Treat Atrial Fibrillation With Ablation and Pacemaker

Medically Reviewed by James Beckerman, MD, FACC on December 04, 2019

If your heartbeat is out of whack from atrial fibrillation and medicine doesn't help, your doctor might suggest two high-tech solutions.

They may try to get your ticker's rhythm back in the right groove with a procedure called ablation. Or they may put a pacemaker in your chest -- a device that sends out pulses to keep your heartbeat on track. Some people need both methods.

Your doctor can help you decide which treatment is right for you, but learn as much as you can about the pros and cons. It will give you the confidence to move forward with a treatment plan that can get your heart pumping right.

Whatever you decide, it's important to get your AFib under control. When your heartbeat isn't regular -- or is too fast or too slow -- you're at a higher risk for blood clots and strokes.

What Is Ablation?

It uses energy to destroy tiny areas of your heart muscle that set off the irregular rhythm. A doctor does the procedure in spots where AFib starts, which is often in your pulmonary veins. Those are the 4 blood vessel that carries oxygen-rich blood from the lungs to your heart.

It's rare, but sometimes you may need to have ablation of the AV node. It's the place that electrical signals pass through as they travel from the upper to the lower heart chambers.

Doctors may do ablation there if you have very rapid atrial fibrillation that you can't control with medication. But if you get the procedure in your AV node, your heartbeat may become too slow. You'll need to get a pacemaker put into your chest.

What Happens During Ablation?

Your doctor puts long, thin tubes called catheters into blood vessels in your leg or neck, and then guides them to your heart. One catheter has an ultrasound at the end -- a device that uses soundwaves to let the doctor see an image of your ticker.

During the procedure, energy from radio waves or lasers travels through the catheter. It burns the parts of your heart that cause the messed-up electrical signals that trigger your rhythm problems. After a few weeks, scars form in those spots, which stop the faulty signals and bring back a steady heart rhythm.

Pros. There are lots of good reasons to have an ablation. It can often stop AFib, and it can also:

  • Help prevent blood clots and strokes
  • Relieve shortness of breath and tiredness
  • Reduce your need for blood thinners and heart rhythm drugs
  • Help you exercise more often and for longer amounts of time
  • Improve the length and quality of your life

For some folks, ablation restores a normal heart rhythm better than medicine.

Cons. Ablation is generally safe, but it does have some risks. Some of the things that can go wrong are:

  • Bleeding around your heart or where the catheter is inserted
  • Hole in the heart
  • Stroke
  • Heart attack
  • Narrowing of the pulmonary vein
  • Damage to the esophagus, the tube that carries food from your mouth to your stomach

Also, your AFib can come back in the first few months after you have ablation. In that case, you may need to have the procedure again, or take heart rhythm drugs.


It's a small device that monitors your heartbeat and sends out a signal to stimulate your heart if it's beating too slowly. Pacemakers are used to treat a slow heartbeat in people with AFib.

The device is made up of a small box called a generator. It holds a battery and tiny computer.

Very thin wires called leads connect the pacemaker to your heart. Impulses flow through the leads to keep the organ in rhythm.

What Happens When You Get a Pacemaker?

It may sound like a big deal, but it's a minor procedure. First, your doctor inserts a needle into a large vein near your shoulder, which guides the leads into your heart.

The pacemaker then goes into your chest through a small cut. Once it's in place, your doctor tests it to make sure it works.

Pros. Your doctor can program your pacemaker to meet your needs. It should keep your heart in rhythm and help you stay more active.

Cons. The surgery to put in the device is safe, but there are some risks, such as:

  • Bleeding or bruising in the area where your doctor places the pacemaker
  • Infection
  • Damaged blood vessel
  • Collapsed lung
  • If there are problems with the device, you may need another surgery to fix it.

Sometimes the impulses your pacemaker sends to your heart can cause discomfort. You may be dizzy, or feel a throbbing in your neck.

Once you have one put in, you might have to keep your distance from objects that give off a strong magnetic field, because they could affect the electrical signals from your pacemaker.

Some devices that can interfere with it are:

  • Metal detectors
  • Cell phones and MP3 players
  • Electric generators
  • Some medical machines, such as an MRI

Your doctor will help you choose the right treatment based on your health. Talk over the risks and benefits with them, and weigh them carefully before you make up your mind.

WebMD Medical Reference



AHRQ: "Radiofrequency Ablation for Atrial Fibrillation: A Guide for Adults."

American Heart Association: "Non-surgical procedures for atrial fibrillation," "What is Atrial Fibrillation (AFib or AF)?"

Cleveland Clinic: "Pulmonary vein isolation ablation."

Haegeli, Laurent M. European Heart Journal, July 2014.

January, Craig T. Circulation, 2014.

Massachusetts General Hospital: "Catheter Ablation for the Treatment of Atrial Fibrillation."

Mount Sinai St. Luke's: "A patient guide to atrial fibrillation and catheter ablation."

National Heart, Lung, and Blood Institute: "How Does a Pacemaker Work?" "How Will a Pacemaker Affect My Lifestyle?" "What are the Risks of Pacemaker Surgery?" "What to Expect During Pacemaker Surgery."

The Society of Thoracic Surgeons: "HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Personnel, Policy, Procedures, and Follow-Up."

The University of Chicago Medicine: "Surgical Treatment for Atrial Fibrillation."

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