Harvard Heart Letter

Ask the doctor: Catheter ablation for afib

Q. I have been taking a heart rhythm medicine to treat my atrial fibrillation. However, it is not working very well. Should I consider a catheter ablation procedure or try other medicines first?

A. Catheter ablation uses a zap of radiofrequency heat energy to burn away cells that cause atrial fibrillation (afib). According to the 2014 guidelines from the American College of Cardiology on afib management, there is a role for catheter ablation if symptoms continue despite the use of medications. Some research even suggests that this procedure may be better than medications for eliminating afib symptoms in the short run. However, symptoms sometimes return a couple of years after the procedure.

Another concern about ablation is safety. While medicines used to treat afib are generally quite safe and usually well tolerated, ablation has serious risks. Newer devices seek to minimize these problems with features such as catheter tips infused with saline to prevent them from overheating or creating blood clots. Catheters that use laser beams or freezing instead of heat to destroy problem tissue are also being developed. Ask your doctor if it's best to try other medications or explore catheter ablation in your case. If you choose ablation, find a physician who has extensive experience with the procedure.

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