Patient Blogs | Atrial Fibrillation
AFib Procedures: So Many Options, How Do I Choose?
photo of surgical equipment in an operating room

Standing (barely) at a high mountain pass in Peru in 2009, dizzy and breathless, I knew this was my last hiking trip ever if I couldn’t get my 24/7 AFib under control. Until then, my cardiologists had told me we’d done everything possible to get my heart back into permanent normal sinus rhythm. But I didn’t like that answer and held out hope for more.

What had they already tried? Cardioversion is usually the go-to first procedure when someone presents in AFib. There are two approaches to cardioversion, and I was familiar with both. I had tried taking anti-arrhythmic drugs to kick my heart out of AFib. Many times. It usually worked, but not always. And it only worked for a few days, and then the AFib would return to stay. The doctors had tried electrical cardioversion (think the heart-shocking-paddles in medical TV shows) on me, but that did not have a lasting result either. By my 2009 Peru pass moment of crisis, I had been in permanent AFib for 30 years.

I did a lot of research after the Peru trip and totally confused myself. There were a couple patient-oriented websites with excellent understandable information, but there were still so many options. The surgical options fell into two basic categories, with so many variations within each option.

Option 1: Cardiac ablations, where the doctor intentionally scars parts of the atrium and/or nodes entering the atrium to redirect the electrical current. There are different kinds of ablations (where they scar, whether they freeze or burn to create the scar, whether it’s open-heart surgery or they enter your heart through a catheter). This option is intended to stop the arrhythmia and put you back in normal sinus rhythm.

Option 2: Left atrial appendage closure, where they seal off a portion of your left atrium to keep potential clots from escaping into the rest of your body. There are multiple options, some involving permanently inserted devices, to accomplish this as well. This option addresses the risk of clotting and does not stop the arrhythmia itself.

I figured I’d get a clearer picture from my regular cardiologist. No! Even though he was an AFib specialist, he was under the misunderstanding that no surgery would fix my long-standing AFib situation. Based on my own research, I concluded that a catheter ablation had the greatest potential and I researched electrophysiologists who specialized in catheter ablation. I was fortunate to find an EP at a local university who had developed a new method for analyzing the potential success of an ablation (using a cardiac MRI), who had trained with the catheter ablation pioneers, and who had a great success record with his ablations. I had a catheter ablation in 2009 and another in 2019.

So, what might you think about as you’re trying to figure out whether to undergo a surgical procedure, and which one to choose?

  • Do your own research using reputable websites. WebMD, of course, but I also like Learn as much as you can about all the available procedures, their risks, and benefits.
  • Don’t assume that a procedure is necessary. The risk of AFib-related stroke can often be managed with blood thinners. The rest of AFib management relates mostly to your quality of life (lifestyle changes, meds, procedures). If your AFib is controlled well using rate or rhythm meds, and you’re not super unhappy with your quality of life, maybe a surgical fix is over the top for you?
  • Pick your doctor very carefully. Not just any cardiologist will do. You need an electrophysiologist (EP), a doctor who specializes in heart arrhythmias. You may want one EP to help you choose whether to undergo a procedure and what procedure to get. And then a procedure-specific specialist for the procedure you opt for.
  • For your procedure-specific EP, pick a doctor who has trained with the best, done many many, many of the given procedure, and who has an excellent track record of success. Travel to the doctor’s location, if you have to, to get that expertise. You don’t want a cardiologist who’s done only a few ablations messing around in your heart.
  • Do more research. Ask questions. Never stop learning about AFib and the treatment options (it’s a quickly evolving field), and never stop asking questions.

If you decide to have a surgical procedure, I wish you the best of luck and hope it puts you into normal sinus rhythm. The first time you hear that thwoop-thwoop-thwoop sound of a normal heartbeat is magical! If you decide not to do a procedure now, you can always revisit the decision in the future. More and more is being learned about AFib every day, new and revised procedures are being developed, and your personal experience of AFib may change over time.


Photo Credit: shapecharge / E+ via Getty Images

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Michele Straube

Michele Straube

Diagnosed since 1979

Michele Straube has lived with atrial fibrillation (AFib) for 42 years. Recently retired from a long career as an environmental mediator, her plans include travel and trailer camping with husband Bob and puppy Tux. She currently teaches ESL to adult immigrants and refugees, and she delivers Meals on Wheels to homebound seniors. She enjoys chatting with AFib patients to explore their path to living with the condition.

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