Another ablation after 20 years, how have they changed?

There are definitely new techniques. Time would probably be quicker also, but that's going to be dependent on the individual. I had a cryo-ablation about 4 or 5 years ago, but radio frequency seems to be the preferred these days. I was about your age at the time and I think mine took about 2 hours.
I had a brother who never noticed his afib, but it really started affecting his life - no energy, short of breath all the time. It took three ablations to get his under control.
After a mitral valve repair about 2 years ago, I no longer have any afib. I'm off all heart meds, still on Eliquis and probably will be for the rest of my life.

Actually, the newest technique is Pulse Field Ablation and real time 3D mapping that shows the doctor where the chaotic signals are and he uses an extremely fast electrical pulse to take care of it. After all spots are done, then the 3D mapping is done again to check if all areas have been done. I’m certainly not the best person to explain this. Do a search on here for PFA, research it online, ask your doctor about it, and definitely get the best most experienced electrophysiologist you can find. There are videos that that show how it’s done. Search gloaming on here. He’s posted a lot of info on here that may be helpful.
The time under anesthesia is shorter than other methods and it has had good results.

Hello. Yes, things have changed, and on many levels. Imaging tech, how much radiation we are exposed to, newer drugs, and as aard has said, they are improving the delivery of energy all the time. PFA is the latest 'n greatest, although it doesn't yet enjoy a reputation of being better than RF (radio frequency) in terms of long-term success. Success in ablations means one full year free of the treated arrhythmia. PFA does have benefits, and it has one not-so-great 'benefit: it is usually shorter, presents less of a threat of burning the esophagus or the phrenic nerve, but..it also requires more fluoroscopy. The bit takeaway, once you get yourself up to speed by reading and thinking about what has changed, is that PFA currently has no statistical advantage in terms of success. The failure rate, across the board, is still about 25%, meaning ablations are only going to get to that 'successful' year point about 75% of the time. However, and this is a big however, the best EPs out there routinely do better, often exceeding 85% success. So, shopping around for a great EP is going to make the difference in most cases. Their skills and experience matter.... a lot! More than the technique.

I have heard of some ablations lasting several hours, but the typical patient these days needs 90 minutes to about two hours. This is for a pulmonary vein isolation, NOT FOR more complex cases where the left atrium has several more foci, say on the front wall or in the left atrial appendage (LAA). So, a more advance case, which yours surely is with you being unaware of your AF, and God knows how long you have been fibrillating as a result, will possibly require multiple walls, and probably multiple ablations now before they can nub it. But, this is what you should expect with your 'average' EP, not with those at the top of their game. Those wizards will find every re-entrant, rotor, or focus, and they'll ablate around them to isolate them. Such an enterprise might take four hours or more.

My main message is, things have changed, but not the meaning and implications of 'standard' or of 'average.' You should spend most of your next few days and weeks sleuthing out the best EP you can afford or find, even if you must travel. Make sure he/she has access to your records, and hopefully they are detailed and comprehensive. And don't forget that he/she will want diagnostics of their own before they take you on.

I also wanted to add that I take Flecanide for rate control, which could be why I don't feel the AF. Even walking two miles on the treadmill at the gym, my HR rarely goes above 90

@mmm123
Thanks, PFA is actually what I intended to say, ...a little too early for my brain, I guess.

@bohaiboy Flecainide is a sodium channel blocker that helps to keep the heart in rhythm. It also has a mild analgesic or anesthetic effect on the body. It is not a rate control medication the same way diltiazem or metoprolol are...those two are definitely calcium channel and beta-adrenergic receptor medications respectively that do help to keep a lid on the rate. The metoprolol never did work well for me. It neither kept me out of rhythm, even though it does have a mild rhythm control aspect to it, but when I did fibrillate it couldn't control my rate. I was typically above 140 BPM, indicating 'RVR', or 'rapid ventricular response'. If your rate is below 100, it means you do not appear to have a typical RVR. Good for you!

Has PFA pretty much replaced RF Ablations since it has been on the market now for almost 2 years?

@bohaiboy Not by any means. Not every EP feels they need to learn how to do PFA and to get certified to conduct such repairs. The very best EPs do both, but they still do RF if they feel it will suffice for their patients' purposes. I had two RF ablations three years ago by an excellent EP in British Columbia, and so far, fingers crossed, knock on wood, turn around counter-clockwise three times, I am free of both PACs and AF.

Is PFA becoming more popular, are more and more surgeons using it, and are the results getting better? Yes, to all three. PFA will probably become the go-to standard within a couple of years because it's generally safer, no need for a TEE in most cases. So, less risk too boot. But currently, as of about six months ago, the 'success rate' between RF and PFA is within two percentage points. This means it's not so much the technique but rather the operator...the EP counts most in a 'successful' ablation...meaning one full year free of the arrhythmia.

The companies making PFA equipment keep trialing and introducing new applicator tips that can fit into and ablate different areas. I believe the LAA was added just about 8 months ago, and surely other applicator tips will come that will allow them to ablate all six walls.