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FAQs Understanding A-Fib: Best Cure Rate
“I have paroxysmal A-Fib and would like to know your opinion on which procedure has the best cure rate.”
The best cure rate isn’t the only criteria you should consider when seeking your Atrial Fibrillation cure.
Let me first review your top three procedure options: cardioversion, catheter ablation, and surgical Maze/Mini-Maze.
Electrocardioversion: When first diagnosed with Atrial Fibrillation, doctors often recommend an Electrocardioversion to get you back into normal sinus rhythm. But for most patients, their A-Fib returns within a week to a month. (However, you might be lucky like the A-Fib patient who wrote us that he was A-Fib free for 7 years after a successful cardioversion.)
Catheter Ablations: Radio-frequency and CryoBalloon catheter ablations have similar success rates 70%-85% for the first ablation, around 90% is you need a second ablation. Currently, CryoBalloon ablation has a slightly better cure rate with the least recurrence.
How to achieve these high success rates? It’s crucial you choose the right electrophysiologist (EP), one with a high success rate and the best you can afford (considering cost and travel expense). What counts is the EP’s skill and experience.
You want an EP who not only ablates your pulmonary veins, but will also look for, map and ablate non-pulmonary vein (PV) triggers. That may require advanced techniques like withdrawing the CryoBalloon catheter and replacing it with an RF catheter to ablate the non-PV triggers. (See our Choosing the Right Doctor: 7 Questions You’ve Got to Ask [And What the Answers Mean].)
Cox Maze and Mini-Maze surgeries: Success rates are similar to catheter ablation, 75%–90%. But surgery isn’t recommended as a first choice or option by current A-Fib treatment guidelines. Compared to catheter ablations, the maze surgeries are more invasive, traumatic, risky and with longer (in hospital) recovery times
When should you consider the Maze/Mini-Maze? The primary reasons to consider a Maze surgery is because you can’t have a catheter ablation (ex: can’t take blood thinners), you’ve had several failed ablations, or if you are morbidly obese.
You should also consider that Mini-Maze surgeries have built in limitations. For example, unlike catheter ablations, mini-maze surgery currently can’t reach the right atrium, or other areas of the heart where A-Fib signals may originate (non-PV locations). The more extensive surgeries create a great deal of lesions burns on the heart which may impact heart function.
So How Do You Choose the Best Treatment For You?
Atrial Fibrillation is not a one-size fits all type of disease.
Your first step is to see a heart rhythm specialist, a cardiac electrophysiologist (EP), who specializes in the electrical function of the heart.
An EP will work with you to consider the best treatment options for you. If your best treatment option is surgical, your EP will refer you to a surgeon and continue to manage your care after your surgery.
To help you find the right EP for you, see Finding the Right Doctor for You and Your A-Fib.
Thanks to Thomas Scheben for this question.
Go back to FAQ Understanding A-Fib
Last updated: June 18, 2018
