Atrial Fibrillation Treatment: Medication vs Ablation

Medically Reviewed by Dr. K on 12 April 2021

If you have recently been diagnosed with atrial fibrillation (AF), which is a type of irregular heartbeat, you're probably wondering what is the best way to treat it.

Medication can aid in the control of your heartbeat. Ablation is a procedure that causes scar tissue to form on your heart, which can also control your heartbeat. Symptoms may worsen if they are not treated.

For AF, doctors used to first prescribe medicine. If that didn't work, the next step was ablation. According to some studies, attempting ablation earlier may lead to better and longer-lasting results.

What Is Ablation?

The most common form of this treatment is catheter ablation. It can stop the faulty signals that cause your heart to beat out of rhythm by forming scar tissue.

A small incision will be made in a vein in your arm, groin, upper thigh, or neck by the doctor. You will be given painkillers so that you will not feel anything.

A catheter (a long, thin tube) will be inserted into your vein and into your heart by the doctor. Your doctor directs it to the location in your heart that is causing the bad signal. Scars will be created on that area using extreme cold, laser light, or radio waves. Electrical signals cannot pass through the damaged area.

The procedure will be performed in a hospital by your doctor. It takes between 3 and 6 hours. The majority of people return home the following day. Any discomfort should disappear within a week.

You must take medication until the ablation becomes effective. If the procedure is successful, your heart rhythm will function normally within three months.

Does Ablation Cure Atrial Fibrillation?

AF may disappear for a long time, but it can reappear.

If you have persistent or chronic AF, you may require a second ablation within a year although it is uncommon. If you've had AF for more than a year, you might need one or more treatments to get it under control.

If your symptoms are intermittent (your doctor will refer to this as paroxysmal AF), ablation is more likely to be effective. After one treatment, approximately three out of every four people will have a normal heart rhythm. For the most part, a second treatment will eliminate AF.

Ablation may not be helpful for everyone. The most difficult patients to treat are the elderly and those with other heart problems.

Medication For Atrial Fibrillation

Typical medications include the following:

  • Blood thinners to help prevent and treat clots
  • Beta-blockers or calcium channel blockers can help you maintain a healthy heart rate.
  • Sodium channel blockers or potassium channel blockers are used to slow down the heart rhythm.

Generally, these medications alleviate symptoms. However, after a year, roughly half of those who take them discover that they no longer work.

You may experience side effects. One of the most common is that you will bleed more easily if you take blood clot-preventing medications.

Medication or Ablation

A recent clinical trial discovered that ablation was more beneficial than medication for people with sporadic AF and heart failure. Over an 8-year period, those who received ablation were half as likely as those who only took medicine to be admitted to a hospital. In addition, fewer people died as a result of ablation.

The two treatments were compared in a 5-year study. It also stated that ablation was more effective than medication alone in treating people with sporadic AF.

The longer you have had AF, the less likely it is that any treatment will be effective. One study focused on people who had long-term, persistent AF. Once again, the outcome continued to improve. People who received the treatment were less likely to experience recurrence of symptoms than those who only took medication. During the study, the group that took medicine also required more hospital stays than the other group.

Does Treatment Have Risks

Yes. Discuss the advantages and disadvantages of AF medications or ablation with your doctor. Your history is going to be a factor.

Certain AF drugs may not be safe if:

  • You have food or dyes allergies.
  • You are pregnant, breastfeeding, or planning to become pregnant.
  • You are over the age of 60.
  • You have liver or kidney disease, lupus, or another type of heart disease.
  • You suffer from asthma, lung disease, or breathing difficulty.

Catheter ablation is a relatively safe procedure. The most common issue is bleeding or infection at the site where the tube enters your blood vessel.

In addition, nearly one-third of people who have ablation will experience a new heart flutter. You may need a second ablation if the medication does not stop it.

Combination Treatment: Medications and Ablation

Yes. For several people with AF, combining ablation with medication produces the best results.

Even though there is no cure for AF, these treatments can help you manage your symptoms and prevent heart failure or stroke.

Sources

Referenced on 9.4.2021

  1. https://www.webmd.com/heart-disease/atrial-fibrillation/medicine-or-ablation
  2. National Heart, Lung, and Blood Institute: “Atrial Fibrillation,” “Catheter Ablation.”
  3. JAMA Cardiology: “Efficacy of Catheter Ablation for Nonparoxysmal Atrial Fibrillation.”
  4. Mayo Clinic: “Atrial fibrillation ablation.”
  5. American Heart Journal: “Trends and predictors of repeat catheter ablation for atrial fibrillation.”
  6. University of Michigan, Frankel Cardiovascular Health Center: “Catheter Ablation.”
  7. Cleveland Clinic: “4 Top Questions About Radiofrequency Ablation for Afib Answered.”
  8. American Heart Association: “Ablation for Arrhythmias,” “Atrial Fibrillation Medications.”
  9. New England Journal of Medicine: “Catheter Ablation for Atrial Fibrillation with Heart Failure.”
  10. Heart: “Long-term efficacy of catheter ablation as first-line therapy for paroxysmal atrial fibrillation: 5-year outcome in a randomised clinical trial.”
  11. Texas Heart Institute: “Antiarrhythmics.”

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