Bryce E. Montané, MD, Assistant Professor and Brian F. Gage, MD,MSc, Professor of Medicine, WashU Medicine Division of General Medicine and Geriatrics, led an interdisciplinary team to review trials of ablation of atrial fibrillation. They found that compared with medical therapy, catheter ablation reduced the relative risk for ischemic stroke by 37%, for death by 27%, and for heart failure (HF) hospitalization by 32%. They also found that surgical ablation reduced the risk for stroke.
Their findings, published online (and in Annals of Internal Medicine – August 2025) support recent guidelines endorsed by the AHA/ACC/ACCP/HRS that recommend catheter ablation as first-line therapy in many patients with new atrial fibrillation. Montané and Gage especially recommend ablation for their patients who are symptomatic from the atrial fibrillation or have atrial fibrillation and concomitant heart failure.
Atrial fibrillation is a common irregular heart rate that quadruples the risk of stroke. To reduce this risk, patients with atrial fibrillation often are prescribed blood thinner. Although blood thinner reduces the risk of stroke, it does not restore normal sinus rhythm and increases the risk of bleeding. Older studies found little net benefit to restoring sinus rhythm by prescribing medicines because these medicines had serious side effects. Thus, many patients ended up staying in atrial fibrillation, which can cause palpitation, reduce exercise tolerance and stroke.
An alternative strategy is to restore sinus rhythm is ablation of the atrial fibrillation. The most common way to perform an ablation is via the use of a catheter inserted into through the groin. A cardiologist inserts the catheter through the right side of the heart and into the left side of the heart to map the electrical activity of the heart. Then cardiologist delivers energy (via radiofrequency or cryoablation) to these areas, creating tiny scars that block the atrial fibrillation and restore sinus rhythm.
Catheter and Surgical Ablation for Atrial Fibrillation: A Systematic Review and Meta-analysis
Authors: Bryce Montané, MD, MSCIShiyang Zhang, MD, Jonathan D. Wolfe, MD Sabrina Prime, MD, Chongliang Luo, PhD, Daniel H. Cooper, MD, Michelle Doering, MLIS Brian F. Gage, MD, MSc