Ablation, when it “didn’t work” or "made things worse"

Wow, that’s something to consider.
Thanks for bringing it to our attention; I wonder if this is true of ablation for other arrhythmias like vtach or PVCs as well.
That would certainly be good for business, wouldn’t it?

Ablations are a 6 billion dollar a year business. These places are everywhere and from a procedural standoint are pretty simple for the docs. Medicare gets billed close to a 100K, granted they don't get paid that but still guranteed income. From a results standpoint the freedom from arryhmia varies widely post ablation. But what are your choices - drugs that aren't very effective in converting to NSR or destroying the AV node and geting a pacemaker but the atria are still in fib or flutter and you still feel like sh!t but go on until heart failure sets in. All in all this heart stuff needs some manufacture upgrades:)

Success is going to depend on skill of do. Unchecked afib has consequences too. Your post is odd and seems to be an attempt to dissuade people from a recognized and useful treatment.

Oh no, I'm sorry you feel my post is odd. I thought it was informative. But maybe would you find any post that points out challenges in the ablation process "odd"?
And the point about the skill of the EP is spot on. We do indeed depend on people knowing what they are doing from the pilot to the cardiologist.

The failure rate, across EPs doing them, AND...across all methods currently certified by the boards at hospitals and by the AMA, is about 25%. The procedure is surgery. Yes, it uses catheters instead of scalpels, but it is still invasive, and it's playing with the innards of one or more chambers of the pump that keeps our brains conscious and functioning.

That not-so-great failure rate for index ablations means that there are two principal components, each having a marked effect on the outcome, and this doesn't apply to just the index....it applies to all subsequent attempts to correct the arrhythmia: the patient and the practitioner. Each patient brings a novel circumstance and orientation to their arrhythmia, but so does each electrophysiologist (EP). Just as there are good surgeons and not-so-good surgeons, there are good EPs and not-so-good EPs. Each brings unique minds and motivations to their learning and then to their work, they each have different training and qualification experiences, and then each finds a comfortable pace and practice that gets them the most wins each weeks' worth of ablations. As Dr. Scott Lee says on his 'Afib Education' channel on YouTube, most EPs out there are most comfortable only doing a simple PVI because, for most of their new patients desperately seeking relief, they're still in the paroxysmal stage, that being the earliest and the most easily treated....but also it's almost certain to only need that easy-peasy (comparatively) pulmonary vein isolation. IOW, the bread and butter.

Last very important factor and point: AF, at least, is a progressive disorder. When I first appeared on Mayo Community to discuss my experience and learning, and to learn from others, I got pushback about that statement. Some didn't like me saying it, but I would refer them to their own sources which I knew would have said the same thing...it's a disorder always looking for another way to mess up the heart. That is why even 'successful' ablations tend to be time-limited. If you take a couple of hours and read hundreds of posts, as I have, on several fora dealing with AF, you'll soon have to accept that most successful ablations fail in time. They must be repeated every 3 years or so, although some patients die without ever having to experience AF again. Remember, we're all different, and we all see different EPs who either do it right or do only what they think is required. I can't imagine a single EP sending a patient out to recovery in AF just because they ran out of patience or knowledge. They finally come up against a heart that simply cannot be ablated sufficiently or they send patients whose hearts show they are now happily in rhythm, and who would assume they had failed if their patient's heart is in steady NSR?

The heart changes in time. Every heart ages. Every heart deteriorates. It might be valves for you, fibrosis, heart failure, an infarct, or it might just be an electrical system that is becoming disordered. None of them will improve if left unmanaged or untreated, but some of them can be greatly retarded, even stopped cold. Ablations can do that. For a while. If one is symptomatic and miserable, even three years free of AF is a blessing. Just ask me.

Wonderful and important points and I agree, also having read hundreds of posts all over the net and having had the privilege to consult with some of the world's top rated EPs, my partner is a doc and I have three close friends who had successful ablations. Symptomatic Afib is awful, it's complicated and unfortunately sometimes an ablation can leave you worse off. "Say not the struggle nought availeth"

@alexjo
I see my typo on doc, but you knew what I meant. My husband had an ablation in 2019 and has been in normal sinus rhythm since. He did have a first-rate doc and that is crucial. Its fine to point out negatives, but they may be outweighed by gains when ablation is done well. Its seems to me when ablations fail and need repeats, its because of doc. Success rates are over 75% I believe.

@kudzu
Would like to know about PVCs also. Scheduled for ablation June 4th on LV

@jc76
Hi, all this with no claims, but it seems that the substrate and risk are different as the ablation for PVCs apparently targets a different area of the heart LV (proper or outflow) or RV. Maybe ask your EP, I don't think it has been studied like the 2025 study in the atrium.

@gloaming
Do you know how successful an ablation would be in the case of a moderately to severely blocked mitral valve? I read that a fib is never “cured” . I also think there may be no point in doing an ablation given I went into a fib and heart failure from a pulmonary embolism but now realize my mitral valve annulus repair done 2012 has failed due to heavy scarring. So…. I can get open heart surgery to debride the annulus and probably end up with a pig valve and fix the a fib with a cox mace 4 …. Gold standard procedure, during the open heart surgery. I have no idea yet how long I will last before requiring surgery but I feel anxious about waiting. I’m breathless on exertion but pretty asymptomatic otherwise. So…. Do I try a catheter ablation in the meantime and hope the valve doesn’t get worse for a few years or just let them cut me open and get the full meal deal? Scared about all of it and feeling like my life has radically changed. Grieving the loss of my athletic lifestyle. Unfortunately, I’m trying to get a more proactive cardiologist because the guy I got stuck with doesn’t answer questions and just says he will keep me rate controlled on drugs. Never taken drugs in the past…. Not even Tylenol. Is it worth trying an ablation or wait for the big operation to fix? I read that after 1 year of persistent AFib, it locks in as permanent a fib and is very tough to get rid of. I feel asymptomatic with the continuous a fib except breathless on exertion esp climbing stairs of walking on a slope…. Only my Apple Watch and cardio mobile tell me I’ve been in 100% a fib since Jan 2026. However, a cardioversion Mar 20, 2026 got me into sinus rhythm for 3 whole days. I must say I felt incredibly good for those three measly days but was it physiologically or psychological? It really upset me when the a fib returned after those three days. Health care in my province of Nova Scotia, Canada has deteriorated. I’m trying to get referrals to surgeons out of province but my current cardiologist is not supportive. He says he is only offering to rate ( drugs) or rhythm control (see an electrophysiologist re ablation). Thank you b