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 sleepy and comfortable during the procedure.
• The doctor inserts thin, flexible wires 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.

Ablation might be done if you have symptoms that won't go away after you take an antiarrhythmic medicine to control your heart rhythm. Either your medicine did not bring back a normal heartbeat, or your medicine caused side effects that are hard to live with.^{1, 2}

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.

Certain people shouldn't have ablation

Ablation isn't a choice for some people, including those who:

• Aren't able to lie still or cooperate with the doctor doing the test.
• Have a history of bleeding problems.
• Have a blood clot in the left atrium of the heart.

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), such as warfarin, 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.

Catheter ablation works better in people who have atrial fibrillation that comes and goes (paroxysmal) than in people who have atrial fibrillation that is persistent (lasts longer than 7 days and doesn't go away on its own). Ablation might be less likely to work the longer a person has persistent atrial fibrillation.²

Other things that limit how well catheter ablation works include older age, other heart problems, obesity, and sleep apnea.² Your doctor can help you decide if ablation is a good choice based on your health.

Catheter ablation is still being studied to see how well it works and how safe it is in the long term.

Paroxysmal atrial fibrillation

• Research shows that ablation helps more than 70 to 80 out of 100 people.³ That means it does not help in about 20 to 30 out of 100 cases.
• In a worldwide survey, ablation helped 84 out of every 100 people.⁴

Persistent atrial fibrillation

• Research shows that ablation helps about 50 out of 100 people.^{2, 5} That means it doesn't work in about 50 out of 100 cases.
• In a worldwide survey, ablation helped about 65 out of every 100 people.⁴

Repeated ablation procedures

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

Research shows that a second ablation is needed in 20 to 40 people out of 100. This means that 60 to 80 out of 100 people don't need another ablation.²

Catheter ablation is considered safe. Most people do well afterward.

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

Problems during the procedure

If problems happen during the procedure, your doctor is prepared to fix them right away. In studies and a worldwide survey, serious problems happened in about 4 out 100 people.^{6, 4} These problems include an accidental hole in the heart, the need for emergency surgery, and nerve damage in the chest.

Rare problems include cardiac tamponade and stroke. They happen in about 1 out of 100 people.³ This means that they do not happen in about 99 out of 100 people. Another serious problem affects the pulmonary vein and happens in about 1 to 6 people out of 100 people.^{3, 6} This means that it does not happen in about 94 to 99 people out of 100.

Death from the procedure is very rare. It happens to about 1 out of 1,000 people.³ This means that 999 out of 1,000 people don't die from the procedure.

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. He or she can fix most of these problems.

The most common problems are related to the catheter that was inserted in a vein. Most of these vein problems aren't serious. They include minor pain, bleeding, and bruising. Vein problems happen in 0 to 13 people out of 100². This means that they don't happen in 87 to 100 people out of 100. In a worldwide survey, serious vein problems happened in 1 out every 100 people.⁴

Serious problems aren't common. These problems include stroke and new heart rhythm problems. A rare problem is a life-threatening problem with the esophagus (atrio-esophageal fistula) that happens to about 1 out of 1,000 people.³ This means it doesn't happen to 999 out of 1,000 people.

Weighing the risks and benefits of catheter ablation

The benefits may outweigh the risks if:	The risks may outweigh the benefits if:
You have symptoms that bother you a lot. Heart rhythm medicines aren't helping. Medicines help, but their side effects bother you a lot. You can't take the medicines because of other health problems.	You have only mild symptoms that don't really bother you. You aren't bothered by side effects of heart rhythm medicines.