What to Expect Before, During and After an AF Ablation

Being told you may need a heart procedure naturally brings questions.

How do they get to the heart? Will I be awake? How long will I be in hospital? What happens afterwards?

If you are preparing for an atrial fibrillation ablation, understanding the process can make the whole experience feel considerably less unfamiliar.

Here is what generally happens before, during and after an AF ablation.

Before your AF ablation

An AF ablation starts well before you enter the procedure room.

Your cardiologist or electrophysiologist will first assess your atrial fibrillation, your symptoms, your medical history and any other health conditions that may influence the procedure.

Testing may include an ECG and an echocardiogram to assess your heart rhythm and heart function. Some patients may require additional imaging or other investigations before their procedure.

You will also receive specific instructions about your medications.

This is particularly important if you take anticoagulants, often referred to as blood thinners, or medications that control your heart rhythm.

Do not stop or change these medications yourself before an ablation.

Your medical team will tell you exactly what should be continued and whether anything needs to be adjusted.

What happens during the procedure?

AF ablation is performed without the need for traditional open heart surgery.

Thin, flexible tubes called catheters are usually inserted through a vein in the groin and carefully guided towards the heart.

With atrial fibrillation, abnormal electrical signals commonly originate around areas where the pulmonary veins connect with the left upper chamber of the heart.

The procedure aims to electrically isolate or treat the areas responsible for triggering AF so those unwanted signals are less able to disrupt the heart’s normal rhythm.

Different forms of energy can be used to achieve this.

Nepean Heart Centre’s electrophysiology service includes experience with complex ablation procedures using 3D mapping systems, Radio frequency ablation and Pulse Field Ablation. The most appropriate technique depends on the patient’s individual circumstances.

Will I feel the procedure?

The type of anaesthesia or sedation used can differ depending on the procedure and individual patient.

Your medical team will explain what is planned beforehand so you know what to expect.

For most people, the surprising part is that there is no large surgical incision. The catheters reach the heart through the blood vessels, with the main access point generally being in the groin.

What happens straight after the ablation?

Once the procedure is complete, you will be moved to a recovery area where your heart rhythm, blood pressure and other observations can be monitored.

Because the catheters entered through a blood vessel in the groin, the team will also monitor the access site for bleeding or swelling.

Patients are generally asked to remain lying down for a period while the groin site begins to heal.Patients are generally asked to remain lying down for a period while the groin site begins to heal.

Depending on your procedure and clinical circumstances, you may go home the same day or stay in hospital overnight. Nepean Heart Centre notes that electrophysiology and ablation procedures may be performed as day procedures, although an overnight admission is sometimes required.

What is recovery like?

Recovery is different for everyone, but most patients are given instructions about activity, medications, wound care and follow up before leaving hospital.

The small puncture site in the groin also needs time to heal, so strenuous activity and heavy lifting may be restricted for a short period. Your own medical team should advise you when it is appropriate to return to work, exercise, driving and other normal activities.

You may also continue taking heart rhythm medications or anticoagulants after your procedure.

This does not mean the ablation has failed.

Your medication plan after AF ablation is based on several factors, including your rhythm and your individual risk of stroke.

Never stop an anticoagulant because you feel your heart rhythm has returned to normal. Current guidance recommends that decisions about longer term anticoagulation after AF ablation should consider the patient’s individual stroke risk rather than simply whether the ablation appears to have been successful.

Can AF come back after an ablation?

It can.

An ablation is performed to reduce the abnormal electrical activity responsible for AF, but it cannot guarantee that atrial fibrillation will never occur again.

Some patients experience excellent long term rhythm control after one procedure. Others may experience recurrent AF and require medication, ongoing monitoring or another ablation.

This is one of the reasons follow up after the procedure is important.

Your cardiologist may use ECGs, Holter monitoring or other heart rhythm monitoring to assess how your heart is behaving over time.

Your recovery is part of your treatment

It can be tempting to think that once the procedure has been completed, the AF journey is over.

In reality, managing atrial fibrillation is often broader than the procedure itself.

Blood pressure, weight, sleep apnoea, diabetes, physical activity, alcohol intake and other cardiovascular risk factors can all influence AF and should continue to be addressed as part of ongoing care.

The goal is not simply to perform an ablation.

It is to help you achieve the best possible long term outcome for your heart.

If you are preparing for an AF ablation and have questions about your procedure, write them down before your appointment. There is no such thing as a silly question when it comes to understanding your own heart care.

At Nepean Heart Centre, Dr Ihab El-Sokkari specialises in cardiac electrophysiology and the management of heart rhythm disorders, including atrial fibrillation and AF ablation.

To discuss atrial fibrillation or your treatment options, speak with your GP or contact Nepean Heart Centre to arrange an appointment.

This information is general in nature. Preparation, procedure and recovery instructions vary between patients. Always follow the specific advice provided by your treating medical team.