Ablation following unsuccessful cardio version?

[Norni]

My brother has had atrial fib for many years and has been on medication. He had a cardio version that did not work. Would it be possible for him to try an ablation? Would it be successful or has his heart been out of rhythm for too long?

[Berlinerin]

Hi Norni!

There are some studies out there that suggest that catheter ablations for AF are less successful in patients who suffer from long-standing, persistant AF. It seems that, especially if these patients undergo only one catheter ablation procedure, the success rate is poor; an article from 2012 states that it was around 23% (see ncbi.nlm.nih.gov/pubmed/230.... I have also read and heard that sometimes the success of the ablation is that a patient suffers fewer episodes of AF or that an anti-arrhythmic drug that didn't control the AF sufficiently before the ablation, worked well after the ablation. That a single catheter ablation procedure cures an AF patient, who has had AF for many years, to me seems to be the exemption. Nevertheless, every patient is different, and if your brother cannot tolerate his anti-arrhythmic drugs well or they don't help him much, and if cardioversions failed, too, then an ablation might still be worth a try. I guess in that case it's just important to keep in mind that it could be that he needs several procedures, and that it could also happen that he never becomes completely not AF-free, but only has fewer episodes.

When I was in hospital for my ablations, I often shared a room with patients who had an ablation for AF. And it seemed to me that most of them were not aware of what I just said, that one procedure might not do the trick. The majority had this ablation because they thought this would be THE cure. Their disappointment was huge when it did not work. I also have a friend who underwent three AF ablations, and he said that his cardio told him before the first procedure: In for a penny, in for a pound! He was referring to my friend's willingness to have a second or even third procedure, if the first one should fail.

So, it's possible to try an ablation, but no one can guarantee that it will be successful. Always hope for the best, but at the same time be realistic.

Best

Berlinerin

[Norni]

Thanks very much that's really helpful.