Treatment: Ablation for atrial fibrillation

Ablation is an effective treatment for atrial fibrillation. During the procedure, a catheter is guided through the blood vessels to the heart. The cardiologist can then use heat, cold or a high-voltage current to destroy small areas of heart tissue that are causing the condition.

You may benefit greatly from ablation if:

• Your medication for atrial fibrillation is not working well enough
• You are experiencing side effects from your medication for atrial fibrillation;
• You wish to stop taking medication for atrial fibrillation

Ablation is usually most effective if you have atrial fibrillation that 'comes and goes', rather than if it has become established and is present all the time.

Before your treatment, you will receive a letter informing you about fasting, medication, shaving and what to bring with you in connection with your treatment.

If you have an ablation, you are welcome to bring a companion, but this is not necessary as you will be able to drive and use public transport (including flights) the day after the procedure. You are also welcome to bring a weekend bag or carry-on suitcase containing some spare clothes and toiletries.

It is not necessary to take blood-thinning medication before your ablation. We always perform a scan to ensure there is no clotted blood in the atria or the left atrial appendage.

However, if you are used to taking blood-thinning medication, you must continue to take it before, during, and after the ablation. Should there be any changes, you will be informed.

An ablation procedure for atrial fibrillation lasts approximately 1,5-2 hours and is performed under deep sedation – practically full anesthesia. You will experience no pain during the procedure.

A plastic cannula will be inserted into a vein in your arm. Your blood pressure and pulse will be monitored, and blood samples will be taken, as well as an ECG being performed.

First, a special ultrasound scan of the heart is performed via the esophagus (TEE). This is done to rule out the possibility that blood clots have formed on the inside of the left atrium despite taking blood-thinning medication. If this is the case, there is a risk that these clots could become dislodged during the operation, in which case the operation must be postponed. This examination is carried out under general anaesthesia.

The catheter procedure is performed under a combination of local and general anaesthetics. Thin catheters are inserted into the heart via blood vessels in the groin. These catheters enable electrical currents in the heart to be measured. The cause of the arrhythmia is eliminated by heating the tip of the catheter to approximately 65 degrees or by using repeated electrical pulses. Whether radiofrequency ablation (RFA) or pulsed radiofrequency ablation (PFA) is used is at the operator’s discretion and will not affect your expected outcome.

If you develop atrial fibrillation during the procedure, we will try to restore a normal heart rhythm (sinus rhythm) by delivering an electrical shock to your chest (a process known as DC Cardioversion).

You will be monitored by a nurse for two hours following an ablation. You will need to lie flat in bed to minimize the risk of bleeding from the puncture sites in your groin.

You must inform the nurse if you experience any discomfort, pain, a sensation of heat or swelling in your groin.

Your appointment letter will state when you are expected to be discharged.

You can drive or use public transport (including flying) the day after the procedure.

For the first week, you should protect your groin by avoiding heavy lifting and long walks, for example. We recommend waiting two weeks before taking part in sports.

You can return to your normal work approximately one week after discharge. However, if your work involves particularly heavy physical labour, you should wait two weeks before resuming it.

You can expect to see a small bruise at the puncture site in your right groin. Some patients may experience a slightly larger bruise, known as a hematoma, which may cause discomfort for the first few weeks after treatment.

Many patients experience a light pain, pressure or a dull ache in their chest during the first few days after treatment. If necessary, you can take one gram of Paracetamol. However, no more than four times a day, i.e. every six hours. It is also common to experience a slight headache. You may also experience occasional migraines with aura. This is sometimes seen during the initial days following ablation. The exact cause is unknown, but the symptoms are harmless and will disappear again.

We usually recommend that you continue taking the heart rhythm stabilizing medication prescribed prior to the treatment for a further one to three months. You should also take the blood-thinning medication for at least three months after the procedure.

Some patients experience palpitations or atrial fibrillation following treatment. This may be due to irritation of the heart muscle caused by the treatment and does often not mean that the treatment has failed. Patients may experience an increased frequency of episodes during the first two to three months after treatment, after which the symptoms usually subside. Therefore, the final effect of the treatment can only be determined after approximately three months. It may be necessary to repeat the treatment. Experience shows that around 20% of patients require further treatment before achieving the optimal result.

If you experience palpitations or atrial fibrillation, we recommend the following:

• If your symptoms are the same as before treatment, you may wait to see if the episode resolves spontaneously
• If your symptoms are different from usual, we recommend that you contact your GP to have an ECG recorded. If necessary, the ECG can be sent to us for assessment
• If the episode is unbearable, you should contact your GP or the emergency service to arrange admission to your local hospital for a ‘shock’ (DC Cardioversion)
• If you experience a recurrence of atrial fibrillation that does not significantly affect you, you can wait a couple of days and see how it progresses. If the atrial fibrillation does not stop on its own within two days, you should contact your doctor to arrange admission to your local hospital for a ‘shock’ (DC Cardioversion). You are always welcome to contact us if you have any concerns
• If you experience frequent relapses following treatment, you may require more efficient heart medication to stabilize your heart rhythm. We will usually recommend taking Cordarone for three months. This is well tolerated by most patients without significant side effects during short term treatment
• You should seek medical attention if you experience severe chest pain, severe shortness of breath or fainting

In rare cases (less than 1% overall risk), the following complications may occur: Significant accumulation of blood at the puncture site, accumulation of blood in the pericardial sac, air in the pleural cavity, effects on the pulmonary veins, formation of small blood clots in the blood vessels, heart or other organs (e.g. brain, kidneys, lungs).

These complications may require observation or special treatment, which can be carried out on site.

Ablation treatment for atrial fibrillation