AFib Treatments: Ablation vs. Medication

Your doctor said you have atrial fibrillation (AFib), a type of irregular heartbeat. Now you’re wondering what’s the best way to treat it.

Medication can help control your heartbeat. So can ablation, a treatment that creates scar tissue on your heart. Without treatment, symptoms often get worse.

Doctors used to prescribe medication first for AFib. If that didn’t help, ablation was the next step. Today, studies show that trying ablation earlier could give better and longer lasting results.

What Is Ablation?

Catheter ablation is the most common form of this treatment. The scar tissue it creates can stop the faulty signals that cause your heart to beat out of rhythm.

The doctor will make a small cut in a vein in your arm, groin, upper thigh, or neck. You’ll get pain medication so you won’t feel anything.

The doctor will thread a catheter (a long, thin tube) through the vein and into your heart. Your doctor guides it to the place in your heart that’s creating the bad signal. They’ll use extreme cold, laser light, or radio waves to make scars on that area. Electrical signals can’t cross the damaged area.

Your doctor will do the procedure in a hospital. It takes 3 to 6 hours. Most people go home the next day. Any soreness should be gone in a week.

You have to take medication until the ablation takes effect. If it’s successful, your heart rhythm will be back to normal within 3 months.

Does Ablation Cure AFib?

There’s no cure for AFib. It may go away for a long time, but it can return.

It’s rare, but if you have persistent or chronic AFib, you might need a second ablation within 1 year. If you’ve had AFib for more than a year, you’ll always need one or more treatments to fix the problem.

If your symptoms come and go (your doctor will call this sporadic AFib), ablation is more likely to work for you. About 3 out of 4 people will have a normal heart rhythm after one treatment. A second treatment will get rid of AFib for most of the rest.

Ablation may not help everyone. Older adults and those with other heart conditions are the hardest to treat.

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How Does Medication Control AFib?

Common medications may include:

These medicines usually relieve symptoms. After a year, though, about half of the people taking them find they no longer work.

You might have side effects. One common one is bleeding more easily when you take drugs designed to prevent blood clots.

Medicine or Ablation: What Does the Research Say?

A recent clinical trial found that people with sporadic AFib and heart failure benefited more from ablation than medication. Over 8 years, those who got ablation were half as likely to be admitted to a hospital as those who took medicine only. And fewer people who had ablation died.

A 5-year study compared the two treatments. It also showed that ablation worked better than medication for treating people with sporadic AFib alone.

The longer you have AFib, the less likely any treatment will work. One study looked at people with longstanding, persistent AFib. Again, ablation led to better results. Symptoms were less likely to return in people who had the treatment than those taking medication only. The group that took medicine also required more hospital stays during the study than the other group.

Does Treatment Have Risks?

Yes. Talk to your doctor about the pros and cons of treating AFib with medication or ablation. Your medical history will be a factor.

Certain AFib medications may not be safe if:

Catheter ablation is a low-risk procedure. The most common problem is bleeding or infection where the tube goes into your blood vessel.

Also, close to a third of people who have ablation will feel a new heart flutter. If medication doesn’t stop it, you may need a second ablation.

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Can These Treatments Be Combined?

Yes. For many people with AFib, the best results are achieved by pairing ablation with medicine.

Even if your AFib doesn’t go away, these treatments can still help control your symptoms and prevent heart failure or stroke.

WebMD Medical Reference Reviewed by James Beckerman, MD, FACC on March 24, 2018

Sources

SOURCES:

National Heart, Lung, and Blood Institute: “Atrial Fibrillation,” “Catheter Ablation.”

JAMA Cardiology: “Efficacy of Catheter Ablation for Nonparoxysmal Atrial Fibrillation.”

Mayo Clinic: “Atrial fibrillation ablation.”

American Heart Journal:Trends and predictors of repeat catheter ablation for atrial fibrillation.”

University of Michigan, Frankel Cardiovascular Health Center: “Catheter Ablation.”

Cleveland Clinic: “4 Top Questions About Radiofrequency Ablation for Afib Answered.”

American Heart Association: “Ablation for Arrhythmias,” “Atrial Fibrillation Medications.”

New England Journal of Medicine: “Catheter Ablation for Atrial Fibrillation with Heart Failure.”

Heart: “Long-term efficacy of catheter ablation as first-line therapy for paroxysmal atrial fibrillation: 5-year outcome in a randomised clinical trial.”

Texas Heart Institute: “Antiarrhythmics.”

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