Ablation success record

Which of the following treatments for AFib has the best success record?

Radiofrequency ablation

Cryoablation

Microwave ablation

High-frequency ultrasound ablation

Surgical ablation

Surgical epicardial ablation

Cox maze ablation

Robotic ablation

Bilateral mini-thoracotomies ablation

Ganglionic Plexus ablation

Thoracoscopic left-sided bipolar RF ablation

7 Replies

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  • It depends on which procedure is right for your version of AF. No hard and fast rules. For example if your only areas of problem are the four pulmonary veins then cryo balloon ablation probably has the best chance of success but this method can't treat other areas in the atria which may need RF.

    Robots can be used in most methods and just make life easier for the EP as it means he doesn't have to wear the lead armour and can sit in an office outside the cath lab. Success would still depend on the skill of the EP.

    You missed out laser by the way.

    Generally speaking you wouldn't do a surgical ablation unless going in to the heart for other reasons. In UK at any rate the transthorasic type ablations are very new and not widely available and usually combined with an internal RF ablation at a later date as a two part attack..

  • I have never had an ablation, but if I did and was to choose

    It would be the one the EP treating me recommended, and that we had discussed at length and that he had performed many times before preferably.

    Be well

    Ian

  • I was given a choice of two hospitals, no time to decide, and that was it! EP at hospital chosen told me I would have GA and RF ablation, end of. So I guess you need to do the research well in advance?

    To be fair I was not asking for ablation or expecting an offer so I was unprepared.

  • Good question, I'm afraid I don't know much on ablations as never had one. I would agree with Ian though, the priority for me would be a centre of excellence, then an EP I trust and then his recommendation followed by my own input from research largely from this excellent forum.

  • Before my op my EP told me using cryro-ablation he'd had over 800 first time successes, about 5% needing a return procedure and two strokes, one of which they caught and stopped doing any permanent damage.

    I had Maze when I had my bypass 'because we're in there anyway' and I'm not convinced it did any good at all, but who knows what would have happened if I hadn't have had it.

  • I did a little research and here is what I found:

    Radiofrequency ablation

    The general consensus from large studies is about a 65–75% success rate for freedom from atrial fibrillation at one year for paroxysmal atrial fibrillation.

    Cryoablation

    The one year freedom from AF in patients with paroxysmal atrial fibrillation was 72.8% (vs. RF 66%).

    Microwave ablation

    Fourteen of 19 patients (74%) were in sinus rhythm with no antiarrhythmic drugs at 12 months

    High-frequency ultrasound ablation

    The mean follow-up period was 9 months. Currently 10/13 (77%) patients are in sinus rhythm, one patient required insertion of a permanent pacemaker, one patient is in atrial fibrillation and another patient is in atrial flutter.

    Surgical epicardial ablation

    Current evidence suggests that epicardial ablative strategies are associated with higher freedom from AF, higher pacemaker implantation rates and comparable neurological complications and cardiac tamponade incidence to catheter ablative treatment. Other complications and risks were poorly reported, which warrants further randomized controlled trials (RCTs) of adequate power and follow-up duration.

    Cox maze ablation

    The cut-and-sew Cox-Maze III procedure has cured atrial fibrillation (AF) in more than 90% of cases, with follow-up beyond 5 years. However, this procedure is technically challenging and invasive, resulting in infrequent adoption.

    Robotic ablation

    It was shown recently in a study with 119 patients, that procedural parameters and outcomes were not significantly different in procedures with the RCS (n = 40) compared to the standard manual approach (n = 79).

    Bilateral mini-thoracotomies ablation

    Overall freedom from atrial fibrillation at 6-12 months is 89% (79%-100%) in paroxysmal AFib

    Thoracoscopic left-sided bipolar RF ablation

    Thoracoscopic surgery with PVI and ganglionated plexus ablation for AF is a safe and successful procedure with a single procedure success rate of 86% at 1 year. Electrophysiological guided thorough PVI and additional left atrial ablation line creation presumably contributes in achieving a high success rate in the surgical treatment of AF.

  • In the CONFIRM trial, patients treated with PVI plus FIRM mapping with ablation of sources of AF were compared to patients treated with PVI alone.

    The authors found that localized rotors or focal impulses were present in 97% of patients undergoing AF ablation. At a median of 273 days, 82.4% of patients receiving FIRM guided ablation in addition to PVI were free of AF compared with 44.9% receiving PVI alone.

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