Pulse field ablation

@gloaming. I did take another look at the studies. There are many of them ranging from 59% to over 90% for PFA. Generally, the sooner after diagnosis it is done, the better. Not a good sign for me who waited years. Apparently, the success rate jumps up for a second ablation. My clinic's studies (Mayo) reports a success rate of 75-80% at 12-month reviews. Again, I suspect that the skill of the doctor is key; more than the procedure itself.

@cstrutt52 This is what we try to impart to people who visit us over on afibbers.org forum: It's a progressive disorder, and left untreated it becomes highly resistant to any interventions, including amiodarone, which is the 'drug of last resort', or even to ablations. Even pacemakers can't stop all AF because pacemakers are mostly, as far as I know, meant to control rapid ventricular response (RVR) during fibrillation, which can be exceedingly onerous for those muscles over time, and we're not talking weeks...days. Even so, pacing, the operations performed by a pacemaker, invites other problems as a recent paper I read suggests. If it is done poorly, inexpertly set up, or without frequent monitoring to ensure accuracy, it can cause as much of the same kind of damage as unchecked AF and RVR. So, the wisest of us soon understand that an early intervention is the best intervention when it comes to heart arrhythmias, but especially tachyarrhythmias, and most especially when there is clear RVR.

So, you are correct, as far as this non-expert can tell, that PFA is enjoying success at about the same rate as RF does, but in the 'right' hands....for both techniques. And I'm very optimistic that PFA will only get better, even if only marginally, as we do more of it and train other EPs to perform it. Until then, RF and PFA are neck-and-neck for successfully stopping AF (one full year after an ablation is the milestone for 'successful ablation), and PFA enjoys a better reputation for minimizing collateral tissue damage due to the nature of the energy being applied, but also HOW it's applied. That's where the skill, and experience, are key.

@gloaming
I had a PFA this past Sept. As it was explained to me, the PFA is way more effective as it doesn't damage surrounding veins and tissue. I'm 79 and this was my 3rd ablation. The last one was effective for 7 years. I was told what happens over time is that scar tissue builds up and causes problems. The short circuit directly causing afib was corrected and in addition there was a lot of "cleanup" done also. It was a longer procedure than most because of extent of the scar tissue damage.
Prior to the ablation, I had to have 3 electro cardioversions done within 2 months. It's been 3 months and I've had no afib incidents and am 100% off flecainide. I was told if everything went ideally, I could expect another 4 yrs afib free. Shorter than the last one maybe due to my age and ablation history.
I'm grateful for the advancement of medical technology that brought us PFA. Also for the excellent cardiology dept. that I've been seeing for the last few years.

@gloaming
I had a PFA this past Sept. As it was explained to me, the PFA is way more effective as it doesn't damage surrounding veins and tissue. I'm 79 and this was my 3rd ablation. The last one was effective for 7 years. I was told what happens over time is that scar tissue builds up and causes problems. The short circuit directly causing afib was corrected and in addition there was a lot of "cleanup" done also. It was a longer procedure than most because of extent of the scar tissue damage.
Prior to the ablation, I had to have 3 electro cardioversions done within 2 months. It's been 3 months and I've had no afib incidents and am 100% off flecainide. I was told if everything went ideally, I could expect another 4 yrs afib free. Shorter than the last one maybe due to my age and ablation history.
I'm grateful for the advancement of medical technology that brought us PFA. Also for the excellent cardiology dept. that I've been seeing for the last few years.

@kodaz Thanks for your comment. If by 'effective' the gentleman surgeon means that it is considerably safer for the phrenic nerve and for the esophagus, then he is correct as far as I know (and have seen in the literature). I can't quibble with that. However, if by 'more effective' that person means it has a higher success rate in stemming AF for a full year (that is the criterion for a successful ablation, one full year free of AF), then the literature I have seen, now about six months old, not long, says that PFA and RF enjoy almost precisely the same success...keeping the patient free of AF for one full year. It's not to say PFA isn't becoming more common, more well understood, more practiced, and therefor will indeed be a better procedure and method all around (wouldn't THAT be great?!?), but as of about six months ago the literature was quite clear....no appreciable difference in recurrence rates between the two methods of deliver.

@gloaming The jury is still out on PFA long term (5+ years post procedure) Long term, it may prove to be equal to, superior to or inferior to RF ablation. Given that it is less likely to cause collateral tissue damage, and therefore faster and less technique dependent, I believe it may well surplant RF (all else being equal).

I had one yesterday! I had to stay overnight but it was not bad. I don't know what to tell you except that I was newly diagnosed a year ago in October and my sypmptoms were still proxysmal. After reading the latest information from experts on YouTube, I learned that there are several options for a patient to try when they are first diagnosed, but the best option is ablation for the best chance at a "cure". I wish I had had mine done months ago, but my cardiologist didn't offer that until I got informed and pushed for it! One cardioversion, several breakouts over the months--short-lived but still annoying--and a trial on Flecainide that may have "worked" but had side effects and a scary list of side-effects! I found a very excellent electrophysiologist and a hospital that did pulse field ablations. I am hopeful and I wish I had done it sooner! According to the experts, the longer it occurs, the more it spreads and the harder it is to treat with ablation. You need a really good doc to do this so check out his creds and ask lots of questions! Good luck! I truly feel your pain!

@kodaz thanks so much for Shari g this positive outcome. I have had 3 unsuccessful ablations but my cardiologist said that he had to stop and couldn’t get to the place in my heart that had the problem because it was too close to my esophagus. Praying this technology works for me. Thanks so much for going me hope. I am 70 and have had this ongoing problem since 2021