Before and After an Ablation

Before the Procedure:

Before stopping any medications it is important to confirm with your doctor or Hunter Heart staff that it is safe to do so. If you are taking warfarin (anticoagulant) then in general this should be continued for the ablation procedure. If you are on a newer anticoagulant (rivaroxaban, apixaban or dabigatran) these are usually withheld for one dose prior to the procedure (stopped on the morning of the procedure for example).

If you are on an anti-platelet medication such as clopidogrel, prasugrel or ticagrelor then these medications may be withheld for 5 days prior to the procedure (if it is safe to do so) and if you are on aspirin then this is usually fine to continue.

Antiarrhythmic medications such as sotalol, flecainide, metoprolol, atenolol, verapamil, diltiazem and digoxin should generally be withheld for 3 days prior to the ablation to maximise the chance of inducing (finding) your arrhythmia at the time of the procedure.

Most other medications should be continued as usual and can be had with a sip of water up to two hours before hand. Since it is important to fast for six hours prior to the procedure, if you are on medications for diabetes you should clarify with your doctor if any changes to these are needed.

After the Procedure:

Depending on the ablation most patients will either stay in hospital for one night or go home later the same day. When the sheaths are removed from the groin no stitches are needed as the incisions are very small and usually can’t be seen at all after a couple of weeks (see picture).

Complications

If you notice any bruising, swelling or bleeding in the groin where the sheaths were removed the best thing to do is lie down and apply firm pressure over the site. A small degree of bruising or swelling can happen with coughing or straining after an ablation procedure but if it is painful or doesn’t settle down with a few minutes of firm pressure then you should contact your specialist (4952 3900) or if after hours your local emergency department.

It is possible to notice some discomfort in your chest following an ablation procedure (particularly with a deep breath in) if there is inflammation around the lining of the heart. This will usually settled down within 1-2 days and can be treated with paracetamol or panadiene if needed. Anti-inflamatories such as neurofen are often effective for this sort of pain and are usually fine for patients post ablation procedures as long as there is no pre-existing heart failure or cardiomyopathy.

In the rare event that you experience any more concerning symptoms such as shortness of breath, a fever, visual disturbance, arm or leg weakness, dizziness or chest pain then it is important to contact your specialist (4952 3900) or visit your local emergency department promptly.

Activity

In general patients can return to things as normal the following day after an ablation. More strenuous activities such as jogging/running or going to the gym should be avoided for a week following an SVT ablation and two weeks following an AF or VT ablation.

Driving

Whether or not you can drive following an ablation relates to whether or not you have had fainting episodes prior. The minimum non-driving period for someone who has had fainting episodes is three months and for someone who has had shocks from their defibrillator (without fainting) the minimum non-driving period is four weeks. It is important to clarify with your cardiologist whether or not you have any restrictions for driving.

Follow-up

Following an atrial fibrillation ablation it is possible to have a recurrence within the first month due to some local inflammation and irritation. This may settle down of its own accord but if it does not you should contact your cardiologist for advice. After an AF ablation it is important to remain on anticoagulation at least until you follow up with your cardiologist in 3 months but it is generally fine to stop your antiarrhythmic medication a month following the procedure.

After an SVT ablation some patients may still notice the occasional ectopic (extra) heart beat. This is quite normal and provided you no longer experience the very rapid palpitations from your SVT, the procedure has still been successful. Some patients describe this as their heart ‘trying’ to race away again but it can’t because the short circuit is no longer there.

For all ablations you should follow up with your cardiologist 3 months after the procedure.

The picture above shows four sheaths that are placed into the femoral vein on the right hand side at the top of the leg. Electrical catheters can then be placed through these sheaths to perform an electrical study or an ablation procedure. Following the procedure the sheaths are removed and a firm suture is tied over the area to prevent any bleeding. This suture is then cut and removed in four hours time.