Catheter Ablation Success Rates
The Task Force that developed the HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation found that in most early studies the majority of centers reported single catheter ablation success rates of 60% or more for paroxysmal atrial fibrillation and 30% or less for persistent atrial fibrillation. For multiple procedures, the majority reported success rates of 70% or more for paroxysmal atrial fibrillation and 50% or more for persistent atrial fibrillation.1 Outcomes varied based on differences in technique, experience, skill, and follow-up.
The first worldwide, multicenter survey on catheter ablation was published in 2005 using data from 1995–2002 from 181 centers. It indicated that 52% of patients having an atrial fibrillation catheter ablation were successful and symptom-free without antiarrhythmic drugs. An additional 23.9% were successful, but were on antiarrhythmic drugs. For many, those drugs did not work prior to the ablation. Achieving this success required a second procedure for 24.3%, and a third procedure for 3.1%. Success rates were highest in high-volume centers.2
The follow-up second worldwide multicenter survey on catheter ablation was presented at Boston Atrial Fibrillation Symposium 2009 and included data from 2003–2006. The success rate was 70% without antiarrhythmic drugs vs. 52% in the first survey, and 10% with antiarrhythmic drugs vs. 23.9% previously, with an overall total success rate of 80% in the second survey vs. 76% in the first. The success rate without drugs was much improved, though the number of procedures required for success is not known at this time. When broken down by type of afib, the success rate without antiarrhythmic drugs was 75% for paroxysmal afib, 65% for persistent afib, and 63% for permanent afib.3
The highest volume centers, those with over 300 procedures, had success rates of 75% without antiarrhythmic drugs,3 though that may have involved multiple procedures for some patients.
The second worldwide survey used data on procedures up until 2006, so safety and efficacy should be expected to be higher today with current procedures and experience rates, particularly in high-volume centers. Some centers today cite success rates of 80%–85% for first ablations and 95% for second ablations.
If you're considering a procedure, ask about the catheter ablation success rate for the specific electrophysiologist and for the center in which it would be done. Also ask about how they define success, such as with or without antiarrhythmic drugs, number of procedures, and how it is measured, such as by event monitoring and at what intervals. It also wouldn't hurt to ask for their success rates for the specific technology and tools to be used on you. This includes complication rates as well.
One early finding was concerning — electrical reconnection of pulmonary veins following catheter ablation. In a study reported in 2003, radiofrequency lesions to the pulmonary veins reconnected themselves in 80% of cases within just 4 months after the catheter ablation, and similar results were seen just 5 months after reablation.4 Since catheter ablation continues to evolve to address safety and efficacy, newer studies and newer technologies will hopefully show improved results.
If you're considering a catheter ablation, you need to know about Catheter Ablation Risks.
1 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Personnel, Policy, Procedures and Follow-Up <http://www.hrsonline.org/News/Media/press-releases/CSAblation.cfm>, Heart Rhythm Society [Internet], Copyright, 2007.
2 Cappato, Riccardo, MD, et al, "Worldwide Survey on the Methods, Efficacy, and Safety of Catheter Ablation for Human Atrial Fibrillation" <http://circ.ahajournals.org/cgi/content/full/111/9/1100>, Circulation: 2005;111:1100-1105.
3 Cappato, Riccardo, MD, et al, Second Worldwide Survey on Efficacy and Safety of Catheter Ablation for AF, Presented at Boston Atrial Fibrillation Symposium 2009.
4 Cappato, Riccardo, et al, "Prospective Assessment of Late Conduction Recurrence Across Radiofrequency Lesions Producing Electrical Disconnection at the Pulmonary Vein Ostium in Patients With Atrial Fibrillation" <http://circ.ahajournals.org/cgi/content/full/108/13/1599?ijkey=84d63d895f09f284f7ef969d68fde35e2522e733>, Circulation: 2003;108:1599.
