Atrial Fibrillation: Should I Have Catheter Ablation?

Normally, the heart has a strong, steady beat. That beat is controlled by the heart's electrical system. Sometimes that system misfires, causing atrial fibrillation.

Catheter ablation is a way to treat atrial fibrillation. Your doctor can get into your heart—without surgery—and fix the misfiring. It's like working on the spark plugs in your car without having to open the hood.

• It's done in a hospital. You'll get medicines to make you sleep or feel sleepy and comfortable during the procedure.
• The doctor inserts thin, flexible tubes called catheters into a vein, usually in the groin or neck. Then the doctor threads the catheters up into your heart.
• X-rays and other images of the heart help the doctor see where to move the catheters.
• The catheters use very hot or very cold temperatures to destroy the areas in your heart that are causing the misfiring problem.

It may seem like a bad idea to destroy parts of your heart on purpose. But the areas that are destroyed are very tiny and don't affect your heart's ability to do its job.

You and your doctor can check a few things to see if ablation is a good choice for you. These things include:^{footnote 3, footnote 4, footnote 5}

• What type of atrial fibrillation you have (paroxysmal or persistent).
• How bad your symptoms are.
• If you have heart failure or a problem with the structure of your heart.
• If you have tried heart rhythm medicines already. Your symptoms may not have gone away or you had side effects that are hard to live with.

The choice to have catheter ablation also depends on what you want.

Catheter ablation does have some serious risks, but they are rare. Many people decide to have ablation because they hope to feel much better afterward. That hope is worth the risks to them. But the risks may not be worth it for people who have few symptoms or for people who are less likely to be helped by ablation.

Taking anticoagulants (blood thinners)

Many people think that having ablation means they'll be able to stop taking an anticoagulant (also called a blood thinner) every day to prevent stroke. But that is only true if your risk of stroke is low. Studies haven't proved that ablation for atrial fibrillation lowers your risk of stroke. So you'll still need to take an anticoagulant if your risk of stroke remains high. Your doctor can tell you about your stroke risk.

Catheter ablation can stop atrial fibrillation from happening and can relieve symptoms. But how well it works can be different for different people. Your doctor can help you decide if ablation is a good choice based on your health.

Catheter ablation works better in people who have paroxysmal atrial fibrillation (episodes last 7 days or less) than in people who have persistent atrial fibrillation (episodes last more than 7 days). For both types, episodes may go away on their own or go away after treatment. Ablation might be less likely to work the longer a person has persistent atrial fibrillation.^{footnote 5}

Things that limit how well catheter ablation works include older age and other heart problems.^{footnote 5}You can help lower the chance of atrial fibrillation coming back by having a heart-healthy lifestyle and managing other health problems.

Paroxysmal atrial fibrillation

Research shows that ablation stops atrial fibrillation from happening for at least 1 year in about 60 to 90 out of 100 people.^{footnote 5} That means it does not help in about 10 to 40 out of 100 cases.

Persistent atrial fibrillation

Research shows that ablation stops atrial fibrillation for at least 6 to 12 months in about 60 to 80 out of 100 people.^{footnote 5} That means it doesn't work in about 20 to 40 out of 100 cases.

Repeated ablation procedures

Atrial fibrillation sometimes returns after an ablation.

If the first procedure doesn't get rid of atrial fibrillation completely, you may choose to have it done a second time. Repeated ablations may have a higher chance of success.

Most people do well after a catheter ablation. But it does have some risks.

Your doctor can help you decide whether the possible benefits of ablation outweigh these risks.

Problems during the procedure

If problems happen during or soon after the procedure, your doctor is prepared to fix them right away. Problems that need treatment happen in about 5 out of 100 people.^{footnote 1} These problems include bleeding, an accidental hole in the heart, and nerve damage in the chest.

Rare problems include cardiac tamponade and stroke. They happen in about 1 out of 100 people.^{footnote 1} This means that they do not happen in about 99 out of 100 people.

Death from the procedure is rare, happening to fewer than 1 out of 100 people.^{footnote 1}

Problems after the procedure

Problems after the procedure can be minor (such as mild pain) or serious (such as bleeding). Your doctor will check you closely after the procedure.

The most common problems are related to the catheter that was inserted in a vein.^{footnote 5}Many of these vein problems aren't serious. They include minor pain, bleeding, and bruising. But some problems, such as serious bleeding, need treatment. Serious bleeding happens in about 3 out of 100 people.^{footnote 1} This means that it doesn't happen in about 97 people out of 100.

Serious problems are rare. An example is a life-threatening problem with the esophagus (atrio-esophageal fistula) that happens to fewer than 1 out of 100 people.^{footnote 2}