Are There Ablation Success Standards?

[tombeaux]

With organization such as AF Association, the American Heart Foundation the AMA and the UN/WHO, who is about to challenge national sovereignty;

IS THERE A SET BENCHMARK WITH STANDARDS THAT ARE UNIVERSALLY ACCEPTED AS A SUCCESSFUL ABLATION? IF NOT, WHY NOT?

I have been more focused over the last few years on matters other than cardiac and electrophysiology. Most of the ablation centers in the U.S. used a (6) six month sustained Normal Sinus Rhythm as a success standard. This standard usually incorporated the use of rate and rhythm control drugs.

Is 6 months still the standard and is that a reasonable trade off for 6+ hours of burning irreversible scare tissue all over your heart?

Has there been any effort by the iconic organization to formalize a standard and get a solid commitment from the ablation centers to commit to honest and accurate reporting of case results and sustainment?

Thank you for your time and consideration.

<3

[Arveno]

Hi Tombeaux. Good question which I asked cardiologist who (by letter without any explanation..) decided and lett us know the day for ablation to my 76 years husband. At that time I know nothing about ablation therefore we decided to wait and try to adapt without such aggressive irreversible procedure. I also asked about success rate of ablation at given clinic etc. Than I studied a lot and asked the same question at another European country. No answers at all.

You can find excellent discussion and number of criteria concerning success standards of ablation at StopAfib.org Forum.

[tombeaux in reply to Arveno]

It would appear that there are still no universal standards of what is considered success.

[Arveno in reply to tombeaux]

Not universal standards but som of most prestigious centers at USA give info about success standards on their home pages. Between other things number of performed ablaions/year, success rate,etc. That is at least some help to patiens concerning or needed ablation.

[tombeaux in reply to Arveno]

It is nebulous at best. I helped Dr. Kiser's staff early on develop efficacy standards at Chapel Hill. Actually before he was at Chapel Hill. He was one of the first to track, at that time, as far out as 3 years. Kiser also developed the modified maze. I almost went for it.

Also, consider this: You have the well known's such as Andre Natale. He left the Cleveland Clinic to go take up practice somewhere in Texas. Do you thik the posted Cleveland Clinic AF performance metris web page announced that the person leaving the facility who had the most profound contribution to the metrics has left and that their standards are now questionable?

Cleveland changed their reporting because of me early on when they were only doing under 100 a year about 20 years ago.

The combined persistent and paroxsymal AF as one number! ...which leads to another problem when a NONDISCRIMINANT ORGANIZATION is not controlling the measures and reporting.

What is truth?

[Sunshine89 in reply to tombeaux]

Good points. Always be aware that there is no National Health Care is US which ultimately means that their care is cash driven which may not lead to unbiased reporting.

[Globe-J]

Anecdotally, what I can gather ablation rate of success is less that 50%

J

[UScore in reply to Globe-J]

the publication of some sort of standardised success rate would be far better than anecdotal evidence, where you are much more likely to hear from disappointed people than satisfied ones.

[clarence16 in reply to Globe-J]

Based on what I have read and discussed with my two cardiologists, that is not correct as a whole. Success rate depends on the type of A-Fib a person has and how long they have had it before having the ablation as well as other factors such as overall general health, etc. One can have a successful ablation on the first try. Others may need to have it more then once. But, it is generally a successful procedure overall.

[doodle68]

How can you standardise or quantify the success of ablation when each person/body is different, you are not starting off from the same point in every patient.

The various permutations of comorbidity/age/weight/ fitness level/degree of AF/ length of time someone has had the condition/expertise of the person carrying out the ablation are infinite so the results will differ. Not everything in life can be reduced to a graph.

[UScore in reply to doodle68]

You have to have some measure of success, otherwise how can the NHS justify spending money on it?

Graphs can be adjusted for age/sex/etc to some degree.

Having access to some decent statistics would be very useful to me because I am getting closer to cancelling my ablation the longer I remain AF free.

[heartmatters1 in reply to UScore]

My cardiologist has put me on the waiting list, even though my attacks are few and far between (fingers crossed). He told me there is a 70% success rate. But I am very reluctant too to have it done. He said that it won't get better & usually progresses 😩

[UScore in reply to heartmatters1]

I'm over 4 months since the last attack. My ablation is scheduled for October

My current plan is to phone up to rearrange the date, which I have to do anyway as I away for when they've given me, and then try to get a date as far into the future as they will allow. Ideally in January (so I'm not recovering over the Christmas period).

This will also mean it could potentially be 7 or 8 months AF free, in which case I'll be even more convinced to cancel/postpone.

[Sunshine89 in reply to heartmatters1]

I have Af 75% of the time and I am reluctant to proceed with ablation when I see so many negative comments about the results and cannot be given assurance that it will work.

[clarence16 in reply to Sunshine89]

It can be very successful, but sometimes needs to be done more than once.

[Sunshine89 in reply to clarence16]

I just can't bend to the idea of allowing someone to play hit and miss with my main engine...

[clarence16 in reply to Sunshine89]

I understand, but over time your "main engine" can be damaged by the A-fib and your quality of life can be affected as well, and you will continue to have a higher risk of stroke with the palpitations coming and going. Yes, the blood thinner lowers that risk, but the ablation can eliminate them altogether. Not a guarantee, (especially the first time doing it) but worth a try. If you have a good EP with a lot of experience doing the procedure and the procedure is done in a good, well respected hospital, your chances are that much better. It is a personal choice...I get it. Good luck.

[Sunshine89 in reply to clarence16]

Thank you Clarence16 for this input. It is definitely food for thought. Although I am 76 I am otherwise healthy so I shall give careful consideration to what you say. My Cardiologist is setting up an appointment at an EP Clinic that runs out of Hamilton General Hospital, Ontario Canada. Not sure how long that will take but at least it will bring some more light on my situation. I had a pacemaker implanted in June of this year (2017), necessary since my heart rate was often around 27 plus it was stopping for periods of 3.5 seconds but with the experience of it putting me into permanent Afib with symptoms that make me feel worse than I originally did I am now scared to proceed with further surgery of any kind.

[AnneTS in reply to doodle68]

Well Said!!!

[doodle68]

Hi UScore you can of course publish figures of sucess rates for ablation but I don't think you can standardise them because there are too many variables some of which I mentioned in my post above.

[greg35]

Hi Tom thats really interesting and I for one never gave this a second thought I will now as I had just seen another EP yesterday and am booked in for my 3rd ablation this year as my constant ectopics are impossible to control and the magnesium and iodine now seemed to have stopped working! I feel the 5 years on PPIs has in some way to blame as I also have constant twitching in my hands and feet no doctor can tell me why but I know its all linked wish doctors would treat us in a holistic way instead of just the one symptom they specialise in!

Regards Ingrid

[greg35]

I forgot to mention my EP said he had 95% success rate I was obviously not one of them, although to be fair thete is an improvement than before the 2 ablations but not enough to give me my life back!

Regards Ingrid

[UScore]

That's a good reason there to have an attempt to standardise success rates. If you want to compare EPs, then it's good to know what they mean by 95% success rate. Do they mean after a year, after 6 months, or maybe just that the procedure itself was a success because they found some interference in the heart and blocked it successfully?

"Success" to the patient might mean many things. But when a surgeon quotes a success rate it is important that is a consistent measure.

[Arveno]

It would be useful to define what is successful ablation or degrees of success than could be possible to measure success rate.

[Coco51]

You may be interested to read this press release from 2012 in which the Gold Standard for success in ablation IS defined. It seems authoratative, based on randomised trials led by Prof Karl Heinz Kuck. Written for the European Heart Rhythm Association and European Society of Cardiology, it sets the standard for successful ablation of persistent longstanding Atrial Fibrillation (the hardest to treat) showing that 45-50% of those patients should expect to remain free of recurring AF for 5 years. With no drug therapy.

Not a permanent cure for everyone then but worth a try IF AF is making your life miserable (which it was for me with no sign of it ever stopping). Obviously if you can manage and function on tablets maybe you might feel differently. But remember AF is progressive and treating it earlier is easier. I had it for ten years very occasionally ( a few times a year) but when it became persistent it was realy a problem.

Worth reading in full but a quote and the link are below.

"Newly analysed data on the long term outcome after successful ablation of longstanding persistent atrial fibrillation, shows that just 40-50% of patients remain free of recurrent AF after 5 years.

The increase volume of data enabled the authors to calculate minimum acceptable success rates for the different types of AF for the first time. Success was defined as freedom from AF, atrial flutter (AFL) and atrial tachycardia (AT) and no antiarrhythmic drug therapy. At 12 months following the ablation procedure, the minimum acceptable success rates are 50% for paroxysmal AF, 40% for persistent AF and 30% for longstanding persistent AF. Professor Kuck said: “If patients see that their doctor or institute is not achieving these minimum success rates, they can ask what the problem is.”

escardio.org/The-ESC/Press-...

Best to all,

Janet

(Second ablation last Friday)