Font Size
A
A
A

Heart Problems: Should I Have Catheter Ablation


What is a Decision Point?

Decision Point

Heart Problems: Should I Have Catheter Ablation?

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Heart Problems: Should I Have Catheter Ablation?

Get the facts

Your options

  • Have catheter ablation.
  • Don't have catheter ablation.

Key points to remember

  • Catheter ablation might be done for a heart rhythm problem if you have symptoms that won't go away, if your medicine hasn't brought back a normal heartbeat, or if your medicine causes side effects that are hard to live with.
  • Ablation works quite well for fast heart rates known as supraventricular tachycardia, or SVT. It doesn't work as well for atrial fibrillation.
  • If the first ablation does not get rid of a heart rhythm problem completely, you may need to have it done a second time. Repeated ablations have a higher chance of success.
  • Catheter ablation is considered safe. It has some serious risks, including heart attack and stroke, but they are rare.
FAQs

What is catheter ablation?

Normally, your heart has a strong, steady beat. That beat is controlled by the heart's electrical system. Sometimes that system misfires, causing a heartbeat that is too fast and isn't steady.

Cardiac ablation is a way to get into your heart—without surgery—and fix the misfiring. It's like working on the spark plugs in your car without having to open the hood.

  • It's done in a hospital.
  • The doctor inserts thin, flexible wires—catheters—into a blood vessel in your neck or leg and threads them up into your heart.
  • X-rays help the doctor see where to move the catheters.
  • The catheters use very hot or very cold temperatures to destroy the areas in your heart that are causing the misfiring problem.

It may seem like a bad idea to destroy parts of your heart on purpose. But the areas that are destroyed are very tiny and don't affect your heart's ability to do its job.

Certain people shouldn't have ablation

Ablation isn't a choice for some people, including those who:

  • Aren't able to lie still or cooperate with the doctor doing the test.
  • Have a history of bleeding problems.
  • Have a blood clot in the left atrium of the heart.

When is catheter ablation done?

Ablation might be done if you have symptoms that won't go away, if your medicine hasn't brought back a normal heartbeat, or if your medicine causes side effects that are hard to live with.

This treatment does have some serious risks, but they are rare. Many people decide to have ablation because they hope to feel much better afterward, and that hope is worth the risks to them. But the risks may not be worth it for people who have few symptoms or for people who are less likely to be helped by ablation.

Heart rhythm problems that may be treated with ablation include:

  • Atrial fibrillation.
  • Supraventricular tachycardia (SVT).
  • Heart flutter, or atrial flutter.
  • Ventricular tachycardia.

Taking anticoagulants (blood thinners)

Many people think that having ablation means they'll be able to stop taking an anticoagulant (also called a blood thinner), such as warfarin, every day to prevent stroke. But that is only true if your risk of stroke is low. Studies haven't shown that ablation for atrial fibrillation lowers your risk of stroke. So you'll still need to take an anticoagulant if your risk of stroke remains high. Your doctor can tell you about your stroke risk.

How well does catheter ablation work?

Catheter ablation works quite well for fast heart rates known as supraventricular tachycardia, or SVT. It doesn't work as well for atrial fibrillation.

  • Ablation for SVT: Catheter ablation helps most people with this type of rhythm problem.
  • Ablation for atrial fibrillation:
    • Research shows that ablation helps 80 out of every 100 people who have atrial fibrillation that comes and goes (paroxysmal). That means it does not help in 20 out of 100 cases.1
    • Ablation works for about 60 out of 100 people who have persistent or chronic (constant) atrial fibrillation. That means it doesn't work in 40 out of 100 cases.1
    • When ablation does work, experts don't know how long it lasts. More research is needed before we can say how long ablation keeps most people out of atrial fibrillation.

If the first ablation does not get rid of a heart rhythm problem completely, you may need to have it done a second time. Repeated ablations have a higher chance of success.

Will you need a pacemaker?

Most people who have catheter ablation don't need a pacemaker. Although ablation destroys tiny areas of tissue in the heart, it doesn't usually keep your heart from doing its job.

But some people do need a pacemaker:

  • If you have the fast heart rate known as atrial fibrillation and regular ablation doesn't help, you may need a special type of ablation called AV node ablation. With AV node ablation, the entire atrioventricular (AV) node is destroyed. Then you need a permanent pacemaker to take over the AV node's job of coordinating your heart rate.
  • About 1 out of 100 people who have the fast heart rate known as AVNRT needs a permanent pacemaker after ablation. This means that 99 out of 100 people with AVNRT will not need a pacemaker.2

What are the risks?

Catheter ablation is thought to be safe. It has some serious risks, but they are rare. They include:

  • Stroke.
  • Heart attack.
  • Puncture of the heart.
  • Need for emergency heart surgery.
  • Problems with the pulmonary vein.
  • A leaking blood vessel.
  • Nerve damage that causes paralysis of the diaphragm.
  • Pericarditis.
  • Cardiac tamponade.
  • Atrio-esophageal fistula. In this life-threatening condition, a hole forms between the heart's upper chamber and the esophagus.
  • Bleeding.
  • New heart rhythm problems.
  • Death (very rare).

You will have to decide whether the possible benefits of ablation outweigh these risks. Your doctor can help you decide.

Weighing the risks and benefits of catheter ablation

The benefits may outweigh the risks if:

The risks may outweigh the benefits if you:

  • You have a type of heart rhythm problem that is likely to be helped a lot by ablation.
  • You have symptoms that bother you a lot.
  • Antiarrhythmic medicines aren't helping.
  • Medicines help, but their side effects bother you a lot.
  • You can't take the medicines because of other health problems.
  • Have a type of heart rhythm problem that is less likely to be helped by ablation.
  • Have only mild symptoms that don't really bother you.
  • Aren't bothered by side effects of antiarrhythmic medicines.

Compare your options

Compare

What is usually involved?









What are the benefits?









What are the risks and side effects?









Have catheter ablation Have catheter ablation
  • The treatment is done in a hospital and takes 2 to 6 hours.
  • You will probably not be fully awake during the treatment. You may be lightly sedated or completely asleep.
  • You may have some discomfort, either from having to lie still or from the ablation itself. Talk to your doctor if you are worried about this.
  • Many people go home the same day. Some people stay in the hospital for 1 or 2 days.
  • Many people feel a lot better after this treatment.
  • If the treatment works, you won't need arrhythmia medicines anymore.
  • Some people are also able to stop taking an anticoagulant, such as warfarin.
  • This treatment doesn't work as well for atrial fibrillation as it does for other heart rhythm problems.
  • Ablation has serious risks, although they are rare. They include stroke, heart attack, and death.
  • If ablation doesn't work the first time, you may have to have it done again.
Don't have catheter ablation Don't have catheter ablation
  • You keep taking medicines every day to treat your heart rhythm problem.
  • You don't have to worry about the rare but serious risks of ablation.
  • Antiarrhythmic medicines may increase your risk of getting a more serious heart rate problem. You will need frequent checkups so your doctor can watch you closely while you take these medicines.
  • If you also have heart disease, your risk of serious side effects from these medicines may be higher.

Personal stories

Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.

Personal stories about catheter ablation

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

I started having episodes of really fast heartbeats 2 years ago. It's this pounding in my chest—very scary. Medicines haven't really helped. I hate the idea of having a procedure like this. But I'm more afraid of the pounding in my chest. I'm going to try catheter ablation.

Will, age 36

Medicines have helped my symptoms a little, but not completely. My doctor talked to me about catheter ablation, but I just can't go through a procedure that deliberately destroys part of my heart. I would rather live with the side effects of the medicine than put myself through that.

Candace, age 58

My doctor has been treating my atrial fibrillation with medicines. But taking them is worse than the palpitations. I'm tired all the time, and I have dizzy spells so often that I can't work. I'm ready to try catheter ablation.

Sophie, age 54

I know that catheter ablation usually works really well for my type of heart problem. But no one can guarantee that it's completely safe. I'm not ready to take any more risks with my body. I'm going to keep using medicines to treat my fast heartbeat.

Juan, age 72

What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to choose catheter ablation

Reasons not to choose catheter ablation

I'm not worried about having a procedure that involves my heart.

I'm very worried about having a procedure that involves my heart.

More important
Equally important
More important

The side effects of my heart medicines are bothering me a lot.

The medicine side effects don't bother me that much.

More important
Equally important
More important

I'm bothered a lot by my heart rhythm symptoms.

My symptoms don't bother me.

More important
Equally important
More important

I'm not happy with my quality of life, either because of my symptoms or because of medicine side effects.

My quality of life is pretty good.

More important
Equally important
More important

I would choose the risks of ablation over the risks of continuing to take my medicines.

I prefer the risks of taking my medicines over the risks of having catheter ablation.

More important
Equally important
More important

My other important reasons:

My other important reasons:

More important
Equally important
More important

Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Having catheter ablation

Not having catheter ablation

Leaning toward
Undecided
Leaning toward

What else do you need to make your decision?

Check the facts

1.

Does catheter ablation work well for all heart rhythm problems?

  • YesSorry, that's not right. Catheter ablation works very well for certain problems, but it doesn't work as well for others.
  • NoYou're right. Catheter ablation works very well for certain problems, but it doesn't work as well for others.
  • I'm not sureIt may help to go back and read "Get the facts." Ablation works very well for certain problems, but it doesn't work as well for others.
2.

Is catheter ablation the first treatment to try for a heart rhythm problem?

  • YesSorry, that's not right. Medicine is usually tried first. Ablation might be done if a person has symptoms that will not go away, if medicines have not brought back a normal heartbeat, or if medicines cause side effects that are hard to live with.
  • NoThat's correct. Medicine is usually tried first. Ablation might be done if a person has symptoms that will not go away, if medicines have not brought back a normal heartbeat, or if medicines cause side effects that are hard to live with.
  • I'm not sureIt may help to go back and read "Get the facts." Medicine is usually tried first.
3.

If ablation doesn't work the first time, can it be done again?

  • YesThat's right. You may need to have it done a second time. Repeated ablations have a higher chance of success.
  • NoSorry, that's not correct. If the first ablation does not get rid of the problem completely, you may need to have it done a second time. Repeated ablations have a higher chance of success.
  • I'm not sure.It may help to go back and read "Get the facts." You may need to have it done a second time. Repeated ablations have a higher chance of success.

Decide what's next

1.

Do you understand the options available to you?

2.

Are you clear about which benefits and side effects matter most to you?

3.

Do you have enough support and advice from others to make a choice?

Certainty

1.

How sure do you feel right now about your decision?

Not sure at all
Somewhat sure
Very sure
3.

Use the following space to list questions, concerns, and next steps.

Your Summary

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.

Your decision

Next steps

Which way you're leaning

How sure you are

Your comments

Your knowledge of the facts

Key concepts that you understood

Key concepts that may need review

Getting ready to act

Patient choices

Credits and References

Credits
CreditsHealthwise Staff
Primary Medical ReviewerE. Gregory Thompson, MD - Internal Medicine
Specialist Medical ReviewerJohn M. Miller, MD - Electrophysiology

References
Citations
  1. Callahan TD IV, Natale A (2008). Catheter ablation of atrial fibrillation. Medical Clinics of North America, 92(1): 179–201.
  2. Blomström-Lunqvist C, et al. (2003). ACC/AHA/ESC guidelines for the management of patients with supraventricular arrhythmias—Executive summary: A report of the ACC/AHA/ESC Committee for Practice Guidelines. Circulation, 108(15): 1871–1909.
You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Heart Problems: Should I Have Catheter Ablation?

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
  1. Get the facts
  2. Compare your options
  3. What matters most to you?
  4. Where are you leaning now?
  5. What else do you need to make your decision?

1. Get the facts

Your options

  • Have catheter ablation.
  • Don't have catheter ablation.

Key points to remember

  • Catheter ablation might be done for a heart rhythm problem if you have symptoms that won't go away, if your medicine hasn't brought back a normal heartbeat, or if your medicine causes side effects that are hard to live with.
  • Ablation works quite well for fast heart rates known as supraventricular tachycardia, or SVT. It doesn't work as well for atrial fibrillation.
  • If the first ablation does not get rid of a heart rhythm problem completely, you may need to have it done a second time. Repeated ablations have a higher chance of success.
  • Catheter ablation is considered safe. It has some serious risks, including heart attack and stroke, but they are rare.
FAQs

What is catheter ablation?

Normally, your heart has a strong, steady beat. That beat is controlled by the heart's electrical system. Sometimes that system misfires, causing a heartbeat that is too fast and isn't steady.

Cardiac ablation is a way to get into your heart—without surgery—and fix the misfiring. It's like working on the spark plugs in your car without having to open the hood.

  • It's done in a hospital.
  • The doctor inserts thin, flexible wires—catheters—into a blood vessel in your neck or leg and threads them up into your heart.
  • X-rays help the doctor see where to move the catheters.
  • The catheters use very hot or very cold temperatures to destroy the areas in your heart that are causing the misfiring problem.

It may seem like a bad idea to destroy parts of your heart on purpose. But the areas that are destroyed are very tiny and don't affect your heart's ability to do its job.

Certain people shouldn't have ablation

Ablation isn't a choice for some people, including those who:

  • Aren't able to lie still or cooperate with the doctor doing the test.
  • Have a history of bleeding problems.
  • Have a blood clot in the left atrium of the heart .

When is catheter ablation done?

Ablation might be done if you have symptoms that won't go away, if your medicine hasn't brought back a normal heartbeat, or if your medicine causes side effects that are hard to live with.

This treatment does have some serious risks, but they are rare. Many people decide to have ablation because they hope to feel much better afterward, and that hope is worth the risks to them. But the risks may not be worth it for people who have few symptoms or for people who are less likely to be helped by ablation.

Heart rhythm problems that may be treated with ablation include:

  • Atrial fibrillation.
  • Supraventricular tachycardia (SVT).
  • Heart flutter, or atrial flutter.
  • Ventricular tachycardia.

Taking anticoagulants (blood thinners)

Many people think that having ablation means they'll be able to stop taking an anticoagulant (also called a blood thinner), such as warfarin, every day to prevent stroke. But that is only true if your risk of stroke is low. Studies haven't shown that ablation for atrial fibrillation lowers your risk of stroke. So you'll still need to take an anticoagulant if your risk of stroke remains high. Your doctor can tell you about your stroke risk.

How well does catheter ablation work?

Catheter ablation works quite well for fast heart rates known as supraventricular tachycardia, or SVT. It doesn't work as well for atrial fibrillation.

  • Ablation for SVT: Catheter ablation helps most people with this type of rhythm problem.
  • Ablation for atrial fibrillation:
    • Research shows that ablation helps 80 out of every 100 people who have atrial fibrillation that comes and goes (paroxysmal). That means it does not help in 20 out of 100 cases.1
    • Ablation works for about 60 out of 100 people who have persistent or chronic (constant) atrial fibrillation. That means it doesn't work in 40 out of 100 cases.1
    • When ablation does work, experts don't know how long it lasts. More research is needed before we can say how long ablation keeps most people out of atrial fibrillation.

If the first ablation does not get rid of a heart rhythm problem completely, you may need to have it done a second time. Repeated ablations have a higher chance of success.

Will you need a pacemaker?

Most people who have catheter ablation don't need a pacemaker. Although ablation destroys tiny areas of tissue in the heart, it doesn't usually keep your heart from doing its job.

But some people do need a pacemaker:

  • If you have the fast heart rate known as atrial fibrillation and regular ablation doesn't help, you may need a special type of ablation called AV node ablation . With AV node ablation, the entire atrioventricular (AV) node is destroyed. Then you need a permanent pacemaker to take over the AV node's job of coordinating your heart rate.
  • About 1 out of 100 people who have the fast heart rate known as AVNRT needs a permanent pacemaker after ablation. This means that 99 out of 100 people with AVNRT will not need a pacemaker.2

What are the risks?

Catheter ablation is thought to be safe. It has some serious risks, but they are rare. They include:

  • Stroke.
  • Heart attack.
  • Puncture of the heart.
  • Need for emergency heart surgery.
  • Problems with the pulmonary vein.
  • A leaking blood vessel.
  • Nerve damage that causes paralysis of the diaphragm.
  • Pericarditis.
  • Cardiac tamponade.
  • Atrio-esophageal fistula. In this life-threatening condition, a hole forms between the heart's upper chamber and the esophagus.
  • Bleeding.
  • New heart rhythm problems.
  • Death (very rare).

You will have to decide whether the possible benefits of ablation outweigh these risks. Your doctor can help you decide.

Weighing the risks and benefits of catheter ablation

The benefits may outweigh the risks if:

The risks may outweigh the benefits if you:

  • You have a type of heart rhythm problem that is likely to be helped a lot by ablation.
  • You have symptoms that bother you a lot.
  • Antiarrhythmic medicines aren't helping.
  • Medicines help, but their side effects bother you a lot.
  • You can't take the medicines because of other health problems.
  • Have a type of heart rhythm problem that is less likely to be helped by ablation.
  • Have only mild symptoms that don't really bother you.
  • Aren't bothered by side effects of antiarrhythmic medicines.

2. Compare your options

Have catheter ablation Don't have catheter ablation
What is usually involved?
  • The treatment is done in a hospital and takes 2 to 6 hours.
  • You will probably not be fully awake during the treatment. You may be lightly sedated or completely asleep.
  • You may have some discomfort, either from having to lie still or from the ablation itself. Talk to your doctor if you are worried about this.
  • Many people go home the same day. Some people stay in the hospital for 1 or 2 days.
  • You keep taking medicines every day to treat your heart rhythm problem.
What are the benefits?
  • Many people feel a lot better after this treatment.
  • If the treatment works, you won't need arrhythmia medicines anymore.
  • Some people are also able to stop taking an anticoagulant, such as warfarin.
  • You don't have to worry about the rare but serious risks of ablation.
What are the risks and side effects?
  • This treatment doesn't work as well for atrial fibrillation as it does for other heart rhythm problems.
  • Ablation has serious risks, although they are rare. They include stroke, heart attack, and death.
  • If ablation doesn't work the first time, you may have to have it done again.
  • Antiarrhythmic medicines may increase your risk of getting a more serious heart rate problem. You will need frequent checkups so your doctor can watch you closely while you take these medicines.
  • If you also have heart disease, your risk of serious side effects from these medicines may be higher.

Personal stories

Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.

Personal stories about catheter ablation

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

"I started having episodes of really fast heartbeats 2 years ago. It's this pounding in my chest—very scary. Medicines haven't really helped. I hate the idea of having a procedure like this. But I'm more afraid of the pounding in my chest. I'm going to try catheter ablation."

— Will, age 36

"Medicines have helped my symptoms a little, but not completely. My doctor talked to me about catheter ablation, but I just can't go through a procedure that deliberately destroys part of my heart. I would rather live with the side effects of the medicine than put myself through that."

— Candace, age 58

"My doctor has been treating my atrial fibrillation with medicines. But taking them is worse than the palpitations. I'm tired all the time, and I have dizzy spells so often that I can't work. I'm ready to try catheter ablation."

— Sophie, age 54

"I know that catheter ablation usually works really well for my type of heart problem. But no one can guarantee that it's completely safe. I'm not ready to take any more risks with my body. I'm going to keep using medicines to treat my fast heartbeat."

— Juan, age 72

3. What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to choose catheter ablation

Reasons not to choose catheter ablation

I'm not worried about having a procedure that involves my heart.

I'm very worried about having a procedure that involves my heart.

More important
Equally important
More important

The side effects of my heart medicines are bothering me a lot.

The medicine side effects don't bother me that much.

More important
Equally important
More important

I'm bothered a lot by my heart rhythm symptoms.

My symptoms don't bother me.

More important
Equally important
More important

I'm not happy with my quality of life, either because of my symptoms or because of medicine side effects.

My quality of life is pretty good.

More important
Equally important
More important

I would choose the risks of ablation over the risks of continuing to take my medicines.

I prefer the risks of taking my medicines over the risks of having catheter ablation.

More important
Equally important
More important

My other important reasons:

My other important reasons:

More important
Equally important
More important

4. Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Having catheter ablation

Not having catheter ablation

Leaning toward
Undecided
Leaning toward

5. What else do you need to make your decision?

Check the facts

1. Does catheter ablation work well for all heart rhythm problems?

  • Yes
  • No
  • I'm not sure
You're right. Catheter ablation works very well for certain problems, but it doesn't work as well for others.

2. Is catheter ablation the first treatment to try for a heart rhythm problem?

  • Yes
  • No
  • I'm not sure
That's correct. Medicine is usually tried first. Ablation might be done if a person has symptoms that will not go away, if medicines have not brought back a normal heartbeat, or if medicines cause side effects that are hard to live with.

3. If ablation doesn't work the first time, can it be done again?

  • Yes
  • No
  • I'm not sure.
That's right. You may need to have it done a second time. Repeated ablations have a higher chance of success.

Decide what's next

1. Do you understand the options available to you?

2. Are you clear about which benefits and side effects matter most to you?

3. Do you have enough support and advice from others to make a choice?

Certainty

1. How sure do you feel right now about your decision?

Not sure at all
Somewhat sure
Very sure

2. Check what you need to do before you make this decision.

  • I'm ready to take action.
  • I want to discuss the options with others.
  • I want to learn more about my options.

3. Use the following space to list questions, concerns, and next steps.

Credits
ByHealthwise Staff
Primary Medical ReviewerE. Gregory Thompson, MD - Internal Medicine
Specialist Medical ReviewerJohn M. Miller, MD - Electrophysiology

References
Citations
  1. Callahan TD IV, Natale A (2008). Catheter ablation of atrial fibrillation. Medical Clinics of North America, 92(1): 179–201.
  2. Blomström-Lunqvist C, et al. (2003). ACC/AHA/ESC guidelines for the management of patients with supraventricular arrhythmias—Executive summary: A report of the ACC/AHA/ESC Committee for Practice Guidelines. Circulation, 108(15): 1871–1909.

Note: The "printer friendly" document will not contain all the information available in the online document some Information (e.g. cross-references to other topics, definitions or medical illustrations) is only available in the online version.

Last Revised: February 15, 2011

Author: Healthwise Staff

Medical Review: E. Gregory Thompson, MD - Internal Medicine & John M. Miller, MD - Electrophysiology


eMedicineHealth Medical Reference from Healthwise

This information does not replace the advice of a doctor. Healthwise disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. How this information was developed to help you make better health decisions.

To learn more visit Healthwise.org

© 1995-2012 Healthwise, Incorporated. Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated.






Medical Dictionary