Atrial fibrillation ablation
Catheter ablation for AF is an effective way to control your heart rhythm. Most people are symptomatically better with success estimated at up to 80% depending on factors such as duration of AF, size of cardiac chambers and comorbidities. 30-50% of people may need to have more than one procedure in time as the heart may heal at sites of prior ablation or new areas may appear. Often medications used to control the heart rhythm can be stopped following ablation. In the vast majority, amount of AF after ablation is markedly reduced and much better controlled.
What are the risks of having an AF ablation?
They include but are not limited to the following.
Common risks and complications (more than 5%) include:
• Bruising bleeding at the puncture site. Bruising can extend beyond the puncture site and can take a few weeks to improve in some cases.
Uncommon risks and complications (1- 5%) include:
- Development of another arrhythmia
- Bleeding related to the groin puncture site or injury to an artery in the groin. This (rarely) may need surgery and or blood transfusion
- Chest pain / Pericarditis. This is an inflammation of the heart sack that can cause chest pain for some weeks after the procedure and is easily managed with anti inflammatories
Rare risks and complications (less than 1%) include:
- Fluid around the heart called a “pericardial effusion” which may need to be drained thru a tube under the breast bone or “sternum”
- A stroke. This may cause long term disability (0.5%)
- Requirement for a pacemaker following the procedure
- Injury to the food pipe related to the ultrasound or temperature probe used during the procedure.
- Injury to the urinary tract if a urinary catheter is required for the procedure.
- Damage to the phrenic nerve that controls the diaphragm (breathing muscle) called phrenic nerve palsy.
- Atrial oesophageal fistula. A hole forms between the gullet and heart. This can cause vomiting of blood and a stroke. This may be life threatening.
- Narrowing of the veins from the lungs to the heart called pulmonary vein stenosis. This can be serious, causing breathlessness and may require further procedures
- Damage to normal electrical system requiring a permanent pacemaker
- Death because of this procedure is rare
What are the costs involved with an ablation?
If you are having this procedure in a public hospital as a public patient, the cost is covered by Medicare. If you are having this procedure in a private hospital, there is no additional out of pocket cost for our specialists. The usual hospital excess applies. Anaesthetists often have an out-of-pocket cost that we encourage you to discuss prior to your planned procedure.
How do I prepare for an ablation?
You will receive a letter with instructions and steps required prior to your procedure including, date of admission, fasting instructions, medications to stop and items to bring with you. You will usually need recent blood test for your kidneys and blood count prior. In general, do not eat or drink for 6 hours before your procedure. Ask your doctor about taking your usual medications. Blood thinners are usually continued for AF ablation procedure. If you take SGLT2 medicine for heart failure or diabetes, you will need to stop taking them at least 3 days before your surgery. Leave any personal items of value such as jewellery at home.
What happens when you arrive at the hospital?
Once you arrive at the hospital for your procedure, you will usually be directed to the cardiac catheter laboratory admission area where you will be formally admitted as a hospital patient. You will be asked to change into hospital gown and put away all your valuable belongings. You will have some basic tests such as ECG, have your vitals recorded, groin shaved and have a cannula inserted into your arm to assist with the procedure. The technologists will place special stickers and wires on your chest and back. In most cases a pre ablation cardiac CT scan of the heart is performed to guide the ablation procedure. If you have this performed externally, please ensure you ask for a copy of the CD to the hospital with you.
Ablation will be performed under general anaesthesia which requires an anaesthetist. The anaesthetist will speak with you about their role. You will require an arterial line to monitor your blood pressure during the ablation that carries some risk of complications.
