Is an atrial fibrillation ablation a big ‘heart operation’?

The idea of having a heart-related procedure can be a daunting prospect for a patient. A detailed understanding of what the procedure involves is critical for making an informed decision about the best treatment option for you. The aim of this article is to provide more of an understanding of what an atrial fibrillation ablation procedure involves and what to expect in the post-procedure recovery phase. The information included in this article complements the section on atrial fibrillation ablation

Atrial fibrillation (AF) ablation is an established interventional procedure for the treatment of AF. Since the first procedure was performed by the pioneering team led by Prof. Haissaguerre and Prof Jais in Bordeaux in the late 90’s, millions of procedures have been performed worldwide. AF ablation is by far the most commonly performed ablation in the field of cardiac electrophysiology.

With increasing experience, in parallel with technological advances, AF ablation has evolved from a procedure that took many hours to one that can be completed in just over an hour. In certain circumstances, AF ablation can be performed as a day-case procedure. Therefore, in the case of atrial fibrillation ablation, the concept of a ‘heart operation/procedure’ is a far cry from the traditional heart operation.

Conceptually, AF ablation can be thought of as a key hole procedure, with the point of access being the vein at the top of the leg (the femoral vein). Plastic ports are inserted into the vein through incisions of less than a centimetre. An example of a port being introduced into a vein is included below. Catheters are then introduced through the ports and advanced via the vein to the heart, as demonstrated in the video clip below.

Once catheters are introduced into the heart, the ablation procedure involves targeting specific areas of the left upper chamber (left atrium) and effectively cauterizing regions of the chamber that could be involved in triggering atrial fibrillation. The most common targets are veins that drain blood into the left upper chamber, known as the pulmonary veins. Therefore, you may commonly hear an atrial fibrillation ablation being referred to as a pulmonary vein isolation procedure.

Different types of energy can be used to perform atrial fibrillation ablation. Examples of radiofrequency energy (heat) and cryo energy (freezing) are demonstrated in the videos below.

The potential risks associated with an ablation procedure and the patient experience during the procedure is covered here.

An important consideration for patients is the recovery phase post-ablation. Specifically, when they can get back of their feet and when they get back to normal activities, including work. While post-procedure management may vary from one ablation centre to the next, the general principles are the same. In the first few days after the procedure, patients are advised to undertake light exercise (walking). Exercise maybe increased gradually with the eventual aim of returning to normal activities (including intense exercise) after two weeks. For patients who do not have physically demanding jobs, after three to four days, patients can return to work. Detailed guidance for UK patients in terms driving following a catheter ablation is included here . Based on these guidelines, if you hold a car or motorcycle license, you may drive after two days following your catheter ablation.