Ablation while asymptomatic

I have intermittent AFIB every 3 months or so, always minimally symptomatic with pulse never going over 95 and lasting just 4-7 hours. I will not look for an ablation with my present symptoms. Having reviewed multiple experiences post ablation, I will do my best to not have one done. The infrequent complications can be problematic, often beyond the issues one has with AFIB alone. The only concern is the necessity of continuing Eliquis or other med to avoid stroke.

AF is a progressive disorder. It may be slow, it may be fast, you may be symptomatic, you may not know it's going on. But it's always advancing. If you had two years in NSR, you had a good index ablation (index = 'first'). But your heart doesn't mark time or stand down in its desire to keep finding ways to beat chaotically. Most ablations last between 3-5 years. Some go on forever, lucky sods. Some are done inside of a whole first week, and I'm one such unlucky person. Second ablation, seven months later, has me in NSR for 39 months now. Not bad.

It is always best, or maybe 'handy' is a better word, if you are fibrillating while being ablated. But it's not necessary. The best EPs are trained in 'mapping' the heart's electrical circuitry and rogue foci, the places where the rogue signals are reaching the left atrium's endothelial lining and causing that vessel to beat. There is no nerve that makes that vessel beat....it's a spreading wave of voltage that normally issues from the sino-atrial node (SAN). When you first start fibrillating, that paroxysmal early stage, 95% of all rogue signals emanate from the ostia of the pulmonary veins where they empty fresh lung blood into the rear of the atrium. Ablating the ostia of the pulmonary veins is known as a 'pulmonary vein isolation', or PVI. Chances are that is all you needed, but here you are needing a second ablation. I'm three years ahead of you on that count. In case this is a defeating feeling for you, I know two people who have had five and six ablations, eleven between them, until they found the right EP to solve their complexity and rid them of their arrhythmia. That was Dr. Andrea Natale at the Texas Cardiac Arrhythmia Institute in Austin. He is world famous.

EPs have a range of options to make your heart fibrillate. It's called challenging the heart. They can use adenosine, caffeine, or isoproterenol. If those don't work, there's not much else they can do except to ablate around your pulmonary veins a second time, although that is unlikely to be effective. Instead, one or more other loci, the mitral valve area, the left atrial appendage, the coronary sinus, even the septum dividing the two atria....they can all harbour those rogue channels that raise voltage into the endothelium, and bang....your off fibrillating once more. As Dr. Scott Lee says on his 'AFib Education Center' channel on YouTube, there are six walls in the left atrium. The more complex the case, the more difficult it is to treat, and that's because not just the pulmonary vein ostia are now involved....it has spread.

@alymat The risk for perforation or thermal damage to the phrenic nerve or the esophagus during radio frequency ablation is about 1.5%., or about 15 in 1000. You risk of becoming 'immune' to anti-arrhythmic drugs is about 25%. If you elect to live with the arrhythmia, your chances of developing mitral valve prolapse, hypertension, hypertrophy of the two left vessels, and ultimately heart failure is quite high, probably north of 3.5%.
https://www.ahajournals.org/doi/full/10.1161/CIRCEP.119.007809
Ablation has been declared as the 'gold standard of care' for AF patients as of about this time last year.

@gloaming
Thank you that’s great information. I hadn’t considered the point that being in normal rhythm for the ablation might be problematic for the EP.

It does make sense to have another ablation. I've had 3 of them. As explained by my electro cardiologist scar tissue slowly forms and that is what causes the short circuits that causes afib episodes. You do not have to be in afib at the time of the procedure. The surgeon can induce an afib episode to see where the problem is that causes the afib.
My last one was in Sept. 2025 which was a new procedure called PFA(pulsed field ablation). Research it to see how it works. It is amazing. I'm 79 and my doctor said getting older increases the probability of afib occuring more frequently. So far, to date, there hasn't been any afib episodes. If that should happen, I'd get another PFA. Personally, I don't tolerate drugs such as flecainide very well, so all I'm taking is Eliquis.
That said, we are all different and react differently to afib solutions. I'm just sharing what has worked for me.