- Electrophysiology and ablation

This is a complex and relatively long procedure which will start off under local anaesthetic but will generally involve the administration of sedation into a drip in your arm during the procedure. Occasionally the procedure is performed under general anaesthetic and your doctor will discuss this with you prior to the procedure. You will be asked to lie on your back in the catheter laboratory (cath lab) room. You will receive an injection of local anaesthetic in your groin. A small tube will be inserted into the vein of your groin which will be moved via the vein into the right side of your heart under x-ray guidance.

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The abnormality of rhythm, known as atrial fibrillation, usually originates from the left side of the heart (the left atrium) and therefore during the procedure the doctor will cross the ablation tube / catheter into the left side of the heart (left atrium) across a small membrane connecting the right and left atria (top chambers of the heart)known as the interatrial septum, in a procedure called trans-septal puncture.

 

Once the catheter reaches the left side of the heart the doctor will  use a special piece of equipment to perform a ‘mapping’ procedure of the left atrium to find where the abnormal rhythm (atrial fibrillation) is originating. The doctor will then apply heat energy (radiofrequency ablation) or cold energy (cryoablation) to these areas. These areas are usually  where the veins draining into the heart (pulmonary veins) meet the left atrium and why the procedure is sometimes referred to as ‘pulmonary vein isolation’. You may feel a degree of discomfort when the doctor is applying the energy to perform the ablation and  if this is the case  further pain relief or sedation via the drip in your arm can be provided.

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The procedure generally lasts 4-6 hours but can sometimes take longer. You will stay overnight on the cardiology ward following the procedure. Before the procedure you will usually be taking blood thinner medication (warfarin or NOAC/DOAC medication). This will usually be continued before and after the procedure but the bookings team will let you know about this. If you are not sure what to do with your medication please contact the team by calling the telephone number on your appointment letter.

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The success of the atrial fibrillation ablation procedure depends on a number of factors which your doctor will discuss with yo. Sometimes  you will require more than one procedure.

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Common complications following ablation for atrial fibrillation include. chest pain (both during the procedure and following the procedure) and bleeding and bruising in the groin. Rare complications include damage to the electrical conductions fibres of the heart requiring a pacemaker (1 in 200), damage to the blood vessels in the groin requiring repair (1 in 1000), damage to the heart causing blood to accumulate around the heart (pericardial effusion, 1 in 100), stroke (1 in 200), narrowing of the veins leading into the heart (pulmonary vein stenosis, 1 in 1000), damage to the phrenic nerve causing potential breathing/bowel problems (1 in 200 to 1 in 1000) and death (1 in 1000). These risks will be different for each patient and are only quoted as a guide. You must discuss  with your Cardiologist about your individual risk of the procedure.

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The procedure is successful in 60-90% of patients, although some patients will need multiple procedures and you must discuss with your Cardiologist your individual chances of success.

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Sometimes you will need a transoesophageal echocardiogram prior to your ablation procedure.