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Before and After an Ablation

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The picture above shows X-Rays of an atrial fibrillation ablation being performed with pulsed field ablation technology using the Farapulse system. 

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 (Xarleto), apixaban (Eliquis) or dabigatran (Pradaxa)] these are usually continued right up to the procedure and stopped ONLY on the morning of the procedure itself. 


If you are on an anti-platelet medication such as clopidogrel (Plavix), prasugrel (Effient) or ticagrelor (Brillinta) 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 (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 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.



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 (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.  



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. 



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.  



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.  

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The picture above shows the very small tubes that are used to pass catheters up through the vein at the top of the leg and then to the heart in order to perform electrical testing and ablation procedures. A stitch may be tied around these tubes following the procedure to provide pressure when they are removed. 

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