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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

Your options

  • Have catheter ablation.
  • Don't have catheter ablation.

Key points to remember

  • Catheter ablation is a way to treat atrial fibrillation. It is done to restore a normal heart rhythm and to relieve symptoms.
  • 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 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. It has some serious risks, such as stroke, but they are rare.
  • If you take a blood-thinning medicine to prevent stroke, you will continue to take it after an ablation.
FAQs

What is 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.

When is catheter ablation done?

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.

How well does catheter ablation work?

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 5You 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.

What are the risks?

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 5Many 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

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.
  • You do not want to take heart rhythm medicines.
  • 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.

Compare your options

Compare

What is usually involved?









What are the benefits?









What are the risks and side effects?









Have catheter ablationHave catheter ablation
  • The treatment is done in a hospital and takes about 2 to 4 hours.
  • You probably will not be fully awake during the treatment. You may be lightly sedated or completely asleep.
  • You will probably stay in the hospital for at least one night.
  • Many people feel better after this treatment.
  • If the treatment works, you won't need heart rhythm medicine.
  • Ablation has risks, although they are rare. They include stroke and death.
  • If ablation doesn't work the first time, you may choose to have it done again.
Don't have catheter ablationDon't have catheter ablation
  • You take heart rhythm medicine to treat atrial fibrillation.
  • You don't have to worry about the 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.

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.

More important
Equally important
More important

The side effects of my heart medicines are bothering me a lot.

The medicine side effects don't bother me that much.

More important
Equally important
More important

I'm bothered a lot by my heart rhythm symptoms.

My symptoms don't bother me.

More important
Equally important
More important

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.

More important
Equally important
More important

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.

More important
Equally important
More important

My other important reasons:

My other important reasons:

More important
Equally important
More important

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

Leaning toward
Undecided
Leaning toward

What else do you need to make your decision?

Check the facts

1, Does catheter ablation work well for everyone with atrial fibrillation?
2, Are blood thinners that are used to lower the risk of stroke still needed after catheter ablation?
3, If ablation doesn't work the first time, can it be done again?

Decide what's next

1,Do you understand the options available to you?
2,Are you clear about which benefits and side effects matter most to you?
3,Do you have enough support and advice from others to make a choice?

Certainty

1. How sure do you feel right now about your decision?

Not sure at all
Somewhat sure
Very sure

Your Summary

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.

Your decision

Next steps

Which way you're leaning

How sure you are

Your comments

Your knowledge of the facts

Key concepts that you understood

Key concepts that may need review

Getting ready to act

Patient choices

Credits and References

Credits
AuthorHealthwise Staff
Clinical Review BoardClinical Review Board
All Healthwise education is reviewed by a team that includes physicians, nurses, advanced practitioners, registered dieticians, and other healthcare professionals.

References
Citations
  1. Lorange Z, et al. (2020). Procedural patterns and safety of atrial fibrillation ablation: Findings from Get With the Guidelines—Atrial Fibrillation. Circulation: Arrhythmia and Electrophysiology, 13: e007944. DOI: 10.1161/CIRCEP.119.007944. Accessed September 22, 2020.
  2. Hindricks G, et al. (2021). 2020 ESC guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). European Heart Journal, 42(5): 373–498. DOI: 10.1093/eurheartj/ehaa612. Accessed February 8, 2021.
  3. January CT, et al. (2019). 2019 AHA/ACC/HRS Focused update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation. Circulation, published online January 28, 2019. DOI: 10.1161/CIR.0000000000000665. Accessed January 31, 2019.
  4. January CT, et al. (2014). 2014 AHA/ACC/HRS Guideline for the management of patients with atrial fibrillation: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. Circulation, published online March 28, 2014. DOI: 10.1161/​CIR.0000000000000041. Accessed April 18, 2014.
  5. Calkins H, et al. (2017). 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. Heart Rhythm, 14(10): e275–e444. DOI: 10.1016/j.hrthm.2017.05.012. Accessed October 17, 2017.
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?

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
  1. Get the facts
  2. Compare your options
  3. What matters most to you?
  4. Where are you leaning now?
  5. What else do you need to make your decision?

1. Get the Facts

Your options

  • Have catheter ablation.
  • Don't have catheter ablation.

Key points to remember

  • Catheter ablation is a way to treat atrial fibrillation. It is done to restore a normal heart rhythm and to relieve symptoms.
  • 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 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. It has some serious risks, such as stroke, but they are rare.
  • If you take a blood-thinning medicine to prevent stroke, you will continue to take it after an ablation.
FAQs

What is 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.

When is catheter ablation done?

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

How well does catheter ablation work?

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.5

Things that limit how well catheter ablation works include older age and other heart problems.5You 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.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.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.

What are the risks?

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.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.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.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.5Many 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.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.2

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.
  • You do not want to take heart rhythm medicines.
  • 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.

2. Compare your options

Have catheter ablationDon't have catheter ablation
What is usually involved?
  • The treatment is done in a hospital and takes about 2 to 4 hours.
  • You probably will not be fully awake during the treatment. You may be lightly sedated or completely asleep.
  • You will probably stay in the hospital for at least one night.
  • You take heart rhythm medicine to treat atrial fibrillation.
What are the benefits?
  • Many people feel better after this treatment.
  • If the treatment works, you won't need heart rhythm medicine.
  • You don't have to worry about the serious risks of ablation.
What are the risks and side effects?
  • Ablation has risks, although they are rare. They include stroke and death.
  • If ablation doesn't work the first time, you may choose to have it done again.
  • 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.

Personal stories

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

3. 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.

More important
Equally important
More important

The side effects of my heart medicines are bothering me a lot.

The medicine side effects don't bother me that much.

More important
Equally important
More important

I'm bothered a lot by my heart rhythm symptoms.

My symptoms don't bother me.

More important
Equally important
More important

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.

More important
Equally important
More important

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.

More important
Equally important
More important

My other important reasons:

My other important reasons:

More important
Equally important
More important

4. 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

Leaning toward
Undecided
Leaning toward

5. What else do you need to make your decision?

Check the facts

1. Does catheter ablation work well for everyone with atrial fibrillation?

  • Yes
  • No
  • I'm not sure
You're right. Catheter ablation helps many people who have atrial fibrillation. But it doesn't work for everyone.

2. Are blood thinners that are used to lower the risk of stroke still needed after catheter ablation?

  • Yes
  • No
  • I'm not sure
That's correct. Experts don't know if ablation lowers the risk of stroke. If a person takes a blood thinner before having an ablation, they will continue to take it to lower the risk of stroke.

3. If ablation doesn't work the first time, can it be done again?

  • Yes
  • No
  • I'm not sure.
That's right. You may choose to have it done a second time. Repeated ablations have a higher chance of success.

Decide what's next

1. Do you understand the options available to you?

2. Are you clear about which benefits and side effects matter most to you?

3. Do you have enough support and advice from others to make a choice?

Certainty

1. How sure do you feel right now about your decision?

Not sure at all
Somewhat sure
Very sure

2. Check what you need to do before you make this decision.

  • I'm ready to take action.
  • I want to discuss the options with others.
  • I want to learn more about my options.
Credits
ByHealthwise Staff
Clinical Review BoardClinical Review Board
All Healthwise education is reviewed by a team that includes physicians, nurses, advanced practitioners, registered dieticians, and other healthcare professionals.

References
Citations
  1. Lorange Z, et al. (2020). Procedural patterns and safety of atrial fibrillation ablation: Findings from Get With the Guidelines—Atrial Fibrillation. Circulation: Arrhythmia and Electrophysiology, 13: e007944. DOI: 10.1161/CIRCEP.119.007944. Accessed September 22, 2020.
  2. Hindricks G, et al. (2021). 2020 ESC guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). European Heart Journal, 42(5): 373–498. DOI: 10.1093/eurheartj/ehaa612. Accessed February 8, 2021.
  3. January CT, et al. (2019). 2019 AHA/ACC/HRS Focused update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation. Circulation, published online January 28, 2019. DOI: 10.1161/CIR.0000000000000665. Accessed January 31, 2019.
  4. January CT, et al. (2014). 2014 AHA/ACC/HRS Guideline for the management of patients with atrial fibrillation: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. Circulation, published online March 28, 2014. DOI: 10.1161/​CIR.0000000000000041. Accessed April 18, 2014.
  5. Calkins H, et al. (2017). 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. Heart Rhythm, 14(10): e275–e444. DOI: 10.1016/j.hrthm.2017.05.012. Accessed October 17, 2017.

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