic medications,

If you factor in persistent cases, 40% is the success rate after five years (as quoted by cardiac surgeon James Cox).

Hello Gloaming.

The very first Google search "catheter ablation success rate" states:

"Our group previously reported stable sinus rhythm in 80% of patients with PAF [paroxysmal AFib] after multiple procedures and a follow-up of 5 years on antiarrhythmic drugs.2 Success rates of catheter ablation for persistent (Pers) AF are lower, and reported between 56–70% after multiple procedures and after 5 years.3–5"

[academic.oup.com]

Multiple procedures and with anti--arrhythmic drugs?

You mentioned that "unfortunate Carey had to have 6 or more CAs to achieve success" ?

Could you link please to the article. Ta !

[www.ecrjournal.com]

[www.stopafib.org]



Edited 1 time(s). Last edit at 05/12/2023 03:18AM by gloaming.

Thank you, Gloaming, for the link.

The article mentions, in the first paragraph: "Success rates vary between 60% and 80%, for paroxysmal AF (PAF), depending on ablation strategies, and between 50% and 60% for persistent AF.4,5"

I followed the footnote (4) to the original study:

"Long-term outcomes of catheter ablation of atrial fibrillation: a systematic review and meta-analysis"
[pubmed.ncbi.nlm.nih.gov]

For 6179 patients, with a single procedure, the outcomes were just 53.1% overall- made up of 54.1% paroxysmal and 41.8% persistent.

If you read the very next paragraph in the article, the higher success was nearly 80% with an average of 1.5 ablations.
The article also mentions that there was wide variation in the results, so some patients needed multiple catheter ablations.

Quote:
"Data were extracted from 19 studies, including 6167 patients undergoing AF ablation. Single-procedure freedom from atrial arrhythmia at long-term follow-up was 53.1% (95% CI 46.2% to 60.0%) overall, 54.1% (95% CI 44.4% to 63.4%) in paroxysmal AF, and 41.8% (95% CI 25.2% to 60.5%) in nonparoxysmal AF."

The definition of success is clearly subjective. There is no cure for afib, just a temporary fix (success) for some period of time. A great EP will likely give you a longer period of success than an inexperienced EP. After your period of success, afib will be back and you go back for another ablation and hope for the best. I have had two successful ablations as posted above for a total of 16 years of no afib. BUT, there is a good chance that I will have afib again before I die. Now 78. I don't regret the ablations.

Hello, Ken. I am not knocking CAs. If they are available and affordable and you are fit enough to have them, they are for you.
For me at 76, the thought of having multiple CAs and having to fund them myself is not feasible.

I had to correct Gloaming's sweeping statement that CAs are 80% successful.
The criteria for success are: long term without AFib episodes (longer than 30 seconds), and no antiarrhythmic medications.

Based on Gloaming's own reference to the article, 80% are successful with an average of 1.5 ablations.

Take an example of 100 people with AFib, 80% success (80 people), including multiple ablations.

From the article:
53 people will be successful after a single ablation. 20 will never achieve success however many CAs they have had (1 out of 5).
That leaves us 27 people who require multiple ablations.

If y is the unknown for >1 ablations.
(53 x 1) + (27 x y) / 80 = 1.5 (average ablations for 80 people who achieved long term success)
Solving for y= 2.5 ablations for the group that required more than a single ablation.

This translates to some having 2 ablations and others having 3 ablations, and if a larger number achieve success with 2 CAs, there will be smaller number who require more than 4 CAs - just like Carey?

Having said all that, I may require a CA for atrial flutter, if it doesn't respond to rate control medication.

All the best in beating the AFib misery, Saul.

Saulger, at 76, wouldn’t Medicare pay for any needed ablation?

Good evening Daisy. I am in Greece !
I love the afibbers.org site of Dr Larsen.
One of the very best.
I tried the Steven Carr method but it hadn't worked for me.
I hope that you are well.

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saulger
...

I had to correct Gloaming's sweeping statement that CAs are 80% successful...

???

?????
Gloaming said:
"It's a confounding factor, obviously, because if people get what should be successful ablations, say running 90%, but some go on to eat more sensibly, have other comorbidities fixed, get more sleep, get more exercise, have healthier relationships, or lose bad ones, etc, etc,, I can't help but wonder if it's something WE'RE doing and not something they're (the EPs) are doing wrong, or failing to do."


According to the data that you shared, a qualified 80% of CAs are successful with 20% not succeeding at all, 53% successful after one ablation, and 27% successful after having an average of 2.5 CA.
It's important that people realise that there is a 47% chance that your CA will not succeed or will be successful only after 2.5 ablations on average.

Very different !

You are welcome to share your thoughts. We are a discussion forum after all.
Saul



Edited 2 time(s). Last edit at 05/12/2023 02:04PM by saulger.

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saulger
According to the data that you shared, a qualified 80% of CAs are successful with 20% not succeeding at all, 53% successful after one ablation, and 27% successful after having an average of 2.5 CA.
It's important that people realise that there is a 47% chance that your CA will not succeed or will be successful only after 2.5 ablations on average.

Very different !

You are welcome to share your thoughts. We are a discussion forum after all.
Saul

But the most important predictor of successful ablations is not quantified in statistics like this—who does the ablation. The “elite” top-ranked EPs may have a 90% success rate while an EP who does 100 per year May have a 50% success rate while the majority of “competent” and moderately experienced EPs are somewhere in between.

Hi Daisy. Can you share a paper for any EP that confirms 90% long-term success rate after a single ablation?
I would love to see it.
S

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saulger
Hi Daisy. Can you share a paper for any EP that confirms 90% long-term success rate after a single ablation?
I would love to see it.
S

I don’t have access to such a paper though I have seen this discussed here on the forum—EPs who participate regularly in research have their outcomes monitored. I also don’t remember whether it was after one or two ablations. But the point I was trying to make is that general statistics for the success of ablations really don’t have much meaning as success rates vary so much according to who does the ablation. That is why you will keep seeing the advice to go to one of the very best if you are seeking an ablation. Unfortunately, there are not very many truly elite level EPs and, for most, seeing one will mean travel—but the difference in outcomes makes it very worth the extra effort.

Another interesting factor is that the handful of EPs with the best outcome records are the ones who see the most complex patients, yet their skills still bring a very high percentage of success.

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saulger
Hi Daisy. Can you share a paper for any EP that confirms 90% long-term success rate after a single ablation?
I would love to see it.
S

I can do better than that. I can show you a 90% success rate ablating afib in patients with multiple prior failed ablations, and I will when I find some time tomorrow. But as you probably expect, the study authors aren't average EPs. They're leaders in the field, and as Daisy pointed out, the EP doing the ablation is the most important factor of all.

The real lesson: If you find the average success rates unsatisfactory then don't choose an average EP.

Hi Daisy, Hi Carey

As I mentioned, I would love to read a paper. either peer-reviewed or even by the EP themselves touting 90% success rate - long term and no antiarrhythmic medications - after a single CA.
I have searched high and low for the evidence and all I ask is that if you quote figures that you link to the evidence.

A large study showed that the recurrence rates after a single CA at 2, 5, an 10 years were:

After years 2 5 10
Paroxysmal: 3%, 11%, 27%
Persistent 13%, 29%, 62%

It stands to reason that some practitioners are very talented and dedicated individuals who are better than the average and are at world-leading hospitals, but a disparity of 90% for some and 50% for others just doesn't exist. It would be medical negligence.

Gloaming cited a study that had 80% success overall. When one looked at the actual numbers of over 6,000 cases, out of a hundred patients, 20 never achieved success, 53% were successful after a single procedure and 27 needed on average 2.5 CAs to achieve success.
This means that 47% (haf of all who undergo CAs) will either not have success at all, or will need 2.5 ablations to be successful.

Very important to realise before going down that route.

The study noted that there are wide fluctuations in the CA outcomes, which I believe are due to the anatomy of the patients, patients age, co-morbidities, obesity etc, and difficulty in achieving transmural lesions with the CA technique to ablate the offending areas that are on the top of the heart, where the nerves originate.

Dr Natale is a star EP in the US. Professor Schilling is a star EP in the UK.
Dr Natale, apparently, doesn't publish results, Professor Schilling does. His results are at average 18 months post procedure:

2020 success paroxysmal 75%, persistent 80%
2019 89% 73%
2018 63% 58%
2017 90% 63%

[londonafcentre.com]

Professor Schillings success varies widely year by year, which I posit is due to the luck of having patients who match the technique.
If it is solely the system and skill that determine the outcome, Prof Schilling's results would be more homogenous.



Edited 1 time(s). Last edit at 05/14/2023 07:32AM by saulger.

Saul, there was a rather important word that you elected not to highlight in that quote. The word was '...should...' I made no claim or inference that the rate IS 90%. I said, I thought clearly (but perhaps I could have smithed my construction a little better), that the rate of success for ablations should (ought to be) running at 90%,. I had intended that the reader should suspect that I am displeased with the real, and substantially lower, rate of about 75%. Again, I could have phrased my thoughts a little more clearly.

Gloaming, it's not a problem.

I am simply trying to get a research paper that confirms a high success rate, long term, no medications, after a single procedure.
.
Carey messaged me that he will forward a report that shows 90% success, including persistent AFib patients.

Should I receive this from Carey, I will stand humbled and will be very pleased !

Moi, aussi. Mi tambien. Me, as well. I think we would all rejoice to see a peer-reviewed, major paper, showing that one or two modern practices have raised the rate of success in catheter ablations. I don't know that dentists could, or would, practice, if their work had a mere 75% probability of success. It must be frustrating to all the EPs out there who, thinking they have finally grasped the magic, find that their very best efforts fall short much too often.

I personally feel that luck plays a part.
If you get a lone AFib patient with a RF (or cryo-balloon) accessible heart, and can create continuous lesions that are transmural, you will have a successful outcome.
I also watched a video showing the the electrical mapping of the heart showed errant foci in a different location, when it was tested again hours later. Stay well.

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saulger
Carey messaged me that he will forward a report that shows 90% success, including persistent AFib patients.

I apologize for the delay. I've had a wicked busy few days and more are to come.

I must correct myself a bit on that 90% figure. That was achieved after two procedures, but those procedures were done on the toughest of the tough cases, those who had failed multiple previous PVI ablations and had persistent afib. Many typical EPs wouldn't even attempt ablations on this patient population and most who did would likely achieve maybe 50% success rates at best.

You can read the abstract here.

Quoting the relevant conclusions:

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At 1 year, 90% were arrhythmia free off-AAD in non-PV ablation group, and 72% who did not receive non-PV triggers ablation at the index procedure (P = 0.035). The success rate of empirical LAA and CS isolation was 78.5% and 82% after the index and repeat procedure, respectively.

That last sentence is especially telling. Achieving a 78.5% success rate with one ablation on that patient population is remarkable.

There are other studies showing one ablation results with a single ablation in the 75% range, but I haven't had time to find them yet. I will. (I need to bookmark these things!)

Thank you, Carey. I appreciate that.
I hope that you are well.

I will read your reference and will also search for the exact numbers, but one year monitoring is not long-term.
The drop-off (recurrence of AFib post CA) after five years is something like 30%.

Thanks again. Saul.

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saulger
I will read your reference and will also search for the exact numbers, but one year monitoring is not long-term.
The drop-off (recurrence of AFib post CA) after five years is something like 30%.

Don't know where you're getting your numbers but 1 year of freedom from atrial tachy-arrhythmias without AADs is proof of a successful ablation. Recurrence of afib after that is due to progression of the disease, not a failed ablation. You're sort of setting up an impossible situation here where you're counting progression of the disease beyond the boundaries of the procedure as failure.

The thread is titled: "What is the longest you've been afib-free after an ablation?"
Not "how many are AFib free after one year"

There are various milestones after a CA.
6 months, 12 months, 2 years, and 5 years.

5 year data is long-term success. If it was not important, it would not be quoted in the study that I referred to.

The only thing that was special about the patients in the study, that you referenced, is that they had two or more previous CAs that failed.
My argument exactly, that 50% of first time CA will fail and will require 2.5 CAs to be in rhythm after five years..

When I said 30% recurrence of arrhythmia after five years, I was erring on the side of caution because it is 50% recurrence.
You said: "I don't know where you are getting your figures from?"

"Clinical Outcome After the Initial Ablation Procedure
Among 161 patients, all PVs were completely isolated during the first procedure. During a median follow-up period of 4.8 years (0.33 to 5.5 years), 86 patients (53.4%) demonstrated recurrent ATa." [ATa = Atrial tachycardia arrhythmia]
[www.ahajournals.org]

(please see attached graph)

Who would be satisfied with just one-year success and to have AFib back after 12 months, and then have a second and third, and fourth CA?

The Cox Maze IV (also thoracoscopically) reports freedom from ATA was 92% (552/598), 84% (213/253), and 77% (67/87) at 1, 5, and 10 years.
[pubmed.ncbi.nlm.nih.gov]

This is exactly the CA dilemma: 20% of folks will never have any success of being AFib-free after many CAs. 27% will require 2.5 CAs on average to achieve long-term success (5 years).
2.5 average CAs means some actually having 3 and 4 CAs inside five years.

If you are interested, there are videos that discuss the electrical mapping of errant impulses, that form the basis for a CA, that show moving errant foci when tested at different times and this, I believe, contributes to the recurrences of AFib every year and diminishing success long-term.

It is difficult to blanket-isolate all foci from inside the heart during a CA.

Be well.



Edited 11 time(s). Last edit at 05/16/2023 09:18AM by saulger.

My first ablation lasted 10 years. It was performed by Dr Chinitz at NYU. I broke thru around 2 years ago and had a second ablation by Dr Chinitz and have been afib free since.