"This book is incredibly complete and easy-to-understand for anybody. I certainly recommend it for patients who want to know more about atrial fibrillation than what they will learn from doctors...."

Pierre Jaïs, M.D. Professor of Cardiology, Haut-Lévêque Hospital, Bordeaux, France

"Dear Steve, I saw a patient this morning with your book [in hand] and highlights throughout. She loves it and finds it very useful to help her in dealing with atrial fibrillation."

Dr. Wilber Su Cavanaugh Heart Center, Phoenix, AZ

"Your book [Beat Your A-Fib] is the quintessential most important guide not only for the individual experiencing atrial fibrillation and his family, but also for primary physicians, and cardiologists."

Jane-Alexandra Krehbiel, nurse, blogger and author "Rational Preparedness: A Primer to Preparedness"


"Steve Ryan's summaries of the Boston A-Fib Symposium are terrific. Steve has the ability to synthesize and communicate accurately in clear and simple terms the essence of complex subjects. This is an exceptional skill and a great service to patients with atrial fibrillation."

Dr. Jeremy Ruskin of Mass. General Hospital and Harvard Medical School

"I love your [A-fib.com] website, Patti and Steve! An excellent resource for anybody seeking credible science on atrial fibrillation plus compelling real-life stories from others living with A-Fib. Congratulations…"

Carolyn Thomas, blogger and heart attack survivor; MyHeartSisters.org

"Steve, your website was so helpful. Thank you! After two ablations I am now A-fib free. You are a great help to a lot of people, keep up the good work."

Terry Traver, former A-Fib patient

"If you want to do some research on AF go to A-Fib.com by Steve Ryan, this site was a big help to me, and helped me be free of AF."

Roy Salmon Patient, A-Fib Free; pacemakerclub.com, Sept. 2013

Normal Sinus Rhythm

Understanding the Basics of an Ablation Procedure

In his 2015 AF Symposium presentation, Dr. Pierre Jais makes reference to the typical progression of a catheter ablation procedure. You may ask, what does he mean? What is the typical progression of an ablation?

Goals of Catheter Ablation for A-Fib

Just a reminder: the main goals of catheter ablation of A-Fib are to restore the heart to normal sinus rhythm and eliminate the symptoms of A-Fib. This also relieves the patient from the associated risks such as blood clot formation, stroke and increased risks of dementia and mortality.

The main goals of catheter ablation of A-Fib are to restore the heart to normal sinus rhythm and eliminate the symptoms of A-Fib.

Progression of a typical ablation for Persistent A-Fib:

• First, the sources of the rogue A-Fib electrical signals are mapped using a computerized system.

• The tip of the catheter is then maneuvered to the various sources of the A-Fib signals (usually starting with the openings to the pulmonary veins). Using RF energy (or Cryo) a tiny burn or lesion is made at each location to disrupt (or ablate) the electrical pathway.

• As the series of lesions progress, more and more of the A-Fib signals stop. OR, A-Fib signals may transition into Atrial Flutter which is a more stable and less erratic heart rhythm.

• At this point it is not uncommon for some A-Fib signals to continue. So, one or more rounds of mapping and ablation may be required to stop any remaining sources of arrhythmic signals.

 • Finally, the heart typically transitions to either a stable atrial tachycardia (a fast, but regular heartbeat) OR transitions into normal sinus rhythm (NSR).

After an ablation, some patients may be in atrial tachycardia but they are NOT in A-Fib. This is still a good… Click To Tweet

After the Ablation

While many patients will be in normal sinus rhythm (hurray!), some patients will be in stable atrial tachycardia (a fast and regular heartbeat)—but here’s the important part— they are NOT in A-Fib. This is still a good result!

Why? If you’re in stable atrial tachycardia, with rhythm or rate control medication your heart will typically heal itself over the following three months—called the ‘blanking period’ (or up to a year) and on its own return to normal sinus rhythm (NSR). (That’s why you shouldn’t rush to decide if your ablation is a success until several months post-ablation.)

For more about catheter ablation see, The Evolving Terminology of Catheter Ablation

See also, Dr. Pierre Jais’ 2015 AF Symposium presentation “The Spectrum of Atrial Tachycardias Following Ablation of Drivers in Persistent AF.”


FAQs A-Fib Treatments: Catheter Ablation Procedures

Catheter ablation illustration at A-Fib.com

Catheter ablation

Atrial Fibrillation patients seeking a cure and relief from their symptoms often have many questions about catheter ablation procedures. Here are answers to the most frequently asked questions by patients and their families. (Click on the question to jump to the answer)

1. “I have a defective Mitral Valve? Is it causing my A-Fib? Should I have my Mitral Valve fixed first before I have a PVA?

2. “With the recent improvements in Pulmonary Vein ablation techniques, should I wait for a better technique? I’m getting by with my Atrial Fibrillation.”

3. “Are there different types of “Pulmonary Vein Ablation”? Are they different from “Pulmonary Vein Isolation?

4. I’’ve heard of Cryo (freezing) catheters for PVA(I) ablations. Are they good or better than the RF (Radio Frequency) catheters for ablations?

5. “How dangerous is a Pulmonary Vein Ablation procedure? What are my risks?

6. “During the ablation procedure A-Fib doctors actually burn within the heart with RF energy. How does this burning and scarring affect how the heart functions? Should athletes, for example, be concerned that their heart won’t function as well after an ablation?

7. “How dangerous is the fluoroscopy radiation during an ablation? I know I need a Pulmonary Vein Ablation (Isolation) procedure to stop my A-Fib—A-Fib destroys my life. I can’t work or exercise, and live in fear of the next attack. Antiarrhythmic meds cause me bad side effects. But I’m worried about being exposed to radiation during the ablation.

8. “I have serious heart problems and chronic heart disease along with Atrial Fibrillation. Would a Pulmonary Vein Ablation help me? Should I get one?

9. “What is an enlarged heart? Does it cause A-Fib?. I was told I can’t have a Pulmonary Vein Ablation (Isolation) procedure because I have an enlarged heart. Why is that?”

10. “I am 82 years old. Am I too old to have a successful Pulmonary Vein Ablation? What doctors or medical centers perform PVAs on patients my age?

11. “Since my PVI, I have been A-Fib free with no symptoms for 32 months. What do you think my chances of staying A-Fib free are?”

12. “How long before you know a Pulmonary Vein Ablation procedure is a success? I just had a PVA(I). I’ve got bruising on my leg, my chest hurts, and I have a fever at night. I still don’t feel quite right. Is this normal?”

13. I want to read exactly what was done during my Pulmonary Vein Ablation. Where can I get the specifics? What records are kept?

14. “What is the typical length of a catheter ablation today versus when you had your catheter ablation in 1998 in Bordeaux, France? What makes it possible?

15. “After my successful Pulmonary Vein Ablation, do I still need to be on blood thinners like Coumadin or aspirin?

16. “I’ve had a successful ablation. For protection against potential stroke risk if my A-Fib re-occurs, which if better—81 mg baby aspirin or 325 mg?

17. Since my ablation, my A-Fib feels worse and is more frequent than before, though I do seem to be improving each week. My doctor said I shouldn’t worry, that this is normal. Is my ablation a failure?

18. “I love to exercise and I’m having a PVA. Everything I read says ‘You can resume normal activity in a few days.’ Can I return to what’s ‘normal’ exercise for me?

19. I have Chronic Atrial Fibrillation (the heart remains in A-Fib all the time). Am I a candidate for a Pulmonary Vein Ablation? Will it cure me? What are my chances of being cured compared to someone with Paroxysmal (occasional) A-Fib?

20. “I’m 80 and have been in Chronic (persistent/permanent) A-Fib for 3 years. I actually feel somewhat better now than when I had occasional (Paroxysmal) A-Fib. Is it worth trying to get an ablation?

21.“Will an ablation take care of both A-Fib and Flutter? Does one cause the other? Which comes first A-Fib or Flutter?

22. Are there other areas besides the pulmonary veins with the potential to turn into A-Fib hot spots? I had a successful catheter ablation and feel great. Could they eventually be turned on and put me back into A-Fib

23. “During an ablation, how much danger is there of developing a clot? What are the odds? How can these clots be prevented?

24. “I was told that I will have to take an anticoagulant for about 2-3 months after my ablation. After all, if fibrillation episodes are reduced or eliminated after an ablation, shouldn’t there be even less need for a prescription anticoagulant rather than more?

25. “I’m six months post CryoBalloon ablation and very pleased. But my resting heart rate remains higher in the low 80s. Why? I’ve been told it’s not a problem. I’m 64 and exercise okay, but I’ve had to drop interval training.”

26. “I’ve heard good things about the French Bordeaux group. Didn’t Prof. Michel Häissaguerre invent catheter ablation for A-Fib? Where can I get more info about them? How much does it cost to go there?

27. “I’m a life-long runner. I recently got intermittent A-Fib. Does ablation (whether RF or Cryo) affect the heart’s blood pumping output potential because of the destruction of cardiac tissue? And if so, how much? One doc said it does.

Last updated: Thursday, September 8, 2016

Return to FAQs

Cardioversion to Restore Normal Sinus Rhythm

VIDEO: EKG display of heart in Atrial Fibrillation, A-Fib

EKG display of heart in A-Fib

Cardioversion for Atrial Fibrillation

Your doctor may recommend a cardioversion to restore your heart to normal sinus rhythm (NSR). There are two types of cardioversion: chemical and electrical. Cardioversion through the use of drugs is called chemical cardioversion. Electrical cardioversion uses a low-voltage, timed electrical shock to restore normal rhythm.

Most cardioversions are planned and scheduled several weeks in advance.

On the other hand, if your A-Fib is so irregular and rapid that it is life threatening, you may be sent to the emergency room, given the intravenous anticoagulant Heparin, and an electrical cardioversion performed.


The goal of chemical cardioversion is to make your heart beat regularly (in normal sinus rhythm). It is usually done in a hospital. Some combination of medications (see Treatment/Drug Therapies) is administered intravenously, such as Cardizem, verapamil, ibutilide, or adenosine (a class V antiarrhythmic agent). Doctors monitor you closely for adverse side effects.

Chemical cardioversion is often done in combination with Electrical Cardioversion described below.

Electrical Cardioversion

Electrical Cardioversion is a medical term for giving your heart a low-voltage electrical shock to synchronize it, that is, to make it beat regularly (in normal sinus rhythm). It is often used in combination with Chemical Cardioversion.

Note: Electrical cardioversion is not the same as Defibrillation. In defibrillation, doctors use high-voltage shocks to treat life-threatening arrhythmias or a heart that has stopped.

During Electrical Cardioversion you are anesthetized and are unconscious when you receive the shock. The shock causes the signal producing areas of your heart to discharge all at once. This stops all electrical activity in your heart momentarily, hopefully allowing your normal heart rhythm to take over. Usually only one shock is required to restore NSR.

VIDEO 1: Patient video, short animation (:60) explaining the steps in performing an electrical cardioversion for patients in Atrial Fibrillation; By eMedTV 1

Low Risk Treatment But High Risk of Clots Forming

Electrical Cardioversion is considered a low risk procedure. But it is a ‘shock’ to the body and requires general anesthesia. (It’s like a mini electrocution. The metal paddles or patches, for example, can potentially leave burn marks on the chest.)

Cardioversion does carry a high risk of forming clots and causing stroke.2

Why? An Electrical cardioversion “stuns” your heart along with your Left Arial Appendage (LAA). Clots may form in the LAA while your heart is stunned and not beating. The clot can break away and enter the blood stream with the potential of causing a stroke. (The LAA is where most A-Fib clots originate.)

To dissolve potential clots, your doctor will have you take an anticoagulant like warfarin (Coumadin) before the treatment and in the three to four weeks following treatment.

While on warfarin (Coumadin), your blood will be tested for how long it takes to clot (a prothrombin time test, PT). The goal is to keep your INR (International Normalized Ratio) score between 2.0 and 3.0. Your dosage will be adjusted if necessary. You may have to have your blood tested weekly until your doctor determines you are in the proper INR range.

Success Rate of Cardioversion

Electrical Cardioversion (often combined with Chemical Cardioversion) is considered a standard, routine, low risk treatment option, particularly for recent onset A-Fib patients. If your A-Fib has just started, it may be a momentary aberration; and an Electrical Cardioversion may correct it.

Cardioversion has a very high initial success rate, returning up to 95% of A-Fib patients to NSR.

While the conversion rate is high, recurrence of A-Fib is high too. As few as 23% of patients remain in normal sinus rhythm for more than one year post-procedure. For most, their A-Fib returns within the first five days.4

Are Repeated Electrical Conversions Dangerous?

People with A-Fib often ask, “How often can I be Electrical Cardioverted? Does it ever become counterproductive or dangerous?” Right now we just don’t know the answer to this question.

Former Senator and NBA basketball player Bill Bradley had three successful Electrical Cardioversions from 1996-1998 without any apparent ill effects.5 I’ve heard of an A-Fib patient who received an Electrical Cardioversion once a month for a year without any apparent problems.

VIDEO 2: Watch an actual Electrical Cardioversion recorded at the patient’s request: “Me Being Cardioverted” posted by reddy321.6But be advised: the patient in this video is partially awake (this is not the norm). This video is a bit unsettling to watch (but not dangerous or painful for the patient).

Don’t Be Frightened

Don’t let this type of video frighten you. It may look and sound traumatic, but Electrical Cardioversion is in fact non-invasive and is one of the easiest and safest short term treatments available for A-Fib.

And don’t let TV shows with emergency room scenes frighten you either. In fact, those scenes are usually depicting defibrillation, not cardioversion (defibrillators use high-voltage shocks to treat a heart that has stopped beating).

In her Personal Experiences story, Kris tells of accidentally being awake during an electrical cardioversion (see Personal Experiences story #37). According to Kris, the shock is relatively mild compared to what you often see portrayed in medical dramas on TV.

Last updated: Wednesday, April 6, 2016

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Return to Treatments for Atrial Fibrillation



References    (↵ returns to text)
  1. VIDEO 1: Short animation explaining electrical cardioversion when in Atrial Fibrillation. YouTube video posted by eMedTV; Last accessed Oct 12, 2014; URL: http://www.youtube.com/watch?v=-jkhQ5Tl2fs
  2. Haines, D. “Atrial Fibrillation: New Approaches in Management.” Un. of Virginia multi-media presentation, 1999, p.2. http://www.a-fib.com/HainesUnOfVirginiaAtrialFibrillation.htm
  3. Boos C , More RS, Carlsson J. Persistent atrial fibrillation: rate control or rhythm control. BMJ 2003;326:1411–2.
  4. Gorman, Christine, “A Candidate’s Racing Heart,” TIME, Sunday, Dec. 12, 1999. http://www.time.com/time/printout/0,8816,35831,99.html
  5. VIDEO 2: Me Being Cardioverted YouTube video; Last accessed February 22, 2013; URL: http://www.youtube.com/watch?v=2nsN0vdXZuY&feature=fvw.

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