shanny, I have the same concerns. On one hand, I'm rather suspicious of the big medicine involved in the ablation. After all, they need to pay for that expensive equipment. And, there's not a lot of research on how long this is going to last (why not use my body as this months lease payment). On the other hand, most of the rhythm control drugs only work on a portion of us afib sufferers, have side effects, and probably will not work forever either. But, we don't want to have a stroke like me either (will the ablation or rhythm control drugs eliminate that risk, I certainly don't know). No certainty anywhere.

I've had 2 ablations and 3 unsuccessful cardioversions. I'm finally at a good place with my afib and atach. Afib is progressive condition. It gets worst iver time. 1 year after I was disgnosed with afib I had and ablation. I had ablation #2 8 months after that. I am extremely happy now with my results. I've tried several antiarrythmia medications. They weren't too successful.

I haven't had an ablation, at least in part, because they don't know how long they will last. It is complicated though... the decision. Age, persistent afib, and symptoms also affect the decision.

I just wanted to clarify something DeTalentedone wrote... afib becomes more frequent in many cases... the phrase "worse over time" isn't exactly accurate. I guess if you are highly symptomatic, you could say "worse". But greater frequency is not always the case. Another word they use, btw, is afib "burden" to mean frequency and duration.

Anyway, they DON'T know how long an ablation will last. The only long term data they have is with ablations that were performed ten or more years ago. It would seem that the durability should be much better for the newer ablations. But, of course, there is no data on that. We all just have to wait.

If success is determined by an ablation that is not assisted by rhythm drugs to maintain normal sinus rhythm and where afib lasts no more than 30 seconds, the success rate is probably about 70% for paroxysmal afib and 60% for persistent afib. (one ablation only) Two ablations moves the success rate by about another 10%, depending on who you listen to.

Recurrence of afib, according to some reliable sources, is about 8% per year. I am not sure when that rate slows or stops. I want to say 5-7 years, but I honestly forget.

But then some people respond to rhythm drugs after ablation with drugs that previously did not work well at all before. Further, after the blanking period, symptoms go down dramatically and in many cases, the afib is significantly less in duration (not counted as success).

So you have to know your objective of the procedure is to know whether ablation is right for you. You also must be willing to accept the risks and the fact that if your CHA2DS2Vasc is high enough, you will have to remain on anticoagulants.

One thing I always look for in Cleveland Clinic Chats and other reliable blogs/websites... they always talk about ablation for the symptomatic that have not responded to drugs. They call it drug refractory. I guess it sounds better than "the drug didn't work".

Concerning drugs not working over time. I understand it is just a matter of finding another drug that works. Not sure how hard that is. But it would seem if you got a ten year ride and no other drug worked, then ablation might give you another ten years. No guarantees with any strategy, but it always seems everyone finds their answer.

On another support group, there was some talk of people getting recurrences after 7-8 years. I would make sure I was treating the underlying cause of the afib, if known.

petey

Hi, Shanny! I think I'm newer to this than you--or most everyone here, for that matter, so I'm sure my thoughts don't mean much, but figured I'd jump in as it looks like we are about the same age, and on the same meds...just different continents!

When I went in for my EP study and ablation, my cardio and EP were under the impression that it was something to do with the AV node or something. Once the EP got in there, though, they found my issues were in the left atria, and were a fib and some other kind. I remember the EP coming back into the room and saying something like, "This isn't a good time." I have to admit that it kind of hurt my feelings, making me think that he didn't have time for me, or hadn't booked the room for long enough, or something. I was even more confused when, at my follow-up appointment, he went on to describe a pulmonary vein isolation procedure, and said again, "This isn't a good time."

After reading posts here, though, I'm thinking that what he meant by that is that he wants to wait for a couple of things to happen. My meds seem to be working just fine for now, and I think he wants to wait until they aren't working quite so well and give ablation technology as much time as possible to develop before doing what could be a risky procedure on someone so young. I'm choosing to take that "so young" part as a compliment, and glad that he is realizing that the risks outweigh the benefits for me, for right now, until or unless something changes. I'm sure he will take things like my symptoms, disease progression, ability to handle the meds or procedure, etc., into consideration in making any recommendations to me about med changes or treatments.

Like Paul, I'm a bit suspicious about a doctor making blanket recommendations for a procedure just because they have expensive equipment that they need to pay for, or want to make a name for themselves, or whatever other motivations they have. With all of the developments in the field, I'd just as soon wait if I can while they perfect their techniques.

Sorry for the essay! I think I tend to go on and on here, in response to my hubby and kids tuning me out somewhere in the first sentence!

Gang,
I believe hat in the U.S., the "first line" treatment for afib is drugs. My preliminary research after diagnosis showed that in Europe, ablation is the first line, particularly in France, where there has been great success in treating afib (Dr. Jais in Bordeaux being one of the top EPs in the world). I know there are some European members of this group, perhaps they can chime in here and confirm/refute what I am saying. In my opinion, with all the incredible advances in ablation techniques, we will move toward a "procedure first" approach. I guess it is all a matter of personal opinion...I was much more afraid of the effects of a lifetime of prescription drugs than I was of getting operated on. I am always amazed at the advances I read about on this site and stopafib.org. I have to say, I am amazed at the bravery of people who can eliminate the worry, and stay on drugs for years and years. I have seen people say they are afraid to have an ablation, but I think it takes courage to deal with this nasty thing, no matter what decision you make. Courage and NSR to us all!

Bill

Hi Shanny,

I think your ep is being very realistic and trying to set expectations. Most people need at least 2 ablations.

In the future there may be a new drug, a better way of doing ablations,the use of stem cells to really cure afib and the list goes on

Focus on living in the present and be grateful that you are doing well on your meds otherwise you will drive yourself nuts.

opsyn

Take care.

At the risk of being flogged waiting does no one any good as this disease will progress in the majority of cases.
Like Biil said ablation is the first line treatment in Europe and I believe the guidelines in the US is either drugs or ablation first with the decision made between doc and patient but will soon be following the EU model this year.
If you can hook up with the likes of a Dr Natale go for it as there is no machine, catheter or drug on the horizon that will match the Maestros Midas Touch.
FIRM is still a pipe dream as the baskets and software have still not been perfected and might never be. The baskets can never touch and map all areas of the atrium.
The touch catheters may help many inexperienced EPs ablate with some of the best but still not matching the experience and methods gained by years of ablation and knowing exactly what to bate.

McHale

To add most of Natale's patients are one and done with av1.4 average with second and third ablations only for the more persistent and permanent cases of AFIB if you let the atrial tissue get diseased. What many patients and EPs are finding even in well controlled AFIB the disease has progressed when they finally go for an ablation with more diseased atrial surface area.

McHale.

Well controlled with drugs the atrium is still remodeling after years and years as a few patients that went to Natale have found out.

Damn where's the Edit button!

Be Well My Friends and don't shoot the messenger

McHave

Shanny,
Nobody can reasonably guarantee that a single ablation will cure for good your afib.
I had an ablation 1 and 1/2 years ago, and I am aware of the fact that afib may come back. But for over a year I have been able to resume a pre-afib life, with no anti-coagulants. That's enough for me to say that I am glad to have gone ahead with the ablation.
It's really a personal decision. Does afib affect your quality of life? If so, how important is quality of life for you? There are some risks in ablation, do they scare you a lot? If you wait, maybe a wonder drug will appear. On the other hand, heart remodeling may happen making your afib more established.
Good luck to you, whatever you decide.

So far I've been fortunate. AF has not progressed since my diagnosis in July 2010. I'm pretty much asymptomatic. Now I have even fewer symptoms than at first. Lightheaded disappeared after I discontinued BP meds. I'm on Warfarin with no side effects. I chose/choose not to try the anti-arrythmics suggested.
Also very fortunate to be in SF where Dr. Natale would be my "go to" EP.

Shanty,
For paroxysmal AFIB the cure rate out at about 10 years now with the like of a top gun like Natale is close to 90% now.
Waiting to become more persistent the "cure" rate drops to about 70-80% with a one and done approach. Your EP is a little clueless or is inexperienced to say the least. Tough choice I know been there and wired, had a stroke.

McHale

And the answer is...
"There is no right answer!!!"

There's lots of factors to consider: you age, symptoms, response to drugs, etc. So for each of us, the decision point is different. I'm reminded... while in the hospital for a drug load before ablation #2, I was able to send significant times with my EP. I asked him flat-out "Would you have the procedure?" His answer was a definite NO, stick with the drugs...

For me, it was simple. I _wanted_ a cure for this and did not want to be on MEDS for the rest of my life. (Afib hit me in 2011, at 54.) So still being considered 'young' I elected to try the ablation.

I seem to recall that at DUKE they have the CABANA trial. As i read it., it is a study to determine if ablation should be the first treatment protocol vs. drugs (rate and rhythm).

I'm reminded of my older brother, who at 46, had a massive heart attack. He was in such (physically) bad shape that bypass was not an option. Fast forward 5 years: technology improved, he had the bypass (now 10 years ago). So there is something to be said for interim treatments.

In "Robert's World", everything (drugs, ablation) is an 'interim treatment'. Though I may be biased.

So if the drugs are good to you, keep your AFIB in check, let you return to a pre-AFIB quality of life, then stay with them. In my case, eventually they all failed.

Robert
PS: Forgive me if i come across a little (-) negatively charged. I seem to swing from the (+) I will beat this things, to the (-) I'll be in perm AFIB next month. Forgot to take my meds last night at 8, and by 10 was having irregular HR.

McHale: Do you have any info on recurrence rates with Dr. Natale?

Here is what I read this November:

"Ten-year follow-up for AF ablation: One of the most worthy criticisms of catheter ablation of atrial fibrillation is its high recurrence rate, which worsens over time. The group of Dr. Andrea Natale (St David's Medical Center, Austin, TX) released a study of 513 paroxysmal AF patients followed for 10 years. Using their well-validated and consistent approach to pulmonary vein isolation, 59% of patients were arrhythmia-free after a decade. Recurrent arrhythmia between years 5 and 10 occurred in only 5% of patients. Predictors of late recurrence were female sex, left atrial size, and obesity. My take: These are remarkable findings because the late recurrence rate was lower than expected and the overall success rate was quite encouraging. Most important, though, was the fact that the modifiable risk factors, obesity and left atrial size, were strong predictors of recurrence."

So late recurrence is at a minimum, but up to 5 years, the recurrence rate is high. It seems getting past 5 years is a big deal. The 8% per year recurrence for the first 5 years seems to hold up. This data came from Medscape.

If you have more information, I'd like to hear it.

petey

Petey
This from Hans Afib survey,

All but one of the 76 procedures reported in this survey (99%) were radiofrequency (RF) catheter ablations. Of the 54 patients undergoing RF ablation as their final or initial procedure, 32 (59%) underwent only one procedure, while 22 patients (41%) underwent 2 procedures for the purpose of curing AF.
The most widely reported ablation procedure was the pulmonary vein antrum isolation procedure (Natale protocol) at 31% of all RF ablations. The second most widely reported procedure was the segmental pulmonary vein isolation procedure (Haissaguerre protocol) at 20%.
The most successful procedures were the pulmonary vein antrum isolation (Natale protocol) and the segmental pulmonary vein isolation (Haissaguerre protocol) with success rates of 76% and 56% for the initial procedures. The poorest performers were the circumferential pulmonary vein isolation procedure (Pappone protocol), at 29%, focal ablation at 17% and generic pulmonary vein ablation at 22%. The overall success rate for initial RF ablations was 44%.
It is clear that having an initially successful final ablation is of prime importance in determining the long- term success of the procedure. The average (mean) complete success rate (no afib, no antiarrhythmics) at the end of year 8 was 86% for those whose last procedure was initially successful versus 42% for those who had not experienced an afib-free index period or who had been on antiarrhythmics during the index period. Corresponding complete success rates for year 10 were 91% and 17% respectively based on a small sample of only 15 respondents.
Of the 40 respondents who were afib-free (without the use of antiarrhythmics) in year 4 only 2 (5%) reverted to having afib episodes by year 8. One more afibber (9% of the 11 for whom data was available in year 10) reverted to having afib in year 10 indicating that status at year 4 is a good indicator of long-term prognosis.

Remember this was for the early years of AFIB ablation using less effective catheters and mapping.
Shannon is compiling much more encouraging 10 year success rates from Natales group. Don't know if this is the same study you posted but ill find out. I was told it more in the 76-90% range if I remember correctly. Either way AFIB burden is greatly reduced and Qol much improved even in failed ablations which can also include AFIB for over 30 secs to a few mins.

McHale