Procedures That Reset Your Heart's Rhythm

Medically Reviewed by Brunilda Nazario, MD on June 20, 2013
4 min read

Not everyone with atrial fibrillation needs to correct it. Some people with an irregular heartbeat can go years without any treatment other than stroke prevention.

"A lot of people have so-called chronic AFib, where it's there all the time. But as long as their heart rate isn't too fast, they're able to live their lives normally, and in some cases don't even notice it," says William Whang, MD, assistant professor of clinical medicine in cardiology at Columbia University Medical Center.

Symptoms of atrial fibrillation can include:

If you don't have any of these problems and your heart is pumping blood normally, your doctor may not try to get it back into a normal rhythm.

"There's no evidence showing that doing this will make a person live longer or have a lower stroke risk," says John Wylie, MD, director of electrophysiology services for Massachusetts-based Caritas Christi Health Care. "So it's hard to make the case for prescribing drugs and surgical interventions, which have their own risks."

But when you do have symptoms, that's a different story. If your heart goes in and out of a normal beat, you may be able to control it with medication alone. If you're in AFib all of the time, your doctor may recommend something else.

This is one of the first options to reset your heart. You'll be asleep under anesthesia, and the doctor will zap your chest with an electric shock.

"This isn't a permanent fix," Whang says. Your heart could fall out of sync again by the time you get home. "But getting the person back into normal rhythm, even for a short time, can tell us whether or not that makes them feel better. That tells us what we should do about treatment."

For example, a young person may not think that their AFib is causing them trouble. But after cardioversion, "They'll say, 'Wow, I didn't realize I was feeling so bad! I thought I was just getting lazy. But it was really the AFib that was sapping my energy,'" Wylie explains.

Before you have a cardioversion, you'll probably need to take medication called a blood thinner for a month. This will give your body time to dissolve any blood clots lurking inside your heart that could come loose because of the procedure and lead to a stroke.

If your symptoms are too severe to wait that long, the doctor will check for clots in your heart by doing a transesophageal echocardiogram (TEE). While you're sedated, they'll put a long, flexible tube with a small device down your throat until it's behind the top of your heart. This device sends out sound waves and picks up their echoes to make a picture on a computer screen. If the doctor doesn't see any clots, you'll be good to go.

Someone whose AFib tends to come back may also need medication to help keep their heart beating normally.

If you still can't seem to get control of your AFib, doctors may recommend a procedure to wipe out the heart tissue that's causing the misfiring signals. It isn't surgery, but you will need a small cut.

The doctor will thread a long, thin tube called a catheter through a vein from your leg or your neck into your heart. Then they'll use heat, cold, or radio energy to create scars on specific places of your heart, which stops them from sending or passing electrical signals.

For people who have ongoing atrial fibrillation and have had more than one cardioversion, Wylie says ablation works a little more than half the time. The success rate is higher, about 70% to 75%, for people whose AFib comes and goes.

"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," Whang says. While we know ablation improves quality of life, we don't yet know its effect on stroke risk and survival.

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, too. Overall, about 5% of patients have some type of complication, including bleeding where the catheter goes into your body or when it enters the heart, as well as a 1% risk of stroke. And in very rare cases -- fewer than 1 in 1,000 -- an opening can develop between the heart and the esophagus. "That's a life-threatening complication and is fatal about half of the time," Wylie says.

If you're already planning heart surgery, your doctor may skip the catheter and do the ablation while you're in the operating room.