Can ablatiion or watchman stop afib and flutter?

Not always

An ablation has about a 25% failure rate to correct AF, but that figure varies between both patients AND their helpful electrophysiologists....two big factors. The complexity of the case, so the patient, matters, but the experience and skill-set of the EP matters at least as much. Some EPs deal extensively with complex cases, which you are, and they enjoy high success rates.

The Watchman is an inert mesh inserted into the left atrial appendage, (LAA) and has no therapeutic effect except to greatly reduce the risk of a clot emerging from inside the LAA. It does nothing for AF. If the Watchman later leaks, determined by a TEE (trans-esophageal echocardiogram), then it does not preclude the prescription for a direct-acting oral anticoagulant such as Eliquis or Xarelto. If the TEE shows no leakage after six months from insertion, many EPs will allow their patients to cease the DOAC, but only if there is also no other risk for strokes in that patient.

Ablations succeed about 75-85% of the time, depending on the complexity of the case. For a simple pulmonary vein isolation, they run about that rate. The typical ablation lasts between 3-5 years if they make it to the one-year mark free of the treated arrhythmia. One year free of the AF means 'successful'. Do ablations every last longer? I just left the afibbers.org forum where 'Ken' claims his first ablation lasted 13 years, and he's now six years in on his second ablation.

Are people getting multiple ablations? I know two people, one male, one female, who have had 11 ablations between them. So, yes.

AFL and AF, flutter and fibrillation, are ablated differently. Sometimes AFL is found in the left atrium, but it usually appears in the right atrium. AF is always found in the left atrium, and it can be located in several places. Each must be located during the 'mapping' process, and then surrounded by a ring of tiny lesions caused by applying energy to the tip of the wand which is placed on the endothelial layer and energy applied for between 8-18 seconds.

You should consult a local EP and ask all sorts of questions. If he/she is reluctant to deal with you, they're just being honest about their experience and skills. Look further afield and find one who tells you they know how to get your particular case busted.

Pacemaker and av ablation recommended for my husband with SVT/flutter and low blood pressure. Had very high heart rate and BP too low to measure. Heart cardioverted, but now pace and ablate is recommended. Had very good ablation for afib in 2020- now may be returning. Is a hard decision but recommended by two knowledgeable docs. He is strong and otherwise healthy 83 yrs old. Anyone with experience of this treatment?

@tsch Ablations have a finite life because the heart is disordered and is continually looking to build new foci for the rogue signals that make the heart beat chaotically. Most ablations fail between 3-5 years, typically, but some last much longer. Also, there is often no reason not to ablate a second, a third, or even a fourth time, but it depends on the overall health of the patient and the structure of their heart. This is where you should see at least two different electrophysiologists for thorough consultation. You want two opinions. If they jive, then I would counsel you to proceed on their shared opinion. If they differ, you have a choice to make or to seek yet a third consultation and hope you don't have a third option...you want an option that matches one of the first two provided to you.

Two opinions so far say he is a reasonable bet to do well with nuking the AV node and just relying on a pacemaker. This is the state literally millions have learned they are in, and they have gone on to live full lives relying on an implanted pacemaker. They work. They also take over from the now-neutralized AV node and provide the 'pacing' his ventricles need to beat at a much more reasonable......AND RELIABLE....rate.

I advise you to learn, from the first two opinions, why a second attempt at an ablation is not what they recommend. If it makes abundant sense, then you both know what to do. The sooner the better.

@gloaming
Thanks for your comments. I am aware of your extensive knowledge. My husband had an excellent ablation in 2020, and altho his afib has remained minor, he has had two episodes of SVT/flutter, about 6 months apart. Most recently April 28 when he needed cardioversion (HR 178; BP unmeasurable) in the ambulance called to take him to the hospital. His health is excellent other than his heart. He has good low blood pressure but it would be lowered too much with meds to lower his heart rate. His regular cardiol and an excellent EP both agree on pace and ablate and I am pretty sure that is a reasonable treatment (and I think my husband agrees.) A regular ablation is not as effective with atypical flutter, which is what he has. We expect he will be fine. Thanks again

@tsch Okay, it seemed to me that you were unsure of the way ahead, so just tried to put it into an objective perspective. If you both are reasonably secure in the proposed plan, I hope it goes well for you. I hope and expect that you will both come out ahead in due course and that he will go on to a comfortable existence. I wish you the best.

Thank you. No, I was not unsure. Like you, I believe the skill of an EP doc is critical, and we have one who is very skilled now and had highly skilled one for the first afib ablation. Pace and ablate will remove the possibility of future serious SVT/flutter and low BP for him, (and possible subsequent heart damage) so it has value.

They considered putting my name on room number 4 at the ER. I spent so much time there dealing with AFib. Two years ago I had ablation surgery and haven’t had a problem since. Easy surgery too.