EP evaluation of persistent AFIB

I need to correct myself: When I quoted 75% success for index ablations, my AF experience was thinking of ablations for AF...NOT for PVCs. However, I wasn't far off. It's 70%, still much higher, and more confidence inspiring, than the 50% cited by the electrophysiologist.
https://www.heartrhythmjournal.com/article/S1547-5271(25)01547-4/fulltext
Having made my last statement above, I don't know your case or its complexity, and I don't know how good and experienced the person citing 50% is. It could actually be that 50% is about all an honest person could allow herself/himself due to the particulars of your case. So, double correction on my part...and I am sorry for my statements. Nevertheless, the best EPs specializing in complex cases, including Dr. Lee on the YouTube channel 'Afib Education Center' will almost certainly approach or surpass 70% if you ask them for a consultation and their skillsets.

@gloaming I recently had 3rd and 4th cardio version, neither of which kept AFib away. After a rather frank discussion with my EP, she told me I was not a candidate for ablation as my AFib would just keep coming back. She has now suggested I skip any ablation and get the Watchman implant. She said I can live with the AFib and with Watchman my chance of a clot causing a stroke are much diminished. I can also get off Eliquis and maybe other heart meds that I feel make me worse rather than better. As a side note, I was told, since in my twenties by my then family dr, that I had a mitral valve prolapse. I have mentioned this to all the current docs but they keep telling me I have AFib. I know how I feel and episodes I have had since I was a child. My "mitral valve" and "AFib" feel the same to me. No one listens. My old family dr told me to go enjoy life and not worry about it, no meds. He said the number one cause of "heart trouble" was doctors prescribing meds. Why do I feel that is the crux of the matter? The Watchman is a 10 minute surgery. If no side effects worth noting, I will go that route. The EP has a very good reputation, and she is rather no nonsense which I prefer. Any suggestions of what other questions I might ask? I go back on 23rd of this month after seeing the gastro dr. I do not drink alcohol or smoke. Liver is scarred, likely from chemo/radiation for NHL in 2000. I fell I need to get off all these medications. Recent CT scan revealed liver issues for pain in abdomen. I have no appendix and no gall bladder. BMI is normal. I thought it was bile dumps causing bloat and pain. At 81, I just want to be able to get thru another day. @ brigid4

Hmm, when I had my ablation about 4 years ago, I asked about fixing my mitral valve regurgitation at the same time. My electrophysiologist (EP) said that he was "just the electrician." He happened to be the best EP in the region - I'm in southern Oregon. In my case, the regurg wasn't bad enough to require surgery at the time anyway so he may have been joking. The ablation was successful and I was off all meds for about 2 and a half years.
When afib started up again, it was because my mitral valve was getting worse so I had minimally invasive mitral valve repair about a year and a half ago. The surgeon (a cardio thoracic specialist) tried to close off the atrial appendage, but wasn't able to do it. But, no more afib so very happy it worked out for me.

As an aside, if you have heart surgery (not just an ablation), I would highly recommend getting into a cardiac rehab program if there is one in your area; it is very helpful in figuring out what you can and can't do, and getting you back on your feet.

@aard Most EPs who aren't hungry for money would refuse a patient unless they had/have other comorbidities and cardiac defects either corrected or well under control. Since mitral valve prolapse can cause AF, there's little point in attempting an ablation until and unless the mitral valve is repaired. Remember, each intervention requiring invasion of the body is risky. Surgeons are loath to enter a body unless the risk is manageable and small, and unless the benefits greatly outweigh the risks. So, attempting to perform a 'successful' ablation when the cause of the AF is still present seems wasteful of resources, the surgeon's time, and adds to the risk burden for the patient already slipping in health.

These are general rules understood by most everyone, patient and physician. However, each case presents as a unique one and all relevant factors have to be considered. The conscientious physician will only intervene surgically if to not do so presents an even greater hazard.

Brigid4, the further AF progresses, the more resistant it is to correction by the 'average' EP. If you really are in 'persistent' AF, meaning the third recognized stage of the disorder, then it means more than two of the six inner surfaces of your left atrium are being energized by rogue signaling cells putting out voltage that confounds the normal signal from the SA node, the sino-atrial node. The best EPs out there, those who are comfortable...AND USUALLY SUCCESSFUL... at treating what are commonly known as 'complex cases', will know how to map your atrium and then how to perform just enough ablation of surfaces to stop the rogue signals. Obviously, the further the disorder has gone, the more complex and involved the mapping and the subsequent ablation will have to be. People with 'permanent' AF have all six walls affected, and if the ablation, extensive as it will have to be, cannot stem the rogue signals, you'll have permanent AF still.

AF won't kill you. Most patients CAN live with it indefinitely, just not very happily if they are symptomatic and if those symptoms interfere with calm and peace. What matters then is that the disorder is kept strictly managed, and that may have to be with a pacemaker or with a very powerful and eventually toxic anti-arrhythmic drug like Tikosyn or amiodarone, both of which are normally started in hospital where you can be monitored. The idea is to keep your heart out of arrythmia as much as possible so that the eventual other problems, like mitral valve prolapse, atrial and ventricular enlargement, pulmonary hypertension, and eventual heart failure can be delayed pretty much until you die of other causes.