What to Expect After Catheter Ablation
After your catheter ablation, the doctor will remove the catheters and apply pressure to avoid bleeding at the catheter insertion site. To prevent bleeding, you'll stay still for up to six hours, though with anesthesia you may be out the whole time. You'll be hooked up to a telemetry monitor that uses EKG-like patches and displays your heart rhythm. You will likely have to stay in the hospital overnight.
Expect to be tired, even out of it, with some chest discomfort for a day or two. It is common to experience afib or heart palpitations after any heart procedure, but they will subside once your heart heals, generally within three months.
You can expect to be on anticoagulants, such as Coumadin (warfarin) or possibly Pradaxa (dabigatran), to prevent blood clots for three-to-six months after the procedure. After that, the CHADS2 or the CHA2DS2-VASc scoring system may be used to determine if you should continue on an anticoagulant. To learn more about these scoring systems, see New Stroke Risk Factors for Those with Atrial Fibrillation (AF): Female Gender, Heart Disease, and Age. You may also be on an antiarrhythmic drug for a few months to manage any afib episodes.
Your doctor may tell you to avoid baths and swimming and to avoid lifting for up to a week following the procedure. You may also wish to give yourself plenty of time to recover before resuming any work or physical activity that may stress the body.
Follow-up visits after the procedure will generally involve many of the same tests as before the procedure, such as:
- Electrocardiogram (ECG)
- Transesophogeal echocardiogram (TEE)
- Computed tomography (CT)
- Holter monitor test
- International Normalized Ratio (INR) if on Coumadin or warfarin
- Other blood tests or lab work.
The HRS Consensus Statement suggests that follow-up should begin within three months after the ablation procedure and continue at six month intervals for at least two years. In addition, each doctor visit should include an ECG, and those who experience palpitations should wear an event monitor.1
Many people experience some atrial fibrillation or atrial flutter following a catheter ablation due to inflammation of the heart tissue. For this reason, the first three months are generally considered a "blanking period" in which success or failure should not be judged.
Some folks have said that their afib following catheter ablation was as bad as before, or worse. That is due to the inflammation, and the arrhythmia is often different from that experienced previously. As the body heals and the inflammation resolves, the afib and atrial flutter generally go away.
The HRS Consensus Statement deals with this issue:
Although early recurrence of AF carries an independent risk of treatment failure, its occurrence should not prompt immediate re-ablation attempts, as 20% to 57% of patients experiencing this event within the first months post-ablation will not have any further arrhythmias during long-term follow-up. Since the mechanism of AF post-ablation may be different from that of the patient’s clinical arrhythmia and may resolve completely upon resolution of the inflammatory process, some operators choose to treat all patients with suppressive antiarrhythmic agents for the first 1 to 3 months following ablation. Repeat ablation procedures should be delayed for at least three months following the initial procedure if the patient’s symptoms can be controlled with medical therapy.1
Just knowing that this may happen should help ease the disappointment and frustration if it does. If you can focus on recovery, you'll soon be past this. Many patients find that medications that failed previously now work to hold back the afib and get them past these initial few months.
For more information about determining catheter ablation success, see Measuring Catheter Ablation Success.
To learn about other atrial fibrillation treatments, see Can Afib Be Cured.