Ablation for atrial fibrillation (AFib) uses either hot or cold energy to destroy the tissue that’s causing an electrical disturbance in the heart. It can be very successful in restoring a normal heart rhythm, but the procedure isn’t always a permanent cure or without risk.

Atrial fibrillation (AFib) is a condition in which the heart’s upper chambers (atria) beat in an unpredictable, irregular manner. It interferes with normal blood flow and raises the risk of a blood clot forming in the atria.

Ablation is one of several treatment options for AFib. This minimally invasive catheter procedure delivers either hot or cold energy to the problematic area of the heart. Once the tissue that’s causing the rhythm disturbance is destroyed, the disruption to the heart rhythm may disappear.

While ablation is often successful, it’s not always a permanent cure nor is it without risk.

Your healthcare team can advise you on whether you’re a good candidate for ablation or whether another treatment is more appropriate.

Ablation uses radiofrequency (heat) or cold energy (cryoablation) to scar a small section of heart tissue that your doctor has identified as the likely cause of your heart’s electrical problems.

The heart relies on a steady, consistent flow of electrical impulses to coordinate the beating of the atria (upper chambers) and the ventricles (lower chambers). When the electrical flow to the heart’s upper chambers doesn’t work correctly, it can cause a fast and irregular rhythm. Eliminating the cause of this problem often allows the heart to return to a normal, healthy rhythm.

Ablation isn’t always the first-line treatment for AFib. Some people may start with antiarrhythmic medications, such as:

Appropriate candidates for ablation are people who haven’t had much success with medications or who can’t tolerate the medications.

For a long time, doctors started most people with AFib on antiarrhythmic medications before trying other treatments. But updated treatment recommendations suggest that ablation could be considered a first-line treatment, even before medications are tried.

Also, ablation may be considered for people with heart failure and reduced ejection fraction, in order to reduce hospitalizations and the risk of death.

If you have an enlarged heart or aren’t a good candidate for surgery (due to frailty or other serious health condition), your doctor may recommend another approach to managing your AFib, rather than taking a risk with ablation.

Ablation can either be done surgically — usually when undergoing heart surgery for another reason, such as getting a heart valve fixed. Or, it can be done with a less invasive procedure called pulmonary vein isolation. This is done in a hospital’s electrophysiology or cardiac catheterization lab.

Ablation is often done as an outpatient procedure, and typically involves the following steps:

  • You’ll either be fully sedated with general anesthesia or given local anesthesia in the area where the catheter (thin tube) is inserted so you can stay calm and comfortable. This means you’ll be awake during the procedure.
  • Once the area where the catheter will be inserted is cleaned, your doctor will make an incision and insert a thin, flexible tube into one of your large blood vessels. This incision is usually in the leg or groin.
  • The doctor will guide the catheter through the blood vessel until it gets to the part of your heart the arrhythmia is coming from.
  • The catheter can map out the heart onto a computer screen. Once the area of concern is identified, either radiofrequency or cryotherapy will be used to burn or freeze the affected area.
  • Once the small area of tissue is destroyed, the catheters are withdrawn and the incision is closed.
  • The entire process can take about 4 hours.

Recovery from ablation

After the procedure, your healthcare team will move you to a recovery room, where you’ll need to lie flat for several hours to avoid bleeding complications in your leg. Sometimes pressure is applied to help prevent bleeding.

Heart functions, including your blood pressure and pulse rate, will be monitored. Your heart rhythm will also be monitored to check for any complications. If you have any symptoms, such as chest pain, it’s important that you let your healthcare team know.

While most ablation procedures are performed on an outpatient basis, some people may need to stay overnight for observation.

When you’re discharged, you’ll receive written instructions about medication use and when it’s safe to resume your regular activities. Most heavy lifting and physical exertion should be avoided for at least 1 to 2 weeks.

In the hands of an experienced physician, catheter ablation is usually a safe and well tolerated procedure. However, as with most procedures, there are some risks. In addition to bleeding at the site of the incision, some possible ablation risks include:

  • blood clot formation or stroke
  • damage to the blood vessel used to thread the catheter to the heart
  • damage to the heart’s electrical system
  • damage to the esophagus, which sits behind the heart
  • pericardial effusion
  • pulmonary vein stenosis (a late onset complication)

You may also need a follow-up ablation procedure if the initial ablation failed to destroy all the tissue causing the rhythm problem.

Ablation for AFib can be effective. Long-term success in the treatment of AFib with ablation is between 50% and 60%, as defined by the absence of AFib episodes lasting longer than 30 seconds. However, subsequent ablation procedures are often necessary.

A 2019 study on radiofrequency ablation and cryoablation suggests that there’s no significant difference between the two techniques (burning versus freezing) in terms of effectiveness.

The National Heart, Lung, and Blood Institute reports that the risk of AFib returning is highest in the first few weeks after ablation. A second ablation is often possible, but AFib recurrence after that may need a different treatment approach.

People taking antiarrhythmic medications before ablation may need to take these medications for at least several weeks after the procedure. Your doctor will determine whether you need to continue your medications beyond this timeframe.

Because AFib can cause blood clots to form in the heart, you may need to continue taking blood thinners after the procedure.

Atrial fibrillation (AFib) is a heart condition that affects millions of people in the United States. Treatment options vary, but catheter ablation can often manage and successfully treat AFib. The procedure involves the use of radiofrequency (heat) or cryoablation (cold energy) to destroy the tissue that’s causing a heart rhythm disturbance.

While the procedure is often successful, it does pose some risks, such as blood clot formation and potential damage to the blood vessel that’s used to thread the catheter to the heart.

If you’ve received a diagnosis of AFib, talk with your doctor about whether you’re a good candidate for ablation and whether it’s an appropriate option for your arrhythmia.