Success rate of cardioversion and ablation.

I’ve read many times here about failed ablations and cardioversions and have also read of the Drs who perform these with great success. This of course is a small slice of what actually happens in the world because obviously there are many more performed that are never heard of here because they either worked and they don’t need any more advice or they didn’t work and they don’t know of this group. What would be an estimate of how successful this method is for controlling Afib, AFlutter etc.? This is on my horizon and I’d just like to know what I’m in for regarding the outcome. Of course I could google this but I thought I’d get some skewed opinions and totals and just wanted some input from this group.

In 2004, I was in the midst of what turned out to be a 2.5 month episode & discussed getting an ECV with my EP. His comment at that time, was, "I can convert you to NSR with the ECV, the question is how do we keep you in NSR." This is a valid point, unless you change something, the conversion is likely not to last long (and there are quite a few reports here of this happening). The EP went on to suggest I just stay in afib as "I was doing well." He meant by this, my afib heart rate was <100 BPM. He did not like ablations in 2004 and also didn't like the rhythm meds. I responded by suggesting a "Plan B." I'd already determined my path to afib was chronic endurance exercise. So my plan included changing my exercise training as well supplementation (primarily magnesium, but also potassium & taurine). I also asked for a script for on-demand use of flecainide to convert to NSR when I went out of rhythm. The upshot? Though the EP said it wouldn't work, I converted the 2.5 month episode with a loading dose of flecainide and have basically followed the rest of the plan subsequently. My AF burden during my initial 4 months of afib was 57%, it is currently <0.05%.

Cardioversions do nothing to treat afib or to prevent it from happening again. Their sole purpose is to stop the arrhythmia right now, but unless an antiarrhythmic drug is being given then there is a very slim chance that will last long. There are outlier stories of people who remained in NSR for months and even years without antiarrhythmic drugs but those are few and far between.

A forum like this is mostly populated by those whose ablation failed or aren't doing an ablation and are trying to manage with drugs and other means. The people who have a single ablation and remain in NSR for years afterwards without drugs rarely seek out a forum like this. We just don't hear from them as often. However, there have been several studies over the years looking at success rates and they all tend to produce numbers like 70-75% success rates for index ablations of paroxysmal afib. So if you have paroxysmal afib and you just go to whatever random EP your PCP refers you to, your chances of a "cure" are 70-75%. If you have persistent afib and particularly longstanding persistent afib, your chances are considerably lower, more on the order of 40-50%. If, instead of a random EP you seek out one of the elite EPs in the world, your chances are dramatically better, more like 90-95% for paroxysmal and 70-75% for persistent.

5-10% is still a big number. Even with an elite EP. If he does a hundred ablations a month, as an example, 5 to 10 are still not successful. Multiple that by his annual ablations he performs.

Maybe the success rate could be 75- 80% (20-25 are not successful out of 100) for an index and future ablations can raise the percentage to the maximum 90-95% you gathered by your research of ablation success rates.

Is there really a number? I tried getting the % from an elite EP and he had no answer. He replied he gives no number because he doesn’t want his patients to be upset if their ablations fails.

Maybe the odds are less than 70% for an index (LAA touch up usually during the second ablation for some, more often for females) and it could take many multiple ablations to be performed due to the skills of the EP, genetic disposition, gender, diet, stress, alcohol, high exercise training, or even left atrium scarring or enlargement or cardiac remodeling— to mention a few possible examples).

There still remain those who are not lucky regardless who they use.



Edited 1 time(s). Last edit at 01/02/2024 04:29PM by susan.d.

Almost nothing in medicine comes with a hard, single number. The human body and medical science are simply too complex for that to be possible, and remember how those numbers are derived in the first place. They all come from statistical samples of data, and never from a measurement of all the procedures performed by every doctor in the world.

But for most people considering an ablation the numbers I gave are fairly accurate and probably do reflect the real world chances of a successful ablation. It's the best data we have.

My EP, who needed to goes at me to put me in NSR reliably, candidly told me up front that a typical index ablation fails about 25% of the time. IOW, about 75% probability of success with one go. He also advised me that a second ablation has about an 80% success rate, suggesting that they are not entirely 'independent events' in probability theory. I'm gonna guess that Natale's numbers are more impressive, say 80 and 90 respectively, but even he cautions that he will need to perform a touchup later to some of his first-time patients when he sees them after their procedure.

The procedure should not be a crapshoot, but unfortunately it often is getting close to a crapshoot...at least it is to many who perform the procedure. The less talented, learned, or skilled/experienced EPs. All it takes is a missed mm gap in the stockade of fibrosis and the electric impulses get through to continue wreaking havoc.

To help illustrate, I use my own case. During Round 2, the EP had worked on two of the pulmonary vein ostia and had moved on to the third. I had been in AF for hours by then...I get worked up a bit about having people bend over me and do things to me when I am supposed to be compliant and docile. He reports that he began to isolate the third again when...I went suddenly, and firmly, into NSR. He didn't even bother to cardiovert me, which he said he almost always does as the last task after an ablation.

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Carey
Almost nothing in medicine comes with a hard, single number. The human body and medical science are simply too complex for that to be possible, and remember how those numbers are derived in the first place. They all come from statistical samples of data, and never from a measurement of all the procedures performed by every doctor in the world.

But for most people considering an ablation the numbers I gave are fairly accurate and probably do reflect the real world chances of a successful ablation. It's the best data we have.

Maybe right. Maybe close. Maybe too high. But if you estimate the number of people who are active on this forum and post and tally up how many stories of their “touch ups “, and then compare and speculate a percentage of those who have successful ablations and no longer post, the 90-95% success rate seems a tad high. It seems with the regulars here, there are a lot of touchup ablations…

So perhaps the 90-95% may be close to accurate, but if you tally up everyone who posts here, their success rate is lower then the national average 90/95% success rate with far more touch up ablations.

The key phrase is "the people here." The people here are a very unique subset heavily biased toward failed ablations. The majority of people who undergo ablation have a successful result and never even look for a forum like this. The published data are much more accurate than any sense we can get from this forum.

Yeah..I’m one of the “people here”. I have a Humphrey Dumpty sort of heart. No matter how many ablations I’ll have (3), Dr Natale told me his goal for me was to ablate me enough times until I could be stable on an arrhythmia drug for life. I know that would not be ideal because I spent the entire month of 11-22 in the hospital mostly in the ICU with drips, pushes, drugs etc and nothing worked. When after my failed ECVs (54 record for the hospital), I got an av node nuke ablation (4th ablation). Not ideal quality of life wise but I’m not living in the hospital.

Just saying I couldn’t get a cure or be lucky to get a long remission…even with the most talented and respected and kindest EP I was fortunate to meet. It happens. I don’t know anyone who had my situation, but I got closure that I tried with ablations. It just wasn’t in the cards.

Apart from the varying success rate I am worried about the 1 in 1000 death rate. If I was in AF permanently and debilitated I might do it but I am in AF approximately 30% of the time which is high and inconvenient but I can walk and ride a bike. I suppose the stroke risk vs death risk is a factor.
The EP I saw in my part of the world has done a few thousand ablations and just gave me the cold facts as any medical procedure has risks. Wish there was an easy out of this.

You do realize that the majority of those 1-in-1000 deaths are primarily due to comorbidities, right? Deaths due to the procedure itself are extraordinarily rare and usually associated with low-experience EPs. If you're basing your decision on that risk vs. the other risks associated with afib then you're looking at the risks all wrong. Probably the lowest risk choice is living with afib indefinitely with only rate control drugs and anticoagulants, but unless you're entirely asymptomatic that choice equals a very poor quality of life. Okay, so you can throw in an antiarrhythmic drug that might improve the QoL, but those drugs all come with their own risks, their own side effects, and they often stop working after a period of time -- or worse, even turn on you and become pro-arrhythmic.

Steven, if you knew you'd have one chance in 1000 of getting your ten dollars back in a lottery, would you play? I wouldn't. I'd know that I'm gonna have to wave bye-bye to my money in all heavy probability. Morally, and ethically, and it's just my own values at play here, I couldn't do that in good conscience. I'd waste my money.

Now, if you have one chance in 1000 of dying due to ANY procedure, or to any medication to which you turn out to be almost anaphylactically intolerant, would you forego those possible cures or successful interventions/mitigations based on the chance that you'd be granted the reprieve 999 times out of 1000? Personally, I would almost rather die than to live with what it was like for me with AF. But if someone comes along and says to me that they have an 80% chance of curing me, or putting me into a much better state, and only 1/1000 that they'll mess up, I would jump onto that passing wagon without even asking for a hand up from one of the passengers already aboard.

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gloaming
Personally, I would almost rather die than to live with what it was like for me with AF. But if someone comes along and says to me that they have an 80% chance of curing me, or putting me into a much better state, and only 1/1000 that they'll mess up, I would jump onto that passing wagon without even asking for a hand up from one of the passengers already aboard.

Gloaming- death is permanent. An AV node ablation is the last resort before throwing in the towel and welcoming death from AF. At least you are alive.

Nobody has a crystal ball that nothing iatrogenic will happen in any type of procedure, cardiac or non cardiac. But when it happens the patient messed up by taking the risk. Don’t blame anyone else but your own arrogance that you believe you are Teflon coated and can beat the odds by nothing bad will stick. Because it’s real. But to a few unlucky souls (I was fortunate to be still be typing ), sometimes something goes south and lands you in the ICU twice where you have the ICU department telling you to make your funeral arrangements because every 5-10 minutes your heart stops for 6-15 seconds repeatedly for two days, and do you want to be coded? Don’t slough something off because the rare low odds don’t affect you. That’s a grave error.



Edited 2 time(s). Last edit at 01/07/2024 09:45AM by susan.d.

"...death is permanent..." So is AF. But you can manage AF. Several ways.