Nonsurgical Procedures for Atrial Fibrillation

For most people, medications may be the best treatment for AFib. But sometimes other treatments may be needed. These include nonsurgical and surgical methods. Talk to your health care professional about what option is best for you.

Electrical cardioversion – the rhythm reset

A health care professional can reset your heart’s normal rhythm with electrical cardioversion. This means they give a small electrical shock on the outside of the chest using paddles or sticky patches. You will be asleep with mild anesthesia during this. This procedure often restores a regular heart rhythm.

This is different from defibrillation, which uses a stronger shock. Defibrillation is used during emergencies, such as when a heart stops suddenly, to quickly restore a normal heart beat.

Your health care professional may choose pharmacological cardioversion. This means using medication to try to reset your heart’s normal rhythm. You will stay at the hospital for a few hours so they can monitor you.

Getting ready for cardioversion

Before cardioversion, you may need a test called a TEE (transesophageal echocardiography). During this test, you swallow a small ultrasound device. This lets the health care team look inside your heart atria for blood clots.

If blood clots are found, you may need  blood thinners* before cardioversion. This will help reduce your stroke risk.

Even with treatment, AFib may come back. You may need medications for a long time to keep your heart’s rhythm and rate in the best range.

Watch an animation of AFib.

Radiofrequency ablation or catheter ablation

Ablation is another procedure that can stop the signals that make the heart beat abnormally. It may be used if long-term medications or electrical cardioversion are not preferred or did not work.

Before an ablation procedure, doctors use a special tool to do electrical mapping of the heart. This helps them find where the “extra” activity is coming from. The map shows which parts of the heart are creating the problems with the heart’s normal rhythm.

How is a radiofrequency ablation done?

A catheter is put into a blood vessel and guided to the heart. The doctor uses the catheter to destroy the tissue that is causing the problem. The scarred areas should no longer send abnormal signals.

If it works, your heart should beat normally again. AFib may return, so some people may need to have ablation more than once. This procedure usually has a short recovery time.

People are generally placed on medications until the procedure takes full effect.

Common types of ablations for AFib include:

• Pulmonary vein isolation ablation (PVI ablation or PVA). Some people have AFib because of extra signals in the pulmonary veins. During this procedure, doctors use the catheter tip to destroy the tissue causing the problem. In most cases, a normal heart rhythm returns.
• AV node ablation with pacemakers. Sometimes, AFib starts in part of the heart called the AV node (atrioventricular node). This is where the electrical signals pass from the atria to the ventricles. Doctors place the catheter near the AV node and destroy a small area of tissue to stop the bad signals. They then place a pacemaker in your chest. This device helps to restore and keep the heart’s normal rhythm.

What is an echocardiogram? (PDF)
What are electrophysiology studies? (PDF)