Pulse field ablation

@gloaming well I am fortunate since my Cardiologist was one of the first to do PFAs. He has had a lot of experience so I hope that means he will be able to get to my problems.

@sjm46 I believe I was diagnosed 3/4 years ago. It took awhile before my first ablation, as my heart is on the right side of my body, so I had to find a Dr that was versed in doing ablations with the heart on the right. Hopefully, this second one will do the trick. If not, I will try to engage a Dr Natale in Austin, who has an outstanding rating for doing ablations. He has an office in La Joya CA, which is not far from Palm Desert where we live.

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.

I just got on the schedule for my pulsed field ablation, hooray! Still waiting for confirmation that I will also get a watchman. I will be first up on the schedule. Any idea how long to expect it to take?

The PF ablation success rate is closer to 82%. After suffering with AFib for about five years, progressively getting worse to 59 episodes in 2024, lasting 20+ hours each, I had a PF ablation at Mayo Rochester. Piece of cake. I had a few short episodes in the few days that followed - was told to expect that - and now I am AFib free. I am back to pushing myself harder, walking fast, even a little jogging, and weightlifting. I've even started drinking again (reasonably). I had mine in February 2025. Hope it lasts forever. I also have esophageal issues (I've had it stretched twice) and a hiatal hernia. The key is to find the right doctor. It's a skills thing. I drove four hours to get to the #1 clinic. 73M.

The PF ablation success rate is closer to 82%. After suffering with AFib for about five years, progressively getting worse to 59 episodes in 2024, lasting 20+ hours each, I had a PF ablation at Mayo Rochester. Piece of cake. I had a few short episodes in the few days that followed - was told to expect that - and now I am AFib free. I am back to pushing myself harder, walking fast, even a little jogging, and weightlifting. I've even started drinking again (reasonably). I had mine in February 2025. Hope it lasts forever. I also have esophageal issues (I've had it stretched twice) and a hiatal hernia. The key is to find the right doctor. It's a skills thing. I drove four hours to get to the #1 clinic. 73M.

The PF ablation success rate is closer to 82%. After suffering with AFib for about five years, progressively getting worse to 59 episodes in 2024, lasting 20+ hours each, I had a PF ablation at Mayo Rochester. Piece of cake. I had a few short episodes in the few days that followed - was told to expect that - and now I am AFib free. I am back to pushing myself harder, walking fast, even a little jogging, and weightlifting. I've even started drinking again (reasonably). I had mine in February 2025. Hope it lasts forever. I also have esophageal issues (I've had it stretched twice) and a hiatal hernia. The key is to find the right doctor. It's a skills thing. I drove four hours to get to the #1 clinic. 73M.

@cstrutt52 This study suggests otherwise, now three months old:
https://www.escardio.org/The-ESC/Press-Office/Press-releases/Pulsed-field-ablation-was-not-superior-to-radiofrequency-ablation-in-paroxysmal-atrial-fibrillation
I'm always happy to see success cases, no matter who the patient is, the EP performing their ablation, and the technique used. The variances in success (one full year free of the treated arrhythmia) are due almost solely to the skill and experience of the operator of the devices. So, choosing one's EP is a critical part of one's eventual success story when it comes to catheter ablations.