“Since my PVI, I have been A-Fib free with no symptoms for 32 months. What do you think my chances of staying A-Fib free are?”
I think your chances of staying A-Fib free are pretty good. A Pulmonary Vein Isolation (Ablation) is like a kind of immunization against A-Fib. If your Pulmonary Veins (PV) are well isolated and stay that way, you can’t get A-Fib there again.
When the PVs are isolated and disconnected and haven’t reconnected, it seems to be permanent. Intuitively it makes sense that A-Fib wouldn’t reoccur in areas that were successfully ablated and that haven’t reconnected. But it’s too early in the history of PVA(I)s to say this definitively.
NOTE: PVA(I) is a relatively new procedure. I had my catheter ablation in 1998 when I was 57 years old and I’m still A-Fib free today at age 74. However, at that time of my ablation, only one of my Pulmonary Veins was isolated. In theory the other veins could start producing A-Fib signals. But that hasn’t happened. My catheter ablation procedure back in 1998 was primitive compared to what is done today.
Regrowth/Reconnection of Ablated Heart Tissue: There is a tendency for ablated heart tissue to heal itself, regrow the ablated area, reconnect, and start producing A-Fib signals again. But if this happens, it usually occurs within the first three to six months of the initial PVA(I).
Recent research indicates that for a small number of people, a successful Pulmonary Vein Ablation (Isolation) procedure may not be a permanent “cure.” Dr. Francis Marchlinski of the University of Pennsylvania persuaded patients who had experienced successful PV ablations and who were A-Fib symptom free, to be re-examined in the EP lab. He found that some had regrowth/reconnection in their ablated vein openings even though they were A-Fib symptom free. He also examined patients who had regrowth/reconnection and reoccurrence of A-Fib after a successful PV ablation.
He estimated that there is a 5-6% chance of regrowth/reconnection each year (though not necessarily of A-Fib recurrence), out to five years. He doesn’t have data for beyond five years.
Who Is Most Likely to Have Recurrences? The people most likely to get recurrences often have pre-existing conditions or risk factors like obesity, diabetes, high blood pressure, sleep apnea, smoking, binge drinking, etc. Even though their PVs may remain well isolated, these risk factors could stimulate A-Fib in some other part of their heart or perhaps cause regrowth/reconnection in the PVs.
Don’t Fear Recurrence. But let’s say you do have a recurrence, for example, after seven years. It’s nothing to worry about and it can be fixed. You go in for a touch-up ablation which may take a whole 20 minutes to do.
The EP usually only needs to fix a gap or a new spot that has appeared, rather than do a whole ablation and isolation of your PVs and heart. (And remember, you have been A-Fib free for all those years!)
This is exactly what happened to Marilyn. Read Marilyn Shook Updates Her 2008 Personal A-Fib Story. She had a ‘touchup’ ablation September 2014 and wrote us in July 2015 that she’s had no A-Fib since.
Live Life Like You Are Cured! It’s a waste of time to be concerned about something that may never happen (A-Fib recurrence). It’s like worrying about getting struck by lightning.
Thanks to Rob Muscolino for this question and to A-Fib Support Volunteer Jerry for helping write this answer.
Last updated: Thursday, February 9, 2017
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