How long does an ablation last? Are multiple ablations possible?

Hi, and welcome. I was 65 when first diagnosed. I developed AF near the tail end of a 10 km maintenance run. For the first three years it was strictly controlled via metoprolol and my natural health. Then it began to come on more frequently, and that was when my cardiologist referred me to an EP for the first time. It took that latter specialist two cracks at stemming my AF. His first attempt failed and I had to go on amiodarone for a few months to get my heart rate to calm down. Second ablation worked.

Statistically, across all practicing EPs everywhere, the success rate for an index ablation is 75%. There is variance due to several factors, but the very strongest factor is the skill and experience of the EP, especially if that person is good enough to have gone on to complex cases and done good work. Not all EPs will tackle complex cases where they have to include ablating the left atrial appendage, the coronary sinus, or the Vein of Marshall. They'll just try the ol' PVI (pulmonary vein isolation) which, in early cases like yours, is a 90% probability that it's the right place to ablate first.

Again, 25% of all index ablations are failures. Do most EPs and patients try again? Yes. Two, three, four, six, and more ablations, and I know people in those categories. The problem is that each such operation carries risk for the patient, and if the EP doesn't really know what he's ablating (shotgunning it) it can be useless as well....great costs for no benefit, and those risks keep adding up. Bottom line, you really MUST shop around and seek the help of the best EP you can afford to fly to, stay a couple of nights in lodgings, and then fly home.

What does the industry call a 'successful' ablation? One full year free of the treated arrhythmia post ablation. After that, it's called 'recurrent' AF, PACs, SVT, PVCs, etc. The typical ablation in the typical patient lasts, if he/she manages to get to the year mark without incident, about 3-5 years....with tons of variance. I know people who were ablated in the dark ages of electrophysiology and have still only ever had the one ablation twenty years ago. I am about to go three years free of AF, but it took the second stab at it from the same gentleman....so to speak. I went seven months between the index and the second attempt. It was a truly nasty interlude, lemme tell ya, and I couldn't wait for the EP to try again. He knew I had faith in him (Canadian Cardiology Student of the Year in 2002). Later, when I was awake, he came by and said he was ablating my third pulmonary vein when my heart resumed normal sinus. They watched, high-fived, and he said he didn't even bother to cardiovert me before wheeling me out of the cath lab., which he almost always does after an ablation.

So, to sum up, in the right hands (and that should be your chief task set for yourself), you should see yourself free of arrhythmia for years. However, the body ages, and the disordered heart progresses in its disorder. The concomitant changes mean that few ablations can possibly last indefinitely. The changes mean that the heart finds other foci through which to launch new spurious signals, at which your heart is likely, not certainly, only likely, to launch into arrhythmia again at some point. If you have only had one or two ablations, I don't know why you shouldn't be able to withstand a third or even a fourth. It's not a killer disorder....AF won't kill you. It can make you truly miserable, especially with anxiety. If you want it beaten into submission (there is no 'cure, only remission), then spend some time, money, and energy seeking out the services of the best EP you can reasonably afford.

Thanks gloaming for this valuable piece of information. I had my first and hopefully last ablation on May 29th with from what I heard and read one of the best EPs in the City of Toronto. I’m 4 months post op and things seems to be going great 👍. I just finished wearing a heart holster monitor to see if it picks up on any irregular heartbeats that I’m not aware of .🤞
I consider myself an intelligent woman and I certainly did my homework on ablations before having the procedure. But, I was surprised and a little disappointed when my cardiologist and EP referred to Afib as a “chronic condition”. 🫤
I’m hoping that I get several years out of my initial procedure, but now realize that it may not be the last.

@gloaming
Question for you. One concern I have about going out of area is follow-ups. Would you then follow up with a local cardiologist? Telehealth with the distant EP? It looks like Medicare just changed coverage for that 10/1/25. What is the typical post-procedure followup with the EP? Thanks.

@californiazebra I am in Canada, so a different system. However, people routinely shop around for various kinds of expert care in the USA, including traveling to the Texas Cardiac Arrhythmia Institute where the vaunted, and wildly popular, Dr. Andrea Natale does his magic. He provides instructions to the at-home care team about checkup imaging and tests, like a TEE (trans-esophageal echocardiogram) that he asks his patients to undergo if he has inserted a Watchman into their left atrial appendage (LAA) while he's ablating them. I haven't heard of any cardiologists bristling and getting huffy that they don't want to help a patient who has undergone a tricky and highly technical procedure out of state and just wants their thumb up to Dr. Natale, or to send him imagery on their behalf....which most also will do if requested (with payment, of course).

So, the usual protocol, leaving aside a Watchman done at the same time, is for you to see a local physician within 10 days of the ablation to ensure you're in NSR and that the incision has healed or at least isn't open or infected. Try for six days to a week if you can. Then, at about the ten to twelve week mark, you get issued a Holter monitor to wear over night, and you're asked to do a normal day, including any sports or exercise. You have to remember to note down on a record they supply of any key activities like meals, lifting, moving something, going for a long walk or run, climbing stairs that require you to get a bit out of breath....that kind of thing so they can remark on your heart's response at that time and hopefully NOT see any blips....just a quickened NSR in response to the higher demand. If the Watchman were installed, then you'd normally get a TEE at the six month mark to ensure it isn't leaking or displaced. If that checks out, you may be asked for one more TEE at the full year mark. If there's still no leaking, and you have no other issues that raise your risk for bleeds or stroke, no other comorbidities that might require anti-coagulation, then you would be invited to cease taking the DOAC like Eliquis or Xarelto...your choice, but they would likely say it's not necessary due to your apparently sealed LAA where the bulk of the risk of clot formation during AF lies.

@gloaming
All very good and complete info. Sounds like the distant and local teams work well together. Probably a more common scenario than I was thinking. Thank you for the response. I really appreciate it.

I am only one year into my A-fib diagnosis; I have had only 5 short "outbreaks" of arrhythmia since I was cardioverted on 12/04/24. I insisted on getting an EP involved after the third time when I actually went to the ED with a pulse of 130. I converted on my own in the ED but I decided not to live like this. I have an ablation scheduled for 33 days from now (but who is counting!) The trial on Flecainide that I agreed to was just too troublesome to me; the Black Box warnings scared me! I too have watched videos and read lots of articles about A-fib and it is a "no cure" condition but it is also a "can spread" condition, so that's why I want to get this in control before I have a "forest fire" instead of a "small trash fire." As for those labels that tend to annoy people like you and me, I have found that everything my husband and I get diagnosed with are "chronic" even if we have no real symptoms! He was just "identified" as having COPD due to a low blood oxygen level but he has had that for years and no doc ever bothered to address it until now! He's listed as prediabetic even though his A1Cs have never been over the top limit! I have "osteopenia" which is a BS diagnosis since almost 70% of women my age have some form of bone degeneration--and the doc NEVER suggest what I should do about that except to try to give me another troublesome medication with very serious side effects, too! As for A-fib, my cardiologist at the very beginning of this experience told me "don't worry, A-fib won't kill you!" Well, it won't technically kill you, but then you learn all the unfortunate things that it can trigger--like increased risk of strokes and heart damage and weakness and dizziness and depression and anxiety--and it seems to me that his casual attitude toward my initial concern was misguided. I hope you stay in NSR and I am betting you will; my brother had an ablation and he's been fine for 10 years. I made all sorts of lifestyle changes and I am very confident that I will be better off too. What I have learned from this site is that we all need to be our own advocates for the best treatment plan for us! If you get blown off by one doc, find another. I have an EP who is top rated in my state and I am really looking forward to getting this done and hopefully living more confidently with my "chronic" condition. Stay positive!

I had mine be many yrs ago like early 30 and I am 62 no problems happy camper!

My cardiologist always said that medication is the first step to control a-fib and when that no longer works, you go to an ablation. Heart surgery always carries a risk.
Medications (settled on flecainaide and diltiazem after a few trials) controlled it for several years, ....then it didn't. I had an ablation (cryo) that controlled my a-fib for a couple years, ....then it didn't. The problem wasn't the ablation, but a leaky mitral valve, which I had repaired (minimally invasive where the surgeon goes between the ribs rather than doing a sternotomy), and which has again completely controlled my a-fib.
So, in short, one ablation and one mitral valve repair to control my afib (keeping my fingers crossed); however, I have a brother who required three ablations and now seems to be doing fine. I have another brother who had an ablation about a year ago and is doing fine.
As for activity, I hiked the John Muir Trail and trekked for two months in Nepal up to 18,000' elevation when just on meds, and did another two months in Nepal 3 months after my ablation; I still hike long distances after my mitral valve repair without any problems. ....70 year old male.
All the best!

@californiazebra I had to go out of my local area for my ablation. I live in SW Colorado and there are no facilities that do the ablation procedure. I flew to Denver and had my PFA done at UC Health in Aurora, CO in May of this year. I have a local cardiologist, but I do telehealth with UC Health. I actually prefer the contact with UC Health and my primary care provider over the local cardiologist. With today's technology and information sharing doing telehealth is not much different from in-person visits. I do daily monitoring of the pulse rate and BP and upload a trend file, so it is available when I do my telehealth visits. I will return to UC Health next May for an in-person in-depth assessment.

@suerte
Thank you for sharing your story. That’s helpful. I saw a local EP who was recommended and takes on complex cases that others won’t take or where others have failed. Told me no one has done more PFAs than he has. He predicts my afib case will take 2-3 ablations. There is another EP in the next county who was the first to do PFA and states he has the most experience. I’m thinking about getting a second opinion to see if he also thinks 2-3. That’s hard to hear up front, but I’ve been in paroxysmal afib 30% of the time in recent months and frequent for 5 years. Very symptomatic. Exhausting condition and hard to hear that estimate and even then no guarantees and told it will likely come back with more ablations needed. Rate control didn’t go well — scary and never again. Recently ended up in the hospital from a scary TIA and aphasia after afib. That got my attention. Have also had a few retinal TIAs after afib. Started Eliquis low dose now but have to double to qualify for ablation. Don’t metabolize meds well with missing liver enzymes so that scares me. Have added risk for nerve damage during ablation due to a rare hereditary neuropathy where light pressure can case nerve damage. All very worrisome. Talking to my regular cardiologist again today. We’ll see how this all plays out.