Ablation for Afib: What Is the Success Rate?
Cardiovascular DiseasesAtrial Fibrillation
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Ablation and Other Atrial Fibrillation (Afib) Treatments: Which Is Right for You?

Ablation and Other Atrial Fibrillation (Afib) Treatments: Which Is Right for You?
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Updated on January 7, 2025
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Atrial fibrillation (afib) is a type of arrhythmia, or irregular heartbeat, in which the upper chambers of the heart don’t pump effectively. As a result, blood can pool in that area and raise the risk of serious complications such as blood clots, heart failure, or stroke.

If you’re one of the roughly 12 million people in the United States living with afib,

 proper treatment can restore a regular heart rhythm, manage symptoms, and reduce your risk of complications. But it’s important to understand what treatment options are available and work closely with your doctor to find the right regimen for you.

The Benefits of Catheter Ablation

A catheter ablation is a minimally invasive procedure in which a flexible tube is inserted into a vein in your groin, arm, neck, or upper thigh. This tube delivers radiofrequency energy to destroy abnormal heart tissue and restore a more regular heart rhythm.

Historically, doctors treated afib with medications first. If that was unsuccessful, the next step would be catheter ablation, explains Oussama Wazni, MD, the section head of cardiac electrophysiology and pacing at Cleveland Clinic. “But the overwhelming evidence now is that people may be better off considering ablation right away.”

More and more research shows that ablation maintains normal rhythm more effectively than antiarrhythmic drugs, and may also prevent hospitalizations, and thus should be considered a firstline therapy for afib.

Ablation also comes with other potential benefits and risks.

Reduction of Afib Symptoms

One of the main reasons for a cardiac ablation is to control symptoms such as shortness of breath or heart palpitations and improve quality of life.

Research shows that catheter ablation leads to significant improvements in quality of life in people with symptomatic afib in the year after the procedure.

 It may also reduce the frequency and duration of afib episodes over the course of five years in young adults.

People often seek care from their doctors for symptom relief, says Dr. Wazni, and addressing afib symptoms is an essential part of treatment.

Potential to Avoid Long-Term Medication

Ablation may lead to decreased reliance on atrial fibrillation medications. In fact, data shows that nearly 90 percent of people with afib no longer needed antiarrhythmic drugs after the procedure.

Ablation could also prevent afib from becoming more persistent or permanent, which can be much more difficult to treat and manage, adds Wazni.

Risks and Side Effects

While a catheter ablation treats atrial fibrillation, it does come with certain risks and side effects, which include:

  • Bleeding or infection at the catheter insertion site
  • Damage to a blood vessel or heart valve
  • A new or worsening arrhythmia
  • A slowed heart rate that requires additional treatment
  • Blood clot in the lungs or legs
  • Stroke or heart attack
  • Pulmonary vein stenosis, or a narrowing of the veins that carry blood between the heart and lungs
  • Kidney damage from contrast dye used during the procedure

But the exact risks depend on various factors, such as the type of ablation and why it’s done. And success rates for this procedure are high. So it’s important to discuss the exact risks and benefits with your doctor to determine whether or not you should undergo an ablation for atrial fibrillation.

Ablation vs. Other Medical Procedures

Other noninvasive and invasive interventions may be used to treat and manage atrial fibrillation.

Cardioversion

Cardioversion is a nonsurgical procedure that uses quick, low-energy shocks to restore the heart’s rhythm if it beats irregularly or too quickly. Two types of cardioversion can be used to treat atrial fibrillation:

  • Electrical cardioversion uses a machine with sensors to deliver a low-energy electrical shock to the chest to quickly restore normal heart rhythm.
  • Pharmacological cardioversion, also called chemical cardioversion, uses medication rather than shocks to reset the abnormal heart rhythm. It takes longer to do so than an electrical cardioversion.

“Cardioversion is an acute intervention to restore normal rhythm,” says Wazni. “It does not maintain the normal heart rhythm or prevent the recurrence of atrial fibrillation.” If you have this procedure, ablation or medication will still be needed to treat afib.

Pacemaker Implantation

A pacemaker is a small, battery-operated device that uses an electrical signal to help your heart beat at a healthier rhythm. While it’s not typically used to treat atrial fibrillation, there may be some cases where it’s part of your management plan. For example, if your heart rate outside of afib is very slow, or if you also have heart failure, you may need a pacemaker to keep a normal heart rhythm.

“A pacemaker is an adjunct therapy to help manage afib — it does not get rid of or treat afib,” says Wazni.

What to Know About Antiarrhythmic Drugs

Drugs were once considered the standard treatment for afib, but the conventional wisdom on when and how to use them to regulate heart rhythm has shifted.

“A few years ago, we would always use antiarrhythmic drugs, and if those failed, we’d do the ablation,” says Wazni. “But now the landscape has changed to the point where we can do an ablation first. However, if the ablation doesn’t work — if the atrium is very diseased or has a lot of scar tissue — the ablation may not be successful on its own. And at that point, we may add an antiarrhythmic drug.”

There are several drugs that may be prescribed to control heart rate and prevent complications related to afib.

Beta-Blockers

Beta-blockers have been used for decades as a first line therapy to help normalize a fast heart rate and treat arrhythmias like afib. They work by blocking the effects of the hormone epinephrine, also known as adrenaline, which helps lower blood pressure and widen veins to improve blood flow. Options include atenolol, metoprolol, and nadolol.

Beta-blockers come with certain risks and side effects, including:

While they continue to be prescribed to treat afib,

 some research notes that there’s no long-term safety and efficacy data around the use of beta-blockers to treat this condition, and the potential risks and side effects may not be worth it when other more favorable treatments are available.

Calcium Channel Blockers

Calcium channel blockers are drugs that prevent calcium from entering cells in the heart and arteries, which allow blood vessels to relax and open. As a result, calcium channel blockers can help slow heart rate in people who have atrial fibrillation. Options include diltiazem and verapamil.

Calcium channel blockers come with certain risks and side effects, including:

Research shows that calcium channel blockers may be less likely than beta-blockers to slow heart rate too much when used for people with nonpermanent afib.

Digoxin

Digoxin falls within the class of heart medicines known as digitalis glycosides.

When you have atrial fibrillation, digoxin may be prescribed to slow electrical signals in the heart and decrease your heart rate.

Digoxin may come with certain risks and side effects, which include:

  • Blurry or discolored vision
  • Dizziness or lightheadedness
  • Enlarged male breast tissue
  • Headache
  • Sleepiness
  • Skin rash
  • Upset stomach
  • Other issues with heart rate or rhythm
Digoxin may also lead to an increased risk of sudden death in people with afib, so other treatments may be recommended first.

Blood Thinners

Atrial fibrillation can cause blood to pool in the heart, which increases your risk of developing a blood clot that can then travel to your brain and cause a stroke. Blood thinners, such as coumadin (Warfarin) don’t treat atrial fibrillation directly, but they may be prescribed to help prevent blood clots from forming, and in turn, reduce your risk of a stroke.

 Blood thinners can lower the risk of stroke in people with atrial fibrillation by up to 66 percent.

A notable side effect that comes with blood thinners is an increased risk of bleeding. But a study led by Wazni found that a minimally invasive procedure called a left atrial appendage closure (which can even be done during a catheter ablation) resulted in significantly less bleeding than blood thinners — all while preserving the benefits of reduced stroke risk.

“Even if you have a successful ablation, the risk of stroke is still moderate to high,” says Wazni, who emphasizes that continuing to take steps to reduce stroke remains essential.

Atrial Fibrillation Treatment
How It Works

Beta-Blockers

Block the effects of epinephrine/adrenaline to widen veins, improve blood flow, and normalize heart rate

Calcium Channel Blockers

Prevent calcium from entering the cells in the heart and arteries to slow heart rate

Digoxin

Slows electrical signals in the heart to decrease heart rate

Blood Thinners

Prevent blood clots from forming to reduce stroke risk

Catheter Ablation

Radiofrequency energy used to destroy the abnormal heart tissue that leads to irregular heartbeats and restore more regular heart rhythm

Left Atrial Appendage Closure

Seals off the left atrial appendage to prevent blood clots from entering the blood stream and eliminates the need for blood thinners

Cardioversion

Electric shock or medication used to reset an abnormal heart rhythm

Pacemaker

Uses an electrical signaling device to help your heart beat more normally

How to Decide on Treatment

When you have atrial fibrillation, it’s important to work closely with your doctor to come up with the right treatment and management plan. “It’s a shared decision process,” emphasizes Wazni.

You’ll want to consider factors such as:

  • The type of atrial fibrillation you have
  • Your afib symptoms
  • Your age
  • Your overall health (including any other health conditions you may have)

Questions to Ask Your Doctor

  • What type of atrial fibrillation do I have? 
  • Am I a good candidate for catheter ablation?
  • Are there other afib treatments I should try before ablation? 
  • What signs of stroke should I be aware of?
  • How do I know if my treatment is working?
  • How often should I schedule afib checkups?
  • Are there any lifestyle changes that may also help me manage afib and stroke risk?

The Takeaway

  • Catheter ablation is a minimally invasive, highly successful procedure that can be used as a first-line treatment for atrial fibrillation to help restore normal heart rhythm.
  • Other treatment options, including medications like beta-blockers or calcium channel blockers, may also be used to treat afib in some cases.
  • While atrial fibrillation can increase your risk of stroke, blood thinners or a procedure called left atrial appendage closure may reduce stroke risk.
  • Make decisions in partnership with your doctor to determine the atrial fibrillation treatment regimen that’s right for you.
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Chung Yoon, MD

Medical Reviewer
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Chung Yoon, MD, is a noninvasive cardiologist with a passion for diagnosis, prevention, intervention, and treatment of a wide range of heart and cardiovascular disorders. He enjoys clinical decision-making and providing patient care in both hospital and outpatient settings. He excels at analytical and decision-making skills and building connection and trust with patients and their families.
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Kerry Weiss is a New York–based freelance writer, editor, and content strategist specializing in health and wellness. She has contributed to a variety of online publications, including Healthline, WebMD, Sharecare, Twill Care, and What to Expect.
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Resources
  1. What Is Atrial Fibrillation. American Heart Association. March 23, 2023.
  2. About Atrial Fibrillation. Centers for Disease Control and Prevention. May 15, 2024.
  3. Atrial Fibrillation. Mayo Clinic. March 8, 2024.
  4. Ablation for Arrhythmias. American Heart Association. October 24, 2024.
  5. Turagam MK et al. Assessment of Catheter Ablation or Antiarrhythmic Drugs for First-line Therapy of Atrial Fibrillation: A Meta-analysis of Randomized Clinical Trials. JAMA Cardiology. April 28, 2021.
  6. Kheiri B et al. Ablation Versus Antiarrhythmic Drugs as First-Line Treatment of Paroxysmal Atrial Fibrillation: A Meta-Analysis of Randomized Trials. Circulation: Arrhythmia and Electrophysiology. August 2021.
  7. Rottner L et al. Atrial Fibrillation Ablation: Current Practice and Future Perspectives. Journal of Clinical Medicine. December 7, 2023.
  8. Mark DB et al. Effect of Catheter Ablation vs Medical Therapy on Quality of Life Among Patients With Atrial Fibrillation The CABANA Randomized Clinical Trial. JAMA Network. March 15, 2019.
  9. Johnson BM et al. Atrial Fibrillation Ablation in Young Adults: Measuring Quality of Life Using Patient-Reported Outcomes Over 5 Years. Circulation: Arrhythmia and Electrophysiology. June 2023.
  10. Osorio J et al. Real-World Data of Radiofrequency Catheter Ablation in Paroxysmal Atrial Fibrillation: Short- and Long-Term Clinical Outcomes From the Prospective Multicenter REAL-AF Registry. Heart Rhythm. November 2024.
  11. Cardiac Ablation. Mayo Clinic. February 2, 2024.
  12. Heart Ablation. Cleveland Clinic. May 17, 2022.
  13. Cardioversion. Mayo Clinic. June 28, 2024.
  14. What Are Pacemakers? National Heart, Lung, and Blood Institute. March 24, 2002.
  15. Wołowiec Ł et al. Beta-blockers in cardiac arrhythmias — a clinical pharmacologist’s point of view. Frontiers in Pharmacology. January 9, 2023.
  16. Beta-Blockers. Mayo Clinic. August 22, 2023.
  17. Author Meyer M et al. Beta-Blockers in Atrial Fibrillation — Trying to Make Sense of Unsettling Results. EP Europace. February 2023.
  18. Calcium Channel Blockers. Mayo Clinic. August 23, 2023.
  19. Atrial Fibrillation Medications. American Heart Association.
  20. Koldenhof T et al. Rate Control in Atrial Fibrillation, Calcium Channel Blockers Versus Beta-Blockers. Heart. 2023.
  21. Digoxin. Mayo Clinic. February 1, 2024.
  22. Digoxin. Cleveland Clinic. April 14, 2023.
  23. Ferrari F et al. Digoxin in Atrial Fibrillation: An Old Topic Revisited. Current Cardiology Reviews. May 2020.
  24. Pundi K et al. Blood Thinners for Atrial Fibrillation Stroke Prevention. Circulation: Arrhythmia and Electrophysiology. June 2021.
  25. Atrial Fibrillation and Stroke. National Institute of Neurological Disorders and Stroke. July 19, 2024.
  26. Wazni OM et al. Left Atrial Appendage Closure after Ablation for Atrial Fibrillation. New England Journal of Medicine. November 16, 2024.
  27. Treatment. NHS. May 17, 2021.