This is a good article, but you have to read the details, and the information is incomplete.

For example: The success rate and complications depended on age (more problems for ages 75-84 years old than younger patients), and for patients with previous hospitalizations for AF.

Success/complications were also correlated with the hospitals' experience with ablation (the more ablations that were performed the higher the percentage of success rate.)

Now, these are common sense results with any medical procedure (older people have more complications, hospitals with more experience have higher success rates, etc.) and actually don't have all that much to do with aFib or ablation per se.

There is also no sufficient information on comorbid conditions (ie, other illnesses and general state of health). Most good EP's will only perform ablations on relatively healthy pts. who will have a good success rate, unless that are particularly skilled with complex cases.

It seems (in these samples) that the success is 70% (or so) without further hospitalization or new ablation after 2 years. To me, 70% is pretty good, although others may interpret this as "mediocre at best" (a physician quoted in this study states this).

However, if you read it, the caution is not about ablation in general but about hospitals getting on board and broadly offering ablation with insufficient knowledge or experience. I read it as more for hospitals to be careful about who is a good candidate for ablation, and when MD's are "qualified", not as a message to pts. that the procedure itself is poor. He points out that many hospitals are considering offering ablations by poorly qualified staff, not that ablations themselves are a failure.

So, again, with research the devil is in the details, not the headlines. IMO, this article, while comprehensive, does not reveal much new. I find research has to be read carefully to truly understand the results and implications. I still contend that ablations are relatively successful - for the right patients and done by well quaiified EP's.

Well said NYNM!!!!

I agree, but complications are real. Here are a few quotes from the article:

"These ablations were performed in nearly 100 hospitals, where the mean annual number of procedures per hospital was 15.4, although the yearly number varied from only seven to 136.9."... (snip)... "Moreover, for each additional five procedures done in the previous year, there was a 2% decrease in the likelihood of complications or readmissions (OR 0.98, 95% CI 0.97 to 0.99)."

With that said, my EP feels that ablation risk still outweighs possible benefit "in my case".

Thank you, Petey.

I'm not sure I said the complications aren't real. Every medical procedure can have a possiibility of complications. That's why there's informed consent.

The original post is "downsides of ablation" but the original article posted is really about therange of factors to consider when a hospital seeks to add ablation to their "menu."

Again, if an MD cautions against an ablation for a particular person, its because in the person's case there's a higher possibility of complications, and it's good medicine to minimize risk.

The problem however, is not ablation per se, its about the probablity of it being successful in a specific case. Complications are more a result of patient variables (such as age, other medical conditions, etc.)

The quote you clipped supports the idea that the more experienced hospitals (who perform 135+ ablations a year) were more successful than the fewer (7 ablations per year). That suggests that patients should choose an experienced hospital if they are a candidate. I would add that it may include a patient travelling to a known ablation center (Mayo, UT, UPenn, NYU, NYCornell, etc.) rather than having it done locally if a good center does not exist nearby. (Since in many cases it is only an overnight stay, it makes sense to look for a large center).

I repeat all this because I don't think "ablation" is the issue, it is the likelihood of it working in a specific patient (and implies that hospitals shouldn't jump on the bandwagon to offer ablation - which is usually for competition and increased revenue).

For some patients, the odds are good and the complications unlikely, for others the odds are not good and/or the complications are likely (and not a good thing).

Actually, that is not what I meant. My EP says that for a person like me with asymptomatic, lone atrial fib, where the afib is having little impact on my quality of life because my ejection fraction is so good and my heart is healthy, because I have exercised over the years and because my CHADS score is zero and my cholesterol is 152 (HDL 60), that my rate is well controlled. AND that ablation is "invasive" and not without risk... she said that my risk of later complications like heart failure, stroke, or anything else is lower than the ablation risk of stroke, silent stroke, and the whole list of stuff, that ablation isn't warranted at this time and that I didn't have to rush to any decision to do anything at this time. I asked about the delay issue and success likelihood falling due to waiting and she replied that I am still considered recent onset. Lastly, she said cardioversion (shock) is an option in March.

I will go to U Penn for any procedure. She knows Dr "Frank" Marchlinski (there at U Penn) very well.

That is good news! Your situation is relatively uncomplicated and does not warrant a more intensive ablation at the time.
Great! I hope the cardioversion, if you have it, is all it takes!

THanks for your clarification of the details of the article, NYNM! Also your comments, Petey. Glad to hear your health situation is so good that ablation is not necessary for you at all.