Ablation success record: Which of the... - Atrial Fibrillati...

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Ablation success record

dave205 profile image
7 Replies

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

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dave205
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7 Replies
BobD profile image
BobDVolunteer

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..

Beancounter profile image
BeancounterVolunteer

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

Buffafly profile image
Buffafly in reply toBeancounter

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.

Mike11 profile image
Mike11

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.

dave205 profile image
dave205

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.

dave205 profile image
dave205

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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