Cardioversion vs. Catheter Ablation
There is more and more evidence that ablation can be performed as a first-line treatment for early stage AFib with excellent outcomes. In addition, ablation may be the best option for patients with AFib and heart failure - Mauricio Arruda MD

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Electrical Cardioversion for Persistent Atrial Fibrillation in the Era of Catheter Ablation: A Real-world Observational Study
Electrical cardioversion (ECV) for persistent AF is acutely efficacious, with a low incidence of major complications. However, during long-term follow-up, recurrence of AF is common, and ECV is not an effective long-term strategy for the maintenance of SR. We propose a strategy for using ECV in the management of persistent AF. Catheter ablation is effective, widely available, and should be the preferred strategy for the majority of patients with persistent AF.
Resources
Rewiring the Heart: Catheter Ablation for AFib
For patients in the early stages of AFib, with symptoms that come and go (known as paroxysmal AFib), catheter ablation has an 80 to 90 percent success rate. Even in patients with more advanced AFib, there is still about an 80 percent success rate when using adjunctive ablation strategies. If the first ablation is unsuccessful, most patients experience significant improvement with a second ablation procedure.
AFib: Cardioversion vs Ablation - Which Works Best?
In this video I discuss the pros and cons of cardioversion vs an afib ablation procedure. Learn when I suggest one procedure over another for my patients.
Cardioversion and Atrial Fibrillation Ablation
I don’t feel that in general I wouldn’t pursue an atrial fibrillation ablation. I think if somebody who has paroxysmal AFib or, and really doesn’t tolerate AFib well, I think it’s not completely unreasonable to consider an atrial fibrillation or pulmonary vein isolation, ablation.
Cardioversion and Catheter Ablation of Atrial Fibrillation Using Novel Oral Anticoagulants
Based on strong clinical trial data, NOACS are now widely used for stroke prevention in AF patients. Data are more limited for NOACs (in comparison to warfarin) used during cardioversion and catheter ablation procedures, but the available data (with the exception of one published study of dabigatran versus warfarin for ablation) generally suggest that NOACS have similar safety profiles to warfarin for these procedures.
Cardioversion vs Ablation: Meaning And Differences
Ultimately, the choice between cardioversion and ablation will depend on a variety of factors, including the patient’s medical history, the severity of their condition, and their overall health. It is important to work closely with a doctor to determine which treatment option is best for each individual patient.
Early direct current cardioversion or ablation for atrial fibrillation or atrial flutter and acute decompensated heart failure
There is a paucity of data on the optimal management strategy for inpatients that are hospitalised for AF or AFL and ADHF and current guidelines recommend an initial rate control strategy. Except for patients with haemodynamic compromise, immediate or very early cardioversion is generally avoided due to the high rate of early recurrence.
Outcomes after catheter ablation and cardioversion in patients with non-valvular atrial fibrillation:
The rates of adverse outcomes (i.e. symptomatic thromboembolic events and major bleeding) were low in this real-life cohort of patients with AF treated with rivaroxaban who underwent catheter ablation or cardioversion as part of the XANTUS study, with no deaths up to 30 days after the procedure. These results were similar to the results of prospective, randomized controlled trials, and observational studies and suggest that the use of rivaroxaban in patients with AF undergoing catheter ablation or cardioversion as part of routine clinical practice may be associated with an acceptable benefit–risk profile.
Risk of stroke after catheter ablation versus cardioversion for atrial fibrillation
In patients with AF, there is a small periprocedural stroke risk with ablation in comparison to cardioversion. However, over longer-term follow-up, ablation is associated with a slightly lower rate of stroke.
Ablation vs Medication for Atrial Fibrillation: what is the gold standard?
Definitive treatment to maintain normal sinus rhythm.
Atrial Fibrillation: Should I Try Electrical Cardioversion?
For most people, cardioversion restores a normal heart rhythm right away. But atrial fibrillation often comes back. Many factors affect how long the heart stays in a normal rhythm. Your doctor can help you understand how well cardioversion might work for you.
Cardioversion (for atrial fibrillation or atrial flutter)
In general, cardioversion is performed in those patients who are symptomatic. Thromboembolic disease is a major cause of morbidity and mortality in patients with AF or AFL. The use of transesophageal echocardiography can rule out any intracardiac thrombus, especially in the left atrial appendage, and facilitate earlier cardioversion.
Catheter Ablation Versus Medical Therapy for Atrial Fibrillation
CA is associated with all-cause mortality benefit, that is driven by patients with AF and heart failure with reduced ejection fraction. CA reduces cardiovascular hospitalizations and recurrences of atrial arrhythmia for patients with AF. Younger patients and men appear to derive more benefit from CA.
My Approach to Selection of Atrial Fibrillation Patients for Ablation
Contemporary management strategies for atrial fibrillation vary widely, partly because of a lack of definitive recommendations, and partly because of the need to individualize therapy based on the patient’s symptoms and comorbidities.
Treatment procedures for atrial fibrillation
Your treatment plan you will be decided based on several factors.
What clinical trials of ablation for atrial fibrillation tell us – and what they do not
Randomized clinical trials have evaluated ablation in several patient populations, including symptomatic patients as first-line or second-line therapy, asymptomatic patients, and patients with heart failure. These trials clarify the durability of ablation in arrhythmia control, clarify quality-of-life improvement, and identify patient populations in whom ablation may be expected to improve clinical outcomes.
Electrical Cardioversion for Persistent Atrial Fibrillation in the Era of Catheter Ablation: A Real-world Observational Study
Electrical cardioversion (ECV) is frequently performed to treat persistent atrial fibrillation (AF). Although several large trials have suggested that rate control in AF may be non-inferior to rhythm-based strategies, individual patients may have better outcomes in terms of quality of life if sinus rhythm (SR) is achieved and maintained. This real-world, retrospective, observational study aimed to define the success rate and role of ECV in the management of persistent AF in the era of catheter ablation.

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