Does being in sinus rhythm before ablation lead to better outcome?

Ablation from what I heard has a hight success rate.
Also when you get one the Dr. puts you in a Afib from what I heard so they can find the trouble spot to fix.
Im not a Doctor Please reach out to ONE to confirm

I am not an expert, although I have done quite a bit of reading and watching videos posted by electrophysiologists (EPs). I believe it is always easier to pinpoint the area(s) of rogue signaling when the patient is in active AF, but it isn't strictly or absolutely necessary. The EP can 'challenge' the heart chemically to make it act up. This doesn't always work, but it can work.

More importantly for you, I think, is that you are still in the earliest stage known as 'paroxysmal' where your AF is self-limiting and your heart spends much/most of the time in normal sinus rhythm (NSR). This is good, for you, but it is also good for the EP because the high probability of success for ablating paroxysmal patients lies in the problem area. There's a 90% chance your problem area, and mine, is going to be just inside the pulmonary vein ostia....their mouths, where they empty their oxygenated blood returning from the lungs into the left atrium. The EPs know that their success is likely to happen if they ablate paroxysmal patients around the pulmonary veins, a procedure called 'pulmonary vein isolation', or PVI.

Again, I'm not medically trained, but my thinking, and you should run this past your EP, is that you would ideally be OFF amiodarone or any other AAR (anti-arrhythmic drug) for several days, if not several weeks (!), especially if you have been taking amiodarone for months now. If you are going to fibrillate, it would be off amiodarone, ostensibly, but you probably would need to be off it for 20 days (?)...I'm wildly guessing. Again, discuss this with your EP.

I would rather have my heart in arrhythmia during ablation, allowing the EP to see the area of the heart responsible for the problem. When in sinus rhythm , it is not possible. At least that was the case for my NSVT. Even with aggressive trying to convert to VT, the attempt failed.

Pacing is the term for challenging your heart and getting afib to show up. I was in sinus going in to ablation, was paced ablated and left in fib / flutter so presenting in sinus I think makes no difference to the result. The first time this happened was in 2020. Took about 5 months to stabilize in sinus but was good for 5 yrs.

@wcuro
Same experience. Ablation attempted during NSR, couldn't get rate to SVT, failed ablation. Came out in A fib, treated for a few months, now out of a fib, but having pSVT. Not convinced at this time to attempt another ablation.

@vtsun
Having just had ablation on my LV some experience with this. I had a prior ablation but was over 10 years ago. The EP will need to map and see where the erratic signals are coming from. Thus with them present and happening it is easier to see where coming from rather than waiting. This speaking for PACs and PVCs. With me the took me off Mexiletine which is an arrhythmia drug so would be more likely PVCs would be there and they were.

I was having PVCs and he was able to map and then treat one of them with ablation. The mapping revealed two more areas where PVCs were coming from but were on outside of heart. Can't treat them with device that is inside your heart. So he is unlikely to treat them as are sporadic unlike the one he treated which was on going.

Now AFIB and VTAC. My EP tried to find the source but would not happen so put me into VTAC and still could not find the source. Had to shock me to get back into rhythm.

I was told heart will be very irritated for 2-6 weeks as has undergone damage and is very irritated. I was told to expect non sustained VFIB and lots of PVCS. I am 13 days out and they are right on. But I was told to expect as heart heals so have been able to deal with them.

I have had PVCs and PACs for over 25 years. After ablation they seemed to be more powerful feeling but could be me with heart focus.

I feel for you. I have had AF for just a few years, and was highly symptomatic. Made me miserable, partly due to the symptoms, but mostly because I wanted it controlled much better than it was when it happened. It was as if metoprolol were completely incapable of keeping my rate down when I did have an episode. Yet, I had to take metoprolol twice daily, and the dose climbed every year or so (a sign, to me, of the inevitable progression of the disorder). Soon metoprolol was as much a problem as AF.

Your heart seems to want to win, even with one hand tied behind its back. I think, after all this time, you are acutely aware of your rhythm and of any minor thoracic movement and your pulse sensation when the more powerful surges of NSR are going on.

I was trying to polar-align a telescope in my back yard observatory last nigh, in the gloomy interior of the dome, trying to get my laptop to talk to the aligning scope, a smart scope and app, properly. At one point, and I was very calm, not agitated or impatient, even though I was being thwarted in my attempts to get this process over with, and had shifted to my knees and hands, like a dog, to take pressure off my limb where I had been seated. As I watched the progress on the screen, I noticed my whole body rocking back and forth in sequence with my heart pulses. You could understand someone coming onto a forum who had never noticed this and wondering it they had high blood pressure or some kind of rhythm problem. Nope, just that faithful, powerful, 24/7/365/your-age pump doing what it was meant to do, and the surging of blood up the aorta makes you rock gently back and forth, maybe half an inch or so each way.

Never did get the scope aligned. Have to try again tonight, but I have ideas. 😀

My brother's cardiologist wanted him in NSR before the procedure. I don't know if it makes a difference in success rate afterward. I was in NSR before my ablation (and I was not on anti-arrhythmia meds) and I have had no problems with arrhythmia since then--11/25! I think your success rate has more to do with how long you have had A-fib, and how well your EP does his mapping and how thorough he is with attacking those errant sites. Good luck!

@labexperiment I was clearly told by my EP that the effort during a successful ablation for PVC’s that the attempt to “aggressively” create VT failed.
The “pacing” into the desired arrhythmia is not always successful. My heart would not convert out of sinus rhythm.

@wcuro All of our hearts are so different, except for that one thing we all have in common: arrhythmia. I went into my SVT ablation in NSR and my EP was able to easily induce SVT, leading to a successful ablation. When he was finished, he was no longer able to induce SVT even with aggressive challenge. Such a life-changing result for me! Best of luck with your situation.