PRE-PROCEDURE INSTRUCTIONS BEFORE ATRIAL FIBRILLATION ABLATION
Cardiac catheter ablation is a special type of procedure where an electrophysiologist “EP”, using very specialized equipment, attempts to treat a heart rhythm disorder. It is performed in a unique room called an EP lab. At its most basic, it is attempting to fix an electrical short circuit inside the heart by ablating (or burning) the tiny part of the heart that is short circuiting.
There are many different types of ablations performed for a the different heart rhythm problems.
Atrial Fibrillation is a very common rhythm disorder. It is commonly linked to other health problems like obesity, diabetes, high blood pressure, and particularly sleep apnea. It is important to treat these other medical problems because this will also help us to control the rhythm. Atrial fibrillation ablation is one tool we use to try to control the rhythm.
Atrial fibrillation, when properly treated, is not life threatening but can significantly worsen your quality of life. It can be very frustrating to go through the treatment process because sometimes multiple ablations are needed. This is more likely the longer the atrial fibrillation has been happening.
Adopting a healthy lifestyle and treating sleep apnea will greatly improve the chance of success!
Before the procedure:
After your clinic appointment, we will adjust your medications. Most of these medicines will be used for a short period of time. The most important is the blood thinner (Warfarin/coumadin, Eliquis, Xarelto, or Pradaxa). If any doses are missed, please let us know as it can lead to a higher risk of stroke. Take your blood thinner the morning of the procedure.
A stomach reflux medicine (Protonix) will be added to help prevent a very rare but dangerous complication. We will stop this after one month.
The day of the procedure:
Don’t eat or drink anything after midnight the night before you procedure unless otherwise instructed.
We ask that you arrive to the pre-operative area a few hours before your procedure so that we can fully prepare you for the procedure. The room where the procedure takes place is also used for other heart emergencies, so there may be unforeseen delays. We apologize greatly for any delays.
Your pre-operative nurse will place an IV in your arm and will shave your groin where the veins will be used. You will meet our anesthesiologist who will be in charge of keeping you comfortable throughout the procedure. You will also meet our EP team. All of them are extremely knowledgeable about your procedure, so feel free to ask any of them any questions.
What to expect during your procedure:
When you arrive to the EP lab, it will be cold to prevent the spread of germs. We have plenty of warm blankets, though! Many special stickers will be placed on your chest and back.
Your anesthesiologist will then take over your care and gently put you into a deep sleep. A breathing tube will be placed to help you breathe during the procedure. A special temperature probe will be placed gently in your mouth for careful monitoring. If needed, we will take some pictures of the inside of the heart using ultrasound to ensure there are no blood clots (Trans-esophageal echocardiogram, or TEE).
The ablation procedure generally takes about 90 minutes to 2 hours, but can sometimes last much longer or shorter. As you wake up, you will be taken to the recovery area where specialized nurses will care for you. We ask that you keep both legs straight for 3 hours, then sit up in bed for another hour before walking around. This helps to keep the sites from bleeding.
You and your family will be given a printed picture afterwards showing the exact ablations performed.
After the procedure:
If everything goes according to plan, we will discharge you home about 4 hours after the procedure is completed. Complications are rare, but if they occur we will continue to care for you until it is safe to go home.
You may experience some chest discomfort. This feels like you’ve been breathing cold air. This is normal. We start an old gout medicine (colchicine) to help with this pain. This medication can cause diarrhea, so let us know if this occurs.
You will be discharged home with a few new medications: a proton pump inhibitor to prevent a very rare complication involving the esophagus, a gout medicine for chest pain, and an anti-arrhythmic to help control the rhythm while you heal. We will stop each of these medicines in followup.
Your most important medicine is your blood thinner. Try to not miss any doses without talking with us first.
Plan to feel a little beat up for 3 or 4 days. We ask you to take it easy for a week to let the legs fully heal. Don’t lift more than 10 lbs or do strenuous exercise. Don’t drive for at least 24 hours after anesthesia.
We will schedule you an early, brief followup with one of our nurse practitioners 1 month after discharge to make sure everything is healing as expected. If there are any concerns, please call and we will work you in earlier.
Thank you for letting us be a part of your care.
Kevin R. Hayes, MD