Drug Therapy vs. Catheter Ablation for Treatment of Atrial Fibrillation

Everyone who has atrial fibrillation eventually faces the tough decision to manage their condition with drugs or some kind of surgical procedure – and many times it requires both!

It’s a constant debate, but for some folks like me, there is no debate. You already know what you want to do. The thought of a life on daily drugs just isn’t an option for me – not yet anyway. This is why I have elected to have an ablation.

For others, however, the decision isn’t so easy. There are so many things to consider and in many cases you don’t have a choice. You may want an ablation but based on your specific situation it may not be a realistic (or smart) option. Likewise, drugs may be doing wonders for you now but that may not be the case in the future.

I ran across a great article on Everyday Health where they outlined the pros and cons of drugs vs. ablation for treating atrial fibrillation. I thought the points that were discussed in the article were spot on. Here is a summary of the pros and cons from the article:

Pros of Drug Therapy

• Many options – There are many drugs available today (relatively speaking).
• Cost effective – Medication is usually less expensive than an ablation (at least in the short-term).
• Non-invasive – Taking pills is certainly easier than going through a surgical procedure!
• Moderate success rate – About 50% overall at one year.

Cons of Drug Therapy

• Dangerous side effects and interactions – Where do I begin? I could write a book just on the potential side effects and interactions. These are highly potent medications that can have long-term ramifications.
• Less effective over time – Less than 20% of patients maintain normal sinus rhythm (NSR) on these drugs over the course of time!
• Blood thinners – Since antiarrhythmic drugs aren’t always effective (i.e. don’t keep you in NSR) you’ll likely need to be on blood thinners, which come with their own potential side effects.

Pros of Catheter Ablation

• Higher success rate – On average, ablation has a 70-80% success rate.
• Low risk of complications – Fewer than 5% of patients develop problems.
• Quick recovery – Usually only requires an overnight stay in the hospital.

Cons of Catheter Albation

• Repeat procedures – For 20-30% of patients, a second ablation is required.
• Doesn’t work for everyone – Ablation works best for healthy individuals that have paroxysmal atrial fibrillation.
• Sometimes drugs are still needed – Sometimes an antiarrhythmic drug is needed after the procedure.
• New arrhythmias – Ablations can sometimes cause new arrhythmias.
• Blood thinners – You need to be on blood thinners temporarily after the procedure.

I have my own “pros and cons” that I would add to ablations. One big pro is that it’s the best chance we have right now to cure atrial fibrillation. I know people who have been afib-free for years after their ablations. They aren’t on drugs of any kind. Steve Ryan, the author of Beat Your Afib, is one of those people. You will NEVER hear of someone that was cured by drug therapy.

The con I would add to ablations is that they are expensive. You’re talking around $100,000. If you need two or three of them, you’re easily approaching over a quarter of a million dollars! Granted, most of us will have that covered by insurance but if you have high deductibles or a less-than-stellar plan, your out-of-pocket costs could still be in the thousands.

What about you? Are there any pros and cons I’m missing? Which do you think you’d choose? Which did you choose, if you’ve already had to make this choice?

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