To correct the arrhythmia itself, there are no "magic pills." "In general, most of the anti-arrhythmic medications we have today are effective between 45% and 55% of the time,” says Wylie. Some are more effective than others, and they all come with their own side effects. The most effective, amiodarone, also carries a side-effect burden, including potential thyroid, lung, and liver damage. “It requires frequent monitoring, just to be sure the person is tolerating it,” says Whang.
If you’ve tried multiple anti-arrhythmic drugs but still can’t seem to get control of your AFib symptoms, doctors may recommend catheter ablation, a nonsurgical but invasive procedure.
During a catheter ablation, doctors make small incisions in the groin and thread long, thin tubes called catheters through a vein up to your heart. The catheters can deliver either radiofrequency (heating energy) or cryoablation (freezing energy) to treat areas in the atrium that are triggering and sustaining the atrial fibrillation. Basically, it creates scar tissue in certain areas of the heart that cause AFib, disconnecting them electrically from the rest of the heart.
How well does it work? For patients who are in persistent atrial fibrillation and have had multiple cardioversions, Wylie says, the success rate is about 50%-60%. For “paroxysmal” patients -- those in and out of AFib -- success is higher, about 70%-75%.
“There are dramatic cases of people in AFib who have had their quality of life ruined by symptoms, and afterward, their frequency of AFib goes down to essentially zero,” says Whang. "We don’t yet know, though, if ablation for AFib improves actual stroke risk and survival, as opposed to just quality of life.”
And those success figures are based on 1.5 procedures per patient, Wylie adds. “That means that there’s a 50-50 chance you’ll need a second procedure to get results.”
Catheter ablation has its own risks, as well. Overall, about 5% of patients have some type of complication, including bleeding where the catheter enters the groin or when it perforates the heart, as well as a 1% risk of stroke. And in very rare cases -- fewer than 1 in 1,000 -- an esophageal fistula can develop, which is an opening between the heart’s left atrium and the esophagus. “That’s a life-threatening complication and is fatal about half of the time,” says Wylie.