If I have had AF for more than four years, can ablations still be successful?

I have always rejected the suggestion of ablations, especially since I suffered a TIA, but my symptoms are now severe

and the drugs aren't keeping them under control. I am not convinced that the risk factors of the procedures are any less than the risks of continuing on the drugs, as both are potentially hazardous, but my life really has become blighted by such debilitating symptoms now. Does anyone know about pace makers and if they would less/more risky as my cardiologist mentioned it briefly.

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15 Replies

  • Hi Debiltated and welcome to the forum.

    I've not had an ablation, but many here have, and in my personal opinion, it's not a risk based decision. The reason for that is that the risks are quite low on either the drugs or with the ablation itself. Perhaps the only exception to this would be long term Amiadoarone drug therapy.

    And I don't understand why having had a TIA would effect the decision one way or another.

    Therefore certainly for me, it's a symptom and lifestyle based decision, if your current symptoms are seriously affecting your lifestyle, then an ablation (yes with some risk but not much) must be considered. You need to be aware that an ablation is not a "one off" fix everything decision, much better to consider it as the first step in a course of treatment to improve your lifestyle, you may need more than one ablation, and certainly after each one don't expect too much for at least three months afterwards.

    As for a pacemaker, as I understand it they do nothing whatsoever for A Fib, they control the Ventria beating and will ensure that the ventricle beats regularly, behind that the Atria will continue to be as irregular as ever before, and depending on what type of operation and pace maker you have fitted, it can be irreversible, so not a decision to be taken lightly.

    Can I suggest you read a lot of the information on the AFA website, that will tell you a lot more, and I have no doubt others here who have had ablations will also tell their stories.

    Good luck


  • What type of AF do you have? Is it paroxysmal (periods of your heart racing) and fairly normal in between these attacks. Or permanent AF, where the beat is constantly out of it's normal rhythm? My initial reaction to your question, as you have had a TIA, would be say consider an ablation. However, until we know your full facts it's hard to say. Please let us know so that the wonderful team on here can try to help you.

  • I have paroxysmal AF my heart never races, it just goes out of rhythm occasionally.

  • Hi Lucy - Does it make you feel ill when it does that and how often does it happen?

  • Is doesn't really make me ill but it does feel like a battle going on in my chest. I have been getting more often in the last year about 3 times a month on average. Flecainade 150 mg usually stops it within about 3 or 4 hours.

  • Sorry to hear you are suffering.I am new to AF( August this year) so all the following is based on reading the journals and listening to the talks at AF days etc and asking cardiologist and EP questions recently. Others on the site can help you with their personal experience. The studies published seem to suggest that success rates are lower if AF is persistent or permanent- however, I have read some studies where the success rates have been high for long term AF and they have ablated other small areas- ganglionated plexi- which has raised the success rates. The EP I saw at the Brompton mentioned they are starting a clinical trial to do this in the new year.

    I asked about pace-makers when i had a cardiology appt, not pace and ablate, but pace maker for rate control , but the cardiologist said that would be in the future- I don't think it stops AF but can help to stop some electrical activity if one's slow heart rate is allowing triggers to over ride normal activity.

    You mention what your cardiologist said but you would need to have an EP's advice re ablation success chances in your particular case- If you haven't yet been referred to one, that would be the next step.

    I asked (last week) about the risks when I met Dr Ernest at the Brompton and she told me the actual figures for major complications that she has experienced with her patients. Of course the decision is yours but the figures she gave me were very, very small compared with the figures I have read in studies. I decided to wait until I have more frequent/ severe attacks, but when that happens to let her know. She was happy for me to just ring her secretary at that point. There was only one drug that might be suitable for me, because of relatively low resting pulse rate, and I will have a heart scan firs( as not suitable if any heart defects )t but have actually decided the side effects are too risky and to do as set out above.

    I hope this is useful- am sure the personal experience of others who have had ablation after long term AF will be more valuable for you.

  • The short answer to your question is yes.

    The long answer is more complicated but simply put the ablation gives you the chance to be less reliant on drugs.


  • Don't know whether this will help, but I think I've had AF for maybe 20 years, but wasn't diagnosed till 10 years ago as it became severe. I couldn't stand it was so bad, ended up in coronary for 8 days. It was also continuous and had been fairly continuous for some time IMO but can't be definite about that.

    Anyhow, had drugs for 2 years which cured my AF but had side-effects, so had an ablation 8 years ago. My EP said there was a very high likelihood that it would be completely or almost completely successful because it was constant, i.e. he would know straight away whether it was fixed or not. But even if he missed a bit I could have another one to tweak it. He said there were risks but very low and he explained what they were.

    The ablation was an immediate and 100% cure for 8 years. An arrhythmia has now come back (as predicted) so I'm due for another ablation, hopefully, after they've done an EP Study.

    I had a 2nd ablation as well a year ago, but they couldn't find the AF, it had done a bunk so didn't do any "burning".

    Both ops I pretty well just walked out and went back to work. Not everyone's experience I know but that was mine.

    PS. I try not to use the word permanent because I have seen it used medically to describe AF that has not responded to treatment, i.e. that's why it's permanent, as opposed to just there all the time/constantly.

  • Although it's not fully proven yet, successful ablations do appear to reduce your risk of stroke/TIA. And even unsuccessful ablations can reduce your symptoms. I waited about 15 years before my ablation and that wasn't a problem as I was still, just, in paroxysmal AF (it was successful).

    Personally I wouldn't go for a pacemaker (pace and ablate) until I had failed at least 3 ablations.


  • As a three times ablatee my answer is yes every time. Ian said everything I would have done.


  • As far as I was told my pacemaker was fit because I had an irregular heart beat were my heart kept missing a beat every so often.The ablation was because of electric signels which send impulses to the heart were erratic giving me AF which give you the symptons of how you feel,people get different symptoms,both ops where totally painless and after 6 months I am feeling much better argzxoni61

  • Wow. Wish I had a "totally painless" pacemaker insertion. Despite being on my fourth, I'm yet to have the painless experience!

  • Go and have an Ablation they are the way forward for AF, MY FIRST ONE lasted 6 yrs free of AF and my second one been 2 yrs and still ok, no drugs ever worked for me, made my heart worse.

  • Thank you so much to everyone who has answered my message and questions. A varied range of opinions and experiences and all very helpful. A great forum for support and personal knowledge. Thankyou!

  • Yep, go for the ablation, the anticoagulants will take care of your TIA concerns!

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