Catheter Ablation for Atrial Fibrillation is an invasive procedure that is used with the aim of improving symptoms from atrial fibrillation to improve the quality of life of a patient.
In this procedure, fine wires or catheters are usually inserted into the heart of patients through the large veins located at the top of the leg. These wires have electrodes at their tips that are used to detect the electric signals produced from the different parts of the heart and can deliver radiofrequency energy or cooling to destroy tissue inside the heart that allows atrial fibrillation to continue. In many cases atrial fibrillation is thought to arise from the pulmonary veins (veins emptying into the left atrium) and Pulmonary Vein Isolation may be suggested by your cardiologist
Your Cardiologist will arrange for some tests to help decide whether AF ablation is likely to be useful. You will need an echocardiogram and perhaps other scans including a CT and MRI scan of the heart.
There are a number of medication (pill) alternatives to AF ablation and your Cardiologist will help you weigh up the pros and cons of proceeding with AF ablation. In general AF ablation is successful (70-80% success rate), but you may need more than one procedure and there is a small chance (1%) of a serious complication which may require other procedures or heart surgery. If you have paroxysmal atrial fibrillation (comes and goes) then AF ablation is more likely to be successful but if you have been in atrial fibrillation for a long time then it is less likely to be successful.
You will be asked not to eat or drink anything on the morning of the procedure. A small plastic tube (cannula) will be inserted into a vein in the arm to give you any medications that are required as part of the procedure. You will be brought to the operating room and the team will introduce themselves before you are given some oxygen and some sedation medication. You may have a transoesophageal echocardiogram performed before the procedure.
As you become sleepy a drape will be placed over you and local anaesthetic injected at the top of the leg. Some fine wires will be inserted through needles into the blood vessels at the top of the leg and fed round to the heart under X-ray guidance. Once the wires are in the correct place, the correct tissue in the heart will be ablated carefully.
The catheters (thin tubes) will then be withdrawn from the heart and pulled back through the top of the leg. After they are removed there will be pressure applied to the top of the leg to reduce bruising.
After the procedure, you will return to the ward to be observed. You will be asked to lie flat for a few hours to reduce the risk of you bleeding from the top of the leg. You will be allowed to drink and then eat when you are no longer drowsy. You may have a focussed ultrasound (echo) of your heart to check there has not been a build-up of fluid in the sac around the heart.
You will normally be able to go home the morning after your procedure. You may have a sore feeling and other slight discomforts in your chest for a few days and feel tired for a week or two.. The dressing at the top of your leg can be removed the day afer you come home. You are not allowed to drive for two days and you should avoid lifting, heavy exercise and flying for a week afterwards.
Atrial fibrillation ablation is a potentially effective procedure to transform quality of life but your case needs careful evaluation by expert Consultant Cardiologists who can help you decide the best way forward. Our cardiologists are available for consultation on any day of the week and weekends as well.
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