What is the success rate of atrial fibrillation (A fib) ablation?

Atrial Fibrillation Ablation Success Rates

Catheter ablation for atrial fibrillation achieves approximately 90% success for paroxysmal AF and 80% success for persistent AF, though multiple procedures are often required to achieve these outcomes. 1

Success Rates by AF Type

Paroxysmal AF

• Single procedure success: 67.8% at 5 years, 56.3% at 10 years, and 47.6% at 15 years 2
• Final ablation success (after multiple procedures if needed): 80.3% at 5 years, 72.6% at 10 years, and 62.5% at 15 years 2
• Accumulated experience from nearly 4000 patients demonstrates approximately 90% success in paroxysmal AF cases 1
• First-year success rates range from 73-80% freedom from AF after pulmonary vein isolation, though 29-41% of patients require a second procedure 1

Persistent AF

• Single procedure success: 46.6% at 5 years, 35.6% at 10 years, and 26.5% at 15 years 2
• Final ablation success: 60.1% at 5 years, 50.2% at 10 years, and 42.5% at 15 years 2
• Accumulated experience shows approximately 80% success in persistent AF cases 1
• Real-world data from 291 patients showed 56% overall success at 2 years, with 78% probability of maintaining sinus rhythm when accounting for multiple procedures 3

Long-Standing Persistent AF

• Single procedure success: 30.4% at 5 years, 18.0% at 10 years, and only 3.4% at 15 years 2
• Final ablation success: 43.4% at 5 years, 32.0% at 10 years, and 20.6% at 15 years 2
• This represents the most challenging AF subtype with significantly lower success rates that have not improved across ablation technology eras 2

Multiple Procedure Requirements

The majority of patients require more than one ablation to achieve long-term success. 1

• In early studies, 70% of patients required multiple procedures to achieve 62% freedom from symptomatic AF 1
• For patients undergoing a second ablation after initial failure, success rate is 64% 3
• For patients requiring third or fourth procedures, success rate is 56% 3
• Recurrences occur most commonly in the first 2 years, with a steady 2% per year recurrence rate from years 2-15 2

Technology Evolution and Success Rates

Ablation outcomes have improved significantly with newer catheter technologies, particularly contact force catheters. 2

By Catheter Era (8-year success after final ablation):

• Contact force catheters (2014-2021): PAF 79.1%, PeAF 55.9%, LsAF 42.7% 2
• Open irrigated tip catheters (2005-2016): PAF 71.8%, PeAF 50.7%, LsAF 36.2% 2
• Solid big tip catheters (2003-2005): PAF 60.0%, PeAF 38.0%, LsAF 31.8% 2

The contact force and open irrigated tip technologies are both superior to older solid big tip catheters for paroxysmal and persistent AF (P < .001), though no technology has improved outcomes for long-standing persistent AF 2

Predictors of Success

Key factors predicting higher ablation success include: 2

• Younger age
• Smaller left atrium size
• Shorter AF duration
• Male sex
• Paroxysmal rather than persistent AF type
• Lower CHA₂DS₂-VASc score
• Fewer antiarrhythmic drugs previously failed
• More recent catheter technology era

Patients with cardiac dysfunction have lower success rates compared to those without structural heart disease 1

Quality of Life Improvements

Catheter ablation significantly improves quality of life, exercise capacity, and left ventricular function, typically within 3-6 months post-procedure. 1

• 90% of young adults (≤50 years) reported QoL improvement up to 5 years post-ablation 4
• AF severity scores improved from median baseline of 14 to 2-4 at all follow-up timepoints (P<0.0001) 4
• Patients reported fewer and shorter AF episodes, fewer emergency room visits, and fewer hospitalizations 4
• In patients with tachycardia-induced cardiomyopathy, left ventricular ejection fraction improved from 26% to 34% on average, with 29% achieving complete normalization by one year 5

Complications

Major complications occur in approximately 6% of procedures. 1

Serious Complications Include:

• Cardiac tamponade 6
• Stroke/thromboembolism (0-5% incidence) 1
• Atrio-esophageal fistula (rare but often fatal) 1, 6
• Pulmonary vein stenosis (dramatically reduced with modern techniques avoiding energy delivery within veins) 1, 6
• Left atrial flutter 1

Real-world complication rates may be higher: A multicenter study reported 6.6% total complications (2.5% serious), including 2 deaths (1 procedure-related) 3

Important Clinical Caveats

AF can recur asymptomatically, making apparent "cures" potentially misleading. 1

• Asymptomatic recurrences may be unrecognized by both patient and physician 1
• This has critical implications for anticoagulation decisions, as stroke risk persists regardless of symptoms 1
• Patients with stroke risk factors should continue anticoagulation indefinitely despite apparent ablation success 1

Post-ablation AF may occur transiently in the first 2 months and does not necessarily predict long-term failure. 1

At 2 years post-ablation, 35% of patients remain on antiarrhythmic therapy, indicating that ablation alone may not eliminate the need for medical management 3