Does An Ablation Mean You Will Be Off Medications Forever?

It’s an exciting time in the world of electrophysiology, and the conversation about gold-standard treatments is constantly shifting. As specialists in treating the heart’s electrical signals, we have relied on catheter ablation technology to destroy errant heart signals in a minimally invasive manner. Until recently, this was performed using thermal therapy – heat or cold – Which came with a potential risk of damage to surrounding structures. More recently, PFA or pulsed field ablation has hit the market, using a nifty technology known as electroporation to destroy cells in the treatment area and save surrounding tissue, including nerve and blood vessels, thus making ablation even safer.

Medical Therapy

However, it’s essential to know that rate and rhythm medications are often prescribed to control the fast and erratic heartbeats associated with Afib. You may also know that atrial fibrillation significantly increases the risk of stroke, and to that end, patients are often put on blood-thinning medication if they are deemed to be at high risk for a stroke. However, medications only work for as long as they’re taken and come with potentially significant side effects. So, when patients find out that there is a procedural intervention for their Afib, they naturally wonder if they can get off their medication shortly after the procedure.

The Answer Depends

Unfortunately, the answer to this question is not entirely straightforward and depends on a patient’s circumstances. For patients with relatively low stroke risk, treating atrial fibrillation with a successful cardiac catheter ablation or pulsed field ablation may be enough to get them off their rate and rhythm, as well as blood-thinning medication. Ultimately, ablation technology for atrial fibrillation is almost always more effective than rate and rhythm control using oral medication.

However, for patients with a significantly higher risk of stroke or for those who have had atrial fibrillation for an extended period, there is always the risk that certain medications may need to be continued. This is most often the case with anticoagulant or blood thinning medication, as treating the arrhythmia does not eliminate existing stroke risk; it just reduces the additional risk of stroke that would otherwise be caused by untreated atrial fibrillation.

A Second Ablation

Fortunately, ablation technology allows for a second ablation if the first ablation is not entirely successful in eliminating the arrhythmia. This is known as a touchup and is employed to catch any irregular electrical signals that may have been missed during the primary ablation, or that may have occurred since. The second ablation is performed similarly to the original ablation and tends to improve upon the initial treatment results.

Success Rates of an Ablation

The degree to which medication may be necessary after an ablation largely depends on the stage at which the atrial fibrillation is caught and treated. While ablation technology is very successful in qualified patients, the procedure’s effectiveness diminishes the longer the arrhythmia is left untreated. For example, in its earliest stages, known as paroxysmal, ablations tend to have a 70+ percent chance of success. This drops dramatically as the arrhythmia becomes more persistent.

The Importance of Seeing an Electrophysiologist Early

For more information on medication and procedural interventions for atrial fibrillation and other arrhythmias, we encourage you to contact our office and schedule a consultation with Dr. Tordini. Doing so is the first step in discovering safe and effective treatment options that can avoid worsening symptoms and outcomes in the future.