#344 Can You Stop the Progression of AFib with a Catheter Ablation?

Can You Stop the Progression of AFib with a Catheter Ablation?

The Natural Progression of Atrial fibrillation (AFib) can start with sporadic episodes, where the heart’s rhythm is irregular but self-terminates. This stage where AFib terminates on its own is known as paroxysmal AFib. Paroxysmal AFib may not cause significant harm to the heart initially, and some individuals may not even be aware of the condition.

Unfortunately, if left untreated, the progression of AFib ultimately may lead from the self-terminating paroxysmal form to the persistent or permanent stages. During the persistent phase, the episodes often become more frequent and may no longer self-terminate. Indeed, medical intervention, like an electrical cardioversion or “shock,” may be required to restore normal sinus rhythm. If AFib remains untreated, AFib may eventually evolve into a permanent state, where any efforts to restore normal sinus rhythm may be futile.

In this article, I share the results of a new study comparing antiarrhythmic medications versus a catheter ablation procedure to stop the natural progression of AFIb.

Why is AFib so Dangerous?

Atrial fibrillation or “AFib,” for short is often described as an irregular and rapid heartbeat, affects millions of people worldwide. Left unchecked, this condition can progress from occasional episodes (paroxysmal) to more frequent and sustained occurrences (persistent) and ultimately to a chronic and irreversible state (permanent). The repercussions can be severe, leading to fatigue, shortness of breath, strokes, and heart failure.

However, there is hope. Advances in medical science have introduced effective interventions that can halt AFib’s progression and even send it into remission particularly if coupled with healthy lifestyle changes. Among these, catheter ablation stands out as a game-changer. But before we explore the remarkable power of this procedure, let’s understand the natural progression of AFib if left untreated.

Breaking the Chain: Interventions that Make a Difference

The good news is that the progression of AFib is not set in stone. Early detection and appropriate measures can significantly alter the course of this condition. Making lifestyle changes, such as weight loss and adopting other heart-healthy habits, can provide a positive impact.

Additionally, antiarrhythmic medications may be prescribed to control the irregular heart rhythm and prevent further complications. While these interventions can be beneficial for some patients, many patients cannot tolerate these medications or these medications don’t work for them. And for those patients in whom the drugs don’t work or they don’t want to be stuck on these drugs for the rest of their lives, the answer is often a catheter ablation procedure.

What is a Catheter Ablation?

Catheter ablation for atrial fibrillation (Afib) is a minimally invasive medical procedure designed to restore the heart’s normal rhythm by targeting and eliminating the abnormal electrical signals responsible for the irregular heartbeats. It is an outpatient procedure which doesn’t involve any cutting or stitches.

During the procedure, thin, flexible catheters are threaded through an IV in the leg and guided to the heart. Once in position, the catheters deliver controlled energy, such as radiofrequency or cryotherapy, to target the misfiring heart cells causing the AFib. Catheter ablation has emerged as a highly effective treatment option to restore normal sinus rhythm without the need for lifelong antiarrhythmics.

The Power of Timely Treatment: Results of a New Study

In a groundbreaking study recently published in the New England Journal of Medicine, researchers from Canada compared the effectiveness of catheter ablation to antiarrhythmic drugs in slowing AFib’s progression.

The study involved 303 patients who were followed for 3 years. One group was randomized to ablation and the other group was randomized to antiarrhythmic drugs. Over a 3-year follow-up, the ablation group experienced significantly better outcomes. Only 1.9% of patients in the ablation group had persistent AFib episodes, compared to 7.4% in the drug therapy group.

The ablation group also had less overall AFib episodes and 3-times less hospitalizations due to Afib-related issues. Also, serious adverse events were twice as likely with the antiarrhythmic drugs when compared to catheter ablation. Thus, not only was catheter ablation much better at stopping the progression of AFib but was also much safer than the antiarrhythmic drugs.

Beyond the Study: Insights from Our Experience:

Drawing from our extensive experience in treating tens of thousands of Afib patients, we can attest to the transformative effects of catheter ablation. For many of our patients, this procedure, especially when coupled with healthy lifestyle changes including weight loss, has resulted in significant improvements and generally complete remission of Afib without the need for antiarrhythmic drugs.

Remember, you don’t have to face Afib alone. Reach out to a cardiac electrophysiologist or “EP” (a cardiologist specializing in atrial fibrillation) near you to explore treatment options, and make lifestyle changes that support your heart’s well-being.

The Blog Photo

Feast your eyes on the breathtaking beauty of the Wasatch Crest Trail, a mountain biking and running trail that stands as one of the most scenic and awe-inspiring trails in the US! Stretching from Big Cottonwood Canyon to Millcreek Canyon, this epic path at about the 10,000 foot level offers a mesmerizing panorama of the majestic mountains overlooking Salt Lake City and Park City. For the last 2 days, my daily exercise has been to ride this trail on my mountain bike. And if you look closely you can still see a few patches of snow that haven’t yet melted…


The information provided in this blog article is for general informational purposes only and should not be considered as medical advice or a substitute for professional medical consultation, diagnosis, or treatment. Always seek the advice of your physician or qualified healthcare provider with any questions you may have regarding a medical condition.

If you are a resident of Utah, Wyoming, or Idaho (these are the states that I have a medical license in), I would be happy to see you either in-person or by a telemedicine visit by calling my office at 801-266-3418.

Disclaimer Policy: This website is intended to give general information and does not provide medical advice. This website does not create a doctor-patient relationship between you and Dr. John Day. If you have a medical problem, immediately contact your healthcare provider. Information on this website is not intended to diagnose or treat any condition. Dr. John Day is not responsible for any losses, damages or claims that may result from your medical decisions.

  1. How can I find a doctor in my area (Wichita,KS) who agrees w your ideas, that is, using catheter ablation for Persistent a fib? I’ve tried 3 doctors in past year and I am not sure that I have the right one now . I understand that the common denominator in this scenario is me. I feel like that my age,76, gives doctors the idea that I’m just old and cranky. I agree that I am old and cranky, but I didn’t feel old until the past year or so and I’m cranky bc I don’t feel well and so far, their medication and treatments haven’t been helpful, I have Apple Watch and it gives me alerts of afib. My heart rate has been slow, not tachy. Last few days though, all I’m getting is alerts that my heart rate is slow, like in the 30’s, and not able to detect the afib. I hope I have time to find good help before my heart slows down even more. Help?

  2. this is a big plus for ablation. i read the study as well. as someone who has undergone a spectacular fail (permanent AFib for 4 months, put on amiodarone, previously had a 60% success rate of self-reverting to NSR; now i go straight in for cardioversion) on their first ablation, and is justifiably wary of signing up for a second one, I wonder what the criteria were or how did they evaluate a ‘successful’ ablation, given the stats of repeat ablations often required? My #1 intervention is still: monitor and avoid triggers; get self-aware. Still more reliable than any invasive surgery.
    another question I have is, which would require much longer follow-up: quality of life after 10 or 20 years; Has the AF returned in patients who have not changed their lifestyle?