Effectiveness and saftey of ablation for atrial firbrillation

[bingopajama]

I am scheduled for an ablation at the Cleveland Clinic for my afib.

1) Could you please tell me the percent success rate(being cured and on no meds). for the procedure on the first attempt?

2)What perecentage of people develop stenosis?

3)I have vegally mediated a-fib and would like to know if that has  different success rate?

4. Is there a procedure that is in trials that may be worth delaying my procedure for an improved chance of success and safety?

Thanks CC for being the best in the world at helping people!  

[CCF-M.D.-MJM]

Hello bingopajama (great name),

That is an interesting first question you bring up.  Most end points defining cured from AF don't necessarily exclude the use of medications.  Success rates for first AF ablations are around about 80%, second ablation can improve your chances to 90%--this is if you have normal heart function.  If you have impaired left ventricular function or do not have a structurally normal heart, you chances decrease to around 60% after a first procedure.

Pulmonary vein stenosis is a rare occurance after AF ablation or pulmonary vein isolation (PVI).  THe incidence of pulmonary vein stenosis is less than 5%.

I do not  know of a study quoting a diffent success rate for PVI from adrenergic versus vagally mediated AF.

I do not know of any landmark changes to PVI that would worth the wait.  As always, we will improve our success rates with time and new technologies, it is just a question of how long you want to wait.

Good luck with you procudure.  I hope it is a success!

[Gaspipe]

Great questions!!

[JEFFRA]

Agreed...excellent questions.  I'm scheduled for an ablation this month at UCLA for left atrial flutter and have the same questions.  Left atrial flutter and afib have very similar characteristics.  I'm also concerned about other arrhythmias that surface as a result of the ablation.  For example, there are documented cases of patients going into atrial flutter after ablation for afib.  good luck!

[Guenter]

I have had three ablations for atrial flutter and yes it did go to atrial fib and ultimately the atrial fib persisted and was very debilitating.  I then had to have an AV node ablation and pacemaker but because I had persistent Atrial fib they I couldn't have AV sequential pacing.  Then with the pacemaker, a bundle branch block was created (this happens normally) but it contributed to my heart failure.  There were other causes but the pacer didn't help.  NOw I have a biventricular pacer and have been cardioverted so I can be paced AV sequentially.  My pacer rate is higher than my instrinsic rate so since Nov when they did it, I have been able to be paced.

[uptowngirl]

Yes, I agree with the others, thanks for posting such a great question!  Let us know how it goes.  Stay warm. Happy Easter/Spring.
Uptown

[jennann]

I'm in LA too.  Who is your cardiologist and EP?
Take care, Jennifer

[dquenzer]

Since most posts are those where problems occured I thought I should post a success.  It seems that all one ever hears is the bad news.

I had AFIB for 3 years.  2 meds failed.  Cardio said should try ablation.  I was having AFIB at least once or twice a week, lasting from a few hours to a few days.

I had a PVI on 2/20/2004.  Immediately after ablation I had some occurances of AFIB for about 3 weeks.  But then it all subsided and I have been AFIB free to this point.

It isn't without risk.   If meds don't work and you are symptomatic it is really the only option of cure.   But the ablation not only solved my AFIB, but also AFLUTTER and huge number of PAC's per day.  Best thing that could have happened to me.

I know not everyone has a success story.  But I think there are more success stories than failures.

[bingopajama]

You asked who my cardiologist is in Los Angeles.  It is Dr. David Cannom.  He truly is one of the nicest Doc's around.  He also does ablations of all sorts.  His tel number ia 213 977-0419.

Best regards,

Bingopajama

[JEFFRA]

My Cardiologist at UCLA is Dr. Shivkumar.  He will be performing the EP study and ablation.

[bingopajama]

Hi I also met with Dr. Shivkumar. My only reason for wanting Dr. Natlae is the sheer number of procedures he has done.  Dr,. Shivkumar seems like an awesome and totally on the level type of person.  Best of luck and my prayers go out to you.  

Best regards,

Bingopajama

[JEFFRA]

Thanks for the feedback.  I just assumed that UCLA is very experienced with this kind of procedure.  I believe they are the only hospital in my insurance's network that is capable of doing this kind of procedure  What did you find in your research?  Do you have any statistics?

[bingopajama]

I found Dr. Shivkumar to be more realistic about the numbers and someone that really gave the pros and cons. The success rates he gave were on the conservative side (around 60%) and of course everyone wants to hear numbers that are higher.  I think his figures are probably way less inflated that what you hear from the CC and other places.

Best regards

[tlu]

A related discussion, afib ablations was started.