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 such as rivaroxaban (Xarelto), apixaban (Eliquis) or dabigatran (Pradaxa) these are usually continued right up to the procedure and stopped ONLY on the morning of the procedure or are continued uninterrupted depending on the operators preference to reduce the risk of blood clots. Hunter Heart will let you know what your specialist prefers. 

 

If you are on an anti-platelet medication such as clopidogrel (Plavix), prasugrel (Effient), ticagrelor (Brillinta) or aspirin (Astrix, Cardiprin, Spren, Cartia, Solprin) then these medications are generally fine to continue for the procedure. 

 

Antiarrhythmic medications such as sotalol (Cardol, Solavert, Sotacor), flecainide (Tambacor), metoprolol (Betaloc, Minax, Metrol), atenolol (Tenormin, Noten) verapamil (Cordilox, Isoptin) and diltiazem (Cardizem, Vasocardol) 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 anytime prior to your procedure. 

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Diabetes Medications

Since it is important to fast for six hours prior to the procedure, if you are on tablets for diabetes you should hold these on the morning of the procedure. These tablets include metformin (Diaformin), gliclazide (Diamicron) or sitagliptin (Januvia), amongst others. 

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If you are taking dapagliflozin (Forxiga) or empagliflozin (Jardiance) for diabetes or heart failure then these medications should be withheld for three days prior to your procedure. If you are taking semaglutide (Ozempic, Wegovy, Rybelsus), tirzepatide (Mounjaro), liraglutide (Saxenda, Victoza) or dulaglutide (Trulicity) for diabetes or weight loss then you can continue them but you MUST have a clear fluid diet for 24 hours prior to your procedure (similar to a colonoscopy). Clear fluids include water, juices without pulp, clear fat free chicken or beef broth, plain coffee or tea without milk or cream and clear sodas like lemonade or plain jelly.

 

If you are taking a fast acting insulin (Novorapid, Humalog, Actrapid, Apidra, Fiasp) then you should NOT take this while you are fasting. If you take a long acting insulin like glargine (Optisulin or Toupee), detemir (Levemir) or degludec (Tresiba) then you should continue these for your procedure. If you are taking a premixed or an intermediate acting insulin such as NovoMix, Humalog Mix or Protaphane then you should usually take half of your usual morning dose and omit your lunchtime dose while fasting.

 

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.

 

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 5-10 minutes of firm pressure then you should contact your specialist on (02 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 settle down within 1-2 days and can be treated with paracetamol or panadeine if needed. Anti-inflammatories such as nurofen 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 (02 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 heavy lifting and going to the gym should be avoided for a week following an SVT or AF ablation and two weeks after a VT ablation. 

 

Driving

In general, it is fine to drive 24 hours following an ablation procedure. If you have had fainting episodes (without a reversible cause) then the minimum non-driving period 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 and anti-arrhythmic medications until you follow up with your cardiologist in 2-3 months (or otherwise as instructed by them). 

 

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 around 3 months after the procedure.