Hello. I have had two ablations, both RF, and only the second one worked.

The 60% probability of success is probably correct, for PFA, but only because he/she thinks you're a more complex case and that even PFA is not likely to get to the right spot. And, he/she is correct because the run-of-the-mill electrophysiologist (EP) is inexperienced with complex cases. I'll explain:

Most EPs will want to do a PVI first (pulmonary vein isolation) because 90% of all paroxysmal cases, which I take it you are (?), can be successfully ablated with a simple and quick PVI. However, only 75% of all PVIs work, at least the first time. Why is there a disparity between the 90% estimate of all cases needing only a simple PVI but that only 75% of first attempts (called 'index' ablations) work? If you're working hard behind your eyes, you'll guess that it relies on the skill and experience of the practitioner.....the EP. As with all surgeries, all kinds, the surgeon is the key factor. And there are surgeons and there are surgeons....if you follow. You want the best EP you can afford, even if it means a hotel stay for three nights in that city.

So, this has nothing to do with PFA or with RF. The technique matters, but ONLY IN THE RIGHT HANDS....EXPERIENCED HANDS. Unfortunately, not all EPs have the expertise to deal with a case like yours because you have had three attempts with zero success. To me, this means the EP is not ablating the right tissues. And that's only if an ablation will work at all in your case. It could be that your case is not treatable by ablation.

My advice, as very inexpert as I am, with no medical training, is to find another EP, a better one, probably upwards of 45 years old, in a large center, who performs RF and PFA, but who claims to deal with complex cases, and who performs 6-10 ablations every week year round. If you have the means and can travel, I can recommend two whom are highly regarded in their field: Dr. Andrea Natale at the Texas Cardiac Arrhythmia Institute in Austin, and Dr. Pasquale Santangeli at Cleveland Clinic. There are others who are excellent, but you'll need to ask around, get your info sent to them, consult over the phone, and see if they 'd like to take a crack at your self. PFA, sure, RF- why not....it's the handler that makes the difference. Yes, PFA is going to be safer because it offers less of a risk for esophageal damage, but again, in the right hands, with a TEE shoved down your esophagus, there's no reason to have damage form an RF ablation (yes, there's a risk, always, but it's so small in the right hands that you just discount it). Again, RF would still work if that's what is needed, PFA is less risky, but the technique, either one, only works for you in the right hands. THAT..................is your challenge.