How successful is an AF ablation likely to be?

The vast majority of patients now are free of symptoms after a single procedure when AF is paroxysmal, but if AF is persistent (there all the time) then a second procedure is needed in about half of cases. With modern technologies, we are able to successfully perform a "pulmonary vein isolation" in over 90% of cases. But this indicates the proportion of patients in whom the procedure has been a technical success, not the proportion where AF never comes back.

 

Overall success rates from the patient's perspective after these treatments for paroxysmal AF are now over 80%, and in persistent AF over 70%, but in patients who have been in persistent AF for many years such success may not be achievable due to long term scarring effects, and of course, some of these patients still require antiarrhythmics to maintain sinus rhythm.

 

If heart rate control remains difficult for patients in whom AF ablation is not a success or is not possible, then pacemakers can be still be used with AV node ablation. But this has downsides of course and would leave the patient's life dependant on their pacemaker for a heartbeat. Nevertheless, it can be useful for some patients.

 

Patients who are taking blood thinners and will continue to receive warfarin or a NOAC during the procedure. The decision of whether or not this can be safely stopped is generally not related to the success of the procedure.

 

The vast majority of patients no longer have symptoms after a single procedure if the atrial fibrillation is paroxysmal. However, if the atrial fibrillation persists (i.e. there is AF constantly), a second procedure is required in about half of the cases to achieve quoted success rates.