Your doctor/cardiologist has talked to you about catheter ablation of atrial fibrillation. Here are some answers to frequently asked questions.
What is the purpose of catheter ablation for atrial fibrillation?
The aim of the procedure is to maintain normal (sinus) rhythm and reduce/eliminate the duration/number of episodes of atrial fibrillation. Despite the term "ablation", no tissue or organ is removed from the body during the procedure.
What is the success rate of catheter ablation of atrial fibrillation?
The success rate depends on the type of atrial fibrillation and the patient's characteristics (in particular, age, obesity, presence of other heart disease). It is very high (80-90%) for paroxysmal forms and lower (up to 70%) for persistent forms. Overall, catheter ablation gives better results than taking anti-arrhythmic drugs.
What tests are required before catheter ablation of atrial fibrillation?
A blood test, a CT scan of the heart and a consultation with an anaesthetist are common tests carried out before an atrial fibrillation ablation procedure.
What happens during a catheter ablation of atrial fibrillation?
You will generally be under general anaesthetic. The electrophysiologist will puncture a vein in the right groin to gain access to the heart. Next, a transseptal puncture is performed, i.e. a passage through the membrane between the 2 upper chambers of the heart (atria). The next step is usually a mapping of the left atrium. Next, the pulmonary veins (where the abnormal electrical activity most often originates) are electrically isolated, either point by point using radiofrequency (cauterisation) or cryotherapy (cooling) by means of a catheter (a fine wire used to record electrical signals and deliver energy). Once the result has been validated, the procedure is completed and the catheters removed.
What are the risks of catheter ablation of atrial fibrillation?
The risks, which are low overall, relate to access to the blood vessels (haematomas), the left atrium (tamponade), working in the heart chambers (formation of clots that can leave the heart and cause a stroke), and the use of general anaesthetic.
How long do I have to stay in bed after an atrial fibrillation ablation?
Depending on the puncture site management technique, bed rest, without bending the right leg (the side used for the procedure), ranges from 1 to 6 hours. In some cases, it is advisable to stay in bed until the following day.
How long do I have to stay in hospital for catheter ablation of atrial fibrillation?
In general, an overnight stay in hospital after the ablation is proposed, i.e. admission on the day of the procedure and discharge the following day after the post-operative examinations. This can be adapted according to the particularities of your case and the practices of the hospital.
What can I expect after an atrial fibrillation ablation?
You will find more information on the page dedicated to post-ablation instructions. Recovery is generally short (one or two days) but may vary from one patient to another.
Do I need to take any medication after an atrial fibrillation ablation?
For patients who are not taking any medication before the ablation, anticoagulant medication is generally recommended for 2 to 3 months after the atrial fibrillation ablation.
For patients taking medication prior to ablation, the usual medication is usually continued, including anticoagulants and antiarrhythmics. Your discharge medication regime will be explained to you by the team looking after you. Three months after the ablation, anticoagulant and antiarrhythmic treatment may be reviewed with your doctor.
Can I drive after an atrial fibrillation catheter ablation?
It is often advisable not to drive for 48 hours, and it is best to arrange for someone to drive you home when you leave hospital. Some people recommend taking up to a week off driving, mainly to allow the puncture site to heal.
Can I travel by plane after an atrial fibrillation ablation?
It is generally advisable not to fly within 1 week of the ablation. Your doctor will be able to give you individual advice.
When can I return to work after catheter ablation of atrial fibrillation?
In general, you can return to work after 1-2 weeks, depending on the physical component of your work.
What is the follow-up after catheter ablation of atrial fibrillation?
The first follow-up consultation after the procedure is generally 4 to 12 weeks after the procedure.
Can atrial fibrillation return after catheter ablation?
Recurrences of arrhythmias can occur up to 3 months after catheter ablation. These do not predict the final outcome of an ablation, which for this reason is assessed, particularly in scientific studies, from 3 months after ablation.
The first atrial fibrillation ablation didn't work, is it worth having another one?
A certain proportion of patients need more than one procedure in order to restore normal rhythm on a lasting basis. Success is incremental, meaning that the success of the 2nd procedure is greater than that of the 1st and so on. Your doctor will be able to explain his treatment strategy for the additional ablation procedure in more detail.
I've been offered catheter ablation for atrial fibrillation. What information can help me make my decision?
The decision to have the procedure is taken in agreement with your doctor.
You need to take into account the symptoms that arise from your atrial fibrillation, which may be more or less severe and affect your daily life.
Studies show that patients who opt for atrial fibrillation ablation have a greater improvement in their symptoms than patients who continue with medication.
Some patients progress from a paroxysmal form of atrial fibrillation to a persistent form, and ablation makes it possible to halt this progression.
Your doctor will also explain the expected benefits of restoring normal rhythm in your particular situation. The potential risks of the procedure should also be discussed.
Potential alternative treatment options and their expected success should also form part of your discussion with the doctor.
You will therefore need to establish the risk-benefit balance of the procedure proposed to you in order to make your decision.
References
Taghji, JACC: Clinical Electrophysiology 2018
Duytschaever, Heart Rhythm 2020
Mansour, JACC: Clinical Electrophysiology 2020
ESC 2020 atrial fibrillation guidelines
2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation
Mark, JAMA 2019
Kuck, Europace 2021