What to Expect After Catheter Ablation
At the end of your catheter ablation, the EP will remove the catheters and apply pressure or a collagen patch to avoid bleeding at the catheter insertion site. To prevent bleeding, you may lay on your back and stay still for a few hours, though you may be out much of that time from anesthesia. During that time, you’ll be hooked up to a telemetry monitor that uses EKG-like patches and displays your heart rhythm.
Most patients are discharged from the hospital in less than 24 hours, making catheter ablation an outpatient procedure. However, during the COVID-19 pandemic, many centers moved to same-day discharge, making it a day procedure.
Expect to be tired and out of it, with some chest soreness and discomfort, for a day or two. It is common to experience afib, heart palpitations, and/or an increased heart rate after any heart procedure. That generally subsides once your heart heals, usually within three months. You may be placed on an antiarrhythmic drug for a few months to manage any afib episodes.
Your doctor may tell you to avoid baths and swimming and avoid lifting for up to a week following the procedure. You may also wish to give yourself plenty of time to recover before resuming work or vigorous physical activity that may stress the body. In addition, you might need to alter the usual intensity of your physical activities and exercises. Therefore, it may be advisable to take it slow and make modifications until you build back up your strength.
Stroke Prevention After Ablation
You may be on an anticoagulant for two to three months after the procedure to prevent blood clots. The anticoagulant will be Coumadin (warfarin) or one of the newer direct oral anticoagulants (DOACs), which include Pradaxa (dabigatran), Xarelto (rivaroxaban), Eliquis (apixaban), and Savaysa (edoxaban).
The CHA2DS2-VASc scoring system is used to determine your risk of a stroke. If you were on an anticoagulant before your ablation, you would likely stay on one afterward. Even after a successful ablation, you might still have episodes of asymptomatic (or silent) afib, events that can increase your risk for a stroke. The DISCERN AF clinical trial showed that asymptomatic to symptomatic afib episodes increased from 1.1 before ablation to 3.7 after.1
A recent point of interest related to strokes and afib is whether the afib causes the strokes or whether the diseased atrium does, in which case afib may be the symptom rather than the cause. To learn more about this thinking, see Is It Afib That Causes Strokes, or Maybe Something Else?
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Follow-Up Visits After Ablation
The HRS Consensus Statement suggests that all patients who undergo catheter ablation of afib should be seen for follow-up for at least 3 months after ablation. Afterward, patients are recommended to be seen annually by a physician (family physician, internist, cardiologist, or electrophysiologist).2
Follow-up visits after the procedure will generally involve many of the same tests as before the procedure, such as:
- Electrocardiogram (ECG)
- Transesophageal echocardiogram (TEE)
- Computed tomography (CT)
- Holter monitor test
- International Normalized Ratio (INR) if on Coumadin or warfarin
- Other blood tests or lab work
Monitoring Afib Following Ablation
There are many cardiac monitoring devices that can be used to detect afib and assess whether a catheter ablation was a success. Traditional medical-grade monitoring methods include electrocardiogram (ECG), Holter monitor, and mobile cardiac telemetry. Frequently, an insertable cardiac monitor (ICM), often called an implantable loop recorder (ILR), may be inserted following an ablation to track the heart rhythm for up to several years. There are also consumer devices that may prove useful for monitoring after an ablation. Learn more about these monitoring devices at Monitoring Devices For Afib.
Regardless of the monitoring device used, it is essential to remember that afib may still occur after the ablation. Many people experience some atrial fibrillation or atrial flutter after a catheter ablation due to inflammation of the heart tissue. For this reason, the first three months are generally considered a “blanking period” during which time success or failure should not be judged.
Some people are concerned that afib during the three-month blanking period means the catheter ablation has failed; however, we often hear at medical conferences that more inflammation may be correlated with more aggressive treatment, often resulting in less afib once the inflammation has subsided and the heart has healed.
The HRS Consensus Statement2 discusses these afib recurrences following ablation:
Since early recurrences of afib and/or the development of atrial tachycardia are common during the first 2–3 months after afib ablation and might resolve spontaneously, repeat ablation procedures should be deferred for at least 3 months following the initial procedure if possible. Atrial fibrillation recurrences during the first 3 months after ablation are rather common. It is generally believed that the mechanisms of afib in this setting are different from that of the patient’s clinical arrhythmia. Acute inflammatory changes owing to energy delivery; modification of the autonomic nervous system with consecutive changes in the atrial substrate; or delayed effect of radiofrequency ablation due to lesion consolidation have been considered. It is also suggested that afib might resolve completely upon resolution of the transient factors promoting early afib recurrences. Accordingly, suppressive antiarrhythmic agents are frequently prescribed for patients with atrial fibrillation recurrences during the first 1–3 months following ablation.
Just knowing that this may happen can help ease the disappointment and frustration if it does. If you can focus on recovery, you’ll soon be healed. Many patients find that previously failed medications now work to hold back the afib and get them past these initial few months.
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