Atrial Fibrillation: Should I Have Catheter Ablation?
You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.
Atrial Fibrillation: Should I Have Catheter Ablation?
Get the facts
- Have catheter ablation.
- Don't have catheter ablation.
Key points to remember
- Catheter ablation might be done for atrial fibrillation if you have symptoms that won't go away, if your medicine hasn't brought back a normal heartbeat, or if your medicine causes side effects that are hard to live with.
- Ablation can relieve symptoms and improve the quality of life in people with atrial fibrillation. But it doesn't work for everyone.
- If atrial fibrillation happens again after the first ablation, you may need to have it done a second time. Repeated ablations have a higher chance of success.
- Catheter ablation is thought to be safe. It has some serious risks, such as stroke, but they are rare.
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.
The benefits may outweigh the risks if:
The risks may outweigh the benefits if:
Compare your options
What is usually involved?
What are the benefits?
What are the risks and side effects?
- The treatment is done in a hospital and takes 2 to 6 hours.
- You probably will not be fully awake during the treatment. You may be lightly sedated or completely asleep.
- You may have some discomfort, either from having to lie still or from the ablation itself. Talk to your doctor if you are worried about this.
- You will probably stay in the hospital for 1 or 2 days.
- Many people feel a lot better after this treatment.
- If the treatment works, you won't need heart rhythm medicine anymore.
- Ablation has serious risks, although they are rare. They include stroke and death.
- If ablation doesn't work the first time, you may need to have it done again.
- You keep taking heart rhythm medicine to treat atrial fibrillation.
- You don't have to worry about the rare but serious risks of ablation.
- You will likely continue to have symptoms of atrial fibrillation.
- Heart rhythm medicines may increase your risk of getting a more serious heart rate problem. You will need frequent checkups so your doctor can watch you closely while you take these medicines.
- If you also have heart disease, your risk of serious side effects from these medicines may be higher.
Personal stories about considering catheter ablation
These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.
Medicines have helped my symptoms a little, but not completely. My doctor talked to me about catheter ablation, but I really don't want to have a procedure on my heart. I can live with my symptoms for now.
Candace, age 58
My doctor has been treating my atrial fibrillation with medicines. But taking them is worse than the palpitations. I'm tired all the time, and I have dizzy spells so often that I can't work. I'm ready to try catheter ablation.
Sophie, age 54
I've already tried one medicine to treat my atrial fibrillation. I still had symptoms that bother me a lot, so my doctor prescribed a different medicine. I think I'll try this one before I think about having an ablation. If my new medicine still doesn't help, I can try ablation later.
George, age 60
My doctor said the risks of ablation are pretty rare. I just want to get this problem fixed so I feel better. I'm going to have the procedure.
Wei, age 49
What matters most to you?
Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.
Reasons to have catheter ablation
Reasons not to have catheter ablation
I'm not worried about having a procedure that involves my heart.
I'm very worried about having a procedure that involves my heart.
The side effects of my heart medicines are bothering me a lot.
The medicine side effects don't bother me that much.
I'm bothered a lot by my heart rhythm symptoms.
My symptoms don't bother me.
I'm not happy with my quality of life, either because of my symptoms or because of medicine side effects.
My quality of life is pretty good.
The risks of ablation don't bother me as much as the risks of continuing to take my medicines.
I prefer the risks of taking my medicines over the risks of having catheter ablation.
My other important reasons:
My other important reasons:
Where are you leaning now?
Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.
Having catheter ablation
Not having catheter ablation
What else do you need to make your decision?
Check the facts
Does catheter ablation work well for everyone with atrial fibrillation?
- YesSorry, that's not right. Catheter ablation helps many people who have atrial fibrillation. But it doesn't work for everyone. It works best for people with paroxysmal atrial fibrillation.
- NoYou're right. Catheter ablation helps many people who have atrial fibrillation. But it doesn't work for everyone. It works best for people with paroxysmal atrial fibrillation.
- I'm not sureIt may help to go back and read "Get the Facts." Catheter ablation helps many people who have atrial fibrillation. But it doesn't work for everyone. It works best for people with paroxysmal atrial fibrillation.
Is catheter ablation the first treatment to try for atrial fibrillation?
- YesSorry, that's not right. Medicine is usually tried first. Ablation might be done if a person has symptoms that won't go away, if medicines have not brought back a normal heartbeat, or if medicines cause side effects that are hard to live with.
- NoThat's correct. Medicine is usually tried first. Ablation might be done if a person has symptoms that won't go away, if medicines have not brought back a normal heartbeat, or if medicines cause side effects that are hard to live with.
- I'm not sureIt may help to go back and read "Get the Facts." Medicine is usually tried first. Ablation might be done if a person has symptoms that won't go away, if medicines have not brought back a normal heartbeat, or if medicines cause side effects that are hard to live with.
If ablation doesn't work the first time, can it be done again?
- YesThat's right. You may need to have it done a second time. Repeated ablations have a higher chance of success.
- NoSorry, that's not correct. If the first ablation doesn't get rid of the problem completely, you may need to have it done a second time. Repeated ablations have a higher chance of success.
- I'm not sure.It may help to go back and read "Get the Facts." You may need to have it done a second time. Repeated ablations have a higher chance of success.
Decide what's next
Do you understand the options available to you?
Are you clear about which benefits and side effects matter most to you?
Do you have enough support and advice from others to make a choice?
How sure do you feel right now about your decision?
Use the following space to list questions, concerns, and next steps.
Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
|Primary Medical Reviewer||Rakesh K. Pai, MD, FACC - Cardiology, Electrophysiology|
|Specialist Medical Reviewer||John M. Miller, MD, FACC - Cardiology, Electrophysiology|
- Fuster V, et al. (2011). 2011 ACCF/AHA/HRS focused update incorporated into the ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation, 123(10): e269–e367.
- Calkins H, et al. (2012). 2012 HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation. Heart Rhythm, 9(4): 632–696.e21.
- Tedrow UB, et al. (2011). Electrophysiology and catheter-ablative techniques. In V Fuster et al., eds., Hurst's The Heart, 13th ed., vol. 1, pp. 1058–1070. New York: McGraw-Hill.
- Cappato R, et al. (2010). Updated worldwide survey on the methods, efficacy, and safety of catheter ablation for human atrial fibrillation. Circulation: Arrhythmia and Electrophysiology, 3(1): 32–38.
- Morady F, Zipes DP (2012). Atrial fibrillation: Clinical features, mechanisms, and management. In RO Bonow et al., eds., Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine, 9th ed., vol. 1, pp. 825–844. Philadelphia: Saunders.
- Agency for Healthcare Research and Quality (2009). Comparative Effectiveness of Radiofrequency Catheter Ablation for Atrial Fibrillation (AHRQ Publication No. 09-EDC015-EF). Rockville, MD: Agency for Healthcare Research and Quality.
Last Updated:December 14, 2012