FAQs
Q: How long does the procedure take?
A: The procedure takes many hours, especially in patients who are in persistent atrial fibrillation. A bulk of the time is taken in setting up the patient, placing them under general anesthesia, inserting catheters, creating a geometry of the heart, mapping the signals, and eventually performing the ablation. Procedures can take up to 8 hours.
Q: What type of anesthesia is used?
A: Typically, general anesthesia.
Q: How long am I kept in the hospital after the procedure?
A: Most patients are discharged on the following day, although if there are additional issues occurring after the ablation patients can be kept for few days in the hospital.
Q: How will I feel after the procedure?
A: This varies. Some patients feel fairly well the following day. However many patients feel as if they were "hit by a truck". Patients are often fatigued and can have some chest discomfort. We recommend taking an average of one week off from work although this will vary.
Q: Why are blood thinners continued throughout the procedure?
A: This is been shown to be the safest way to do the procedure. Although bleeding may be more likely the chance of a stroke is reduced.
Q: What additional medications will be given to me before and after the procedure?
A: Starting prior to the procedure two medications will be given to you to help protect your esophagus. After the procedure you will typically be placed on two separate diuretics. Patients typically will accumulate fluid as a result of the procedure and usually for a week after the procedure the diuretics are given. Sometimes anti-arrhythmic medications are given for sometime after the procedure to prevent early recurrences of the arrhythmia. Also, if AF does occur after the procedure, anti-arrhythmic medications may also be prescribed, and often may be more effective than prior to ablation.
Q: Why is an MRI or CT scan done prior to the procedure?
A: This pre-procedure imaging helps with defining your atrial and pulmonary vein anatomy and the images are used during the procedure to help guide the location of the ablation.
Q: What is the success rate of the procedure?
A: This depends on many factors. It is very important to note that atrial fibrillation ablation is not a perfect procedure. There can be many areas in both atria that can serve as drivers for atrial fibrillation, and it can be difficult to identify and successfully ablate all of these areas in a single procedure. In addition, other areas can develop over time, so that a procedure can be successful for some time then stop working. The highest success rate is in patients who have recent onset of their arrhythmia, have paroxysmal atrial fibrillation (meaning the AF lasts for shorter periods and stops on its own), have normal or only slight atrial enlargement, are not overweight, do not have sleep apnea, and whose blood pressure is well controlled. In this group of patients the success rate for a single procedure can be as high as 75-80 percent. In most of these patients, the drivers for atrial fibrillation are in the pulmonary veins, and can be cured by conventional pulmonary vein isolation. In patients with longer duration of atrial fibrillation, persistent AF (meaning in it continuously or requiring cardioversion), who have significant atrial enlargement, who are overweight, who have sleep apnea, or who have poorly controlled hypertension or continued alcohol use, the success rate can be lower, even as low as 50% long term. We therefore recommend before an ablation aggressive weight loss, evaluation and treatment of sleep apnea, aggressive control of blood pressure to completely normal values, and minimizing alcohol intake.
Q: Does AF occurring in the first month or two after ablation mean that the procedure did not work?
A: No. Although we would rather not see arrhythmias during this time (the time period after ablation is often referred to in studies as the “blanking period”), sometimes these arrhythmias quiet down on their own. The thought is that the ablation can cause some irritation that eventually quiets down. However, the procedure can be unsuccessful in a significant portion of patients, and additional procedures may be necessary (see below).
Q: Will more than one procedure be required to satisfactorily treat my atrial fibrillation?
A: As noted above, atrial fibrillation ablation is not a perfect procedure and the success rates are unfortunately lower than we would like, especially in patients with persistent atrial fibrillation with enlarged atria. Therefore, a significant proportion of patients undergoing atrial fibrillation ablation will require repeat procedures. We have seen patients who require three and rarely four procedures to treat their AF. The good news is that often the repeat procedures are shorter in duration and with multiple procedures success rates even in tougher cases can approach 90 percent.
Q: What are the potential complications of atrial fibrillation ablation?
A: There are many potentially serious complications of this procedure. These include (but are not limited to) cardiac perforation (hole in heart, which could require drainage of blood from around the heart or even surgery), stroke, death, valve damage, narrowing of the pulmonary veins (known as pulmonary vein stenosis), heart block requiring pacemaker implantation, damage to blood vessels in the femoral area, hematoma/bleeding, phrenic nerve paralysis (damage to the nerve that supplies the diaphragm muscle causing breathing difficulties). A rare but often fatal complication is the formation of an atrio-esophageal fistula (a connection between the heart and esophagus), which typically forms one to 6 weeks after the procedure; for this reason we ask that you call our office immediately if after ablation you have fever, difficulty swallowing, or neurologic symptoms.
Q: What type of followup is required after the procedure?
A: Often times an echocardiogram is ordered a week or so after the procedure to rule out any fluid around the heart. Typically you will then be seen in the office a few weeks after the procedure. After that, we may obtain a Holter Monitor, Event Monitor, Alivecor Monitor, or even an Implantable Monitor, to assess the success of the ablation and to pick up any arrhythmias that might not be felt. Subsequently we may see you on an intermittent basis. However we often return the patient back to their primary cardiologist for follow up.
Q: Can I stop my anticoagulant or blood thinner after the procedure?
A: This is a complex and controversial question. If your risk for a stroke is fairly low (a low CHADSVasc2 score), in many instances with shared decision-making between the doctor and patient going over the risks and benefits of each approach, the anticoagulant may be stopped. In some instances it will be recommended that the anticoagulant be continued indefinitely. In some cases various types of monitoring may help make the decision.