Frequently Asked Quesions

How is an Ablation done? Is there cutting involved?

Catheter based Ablation for A fib is considered a PROCEDURE (similar to a heart catheterization or angioplasty), AND IS NOT A SURGERY. Catheter based ablation for A Fib is done from small needle punctures in the veins that run in the groin . There is NO SURGICAL INCISION involved. There are no chest tubes involved. Most patients can stand up and walk after 6 hours of bedrest.


Does A Fib ablation work immediately or does it take some time to work?

Even in the best A Fib ablation centers of the world, after an A Fib Ablation, it can take a few weeks, up to 3 months for your heart to heal. Until then, it is common to experience some palpitations, chest discomfort etc. You may even experience some Atrial Fibrillation in the 1st 3 months. It does not mean that the ablation did not work. Medicines are generally not stopped for the 1st 3 months.

 

I have heard that some people with A fib need multiple ablations. Is this true?

More than one ablation may be necessary, especially if you have had A Fib for a long time (persistent A Fib). If you have had A Fib for a long time, chambers of the heart can start enlarging and scar tissue can replace healthy heart muscle. If this happens, then chances are you may need two or more ablations.

 

Can I stop taking blood thinners like Coumadin (warfarin) ?

Decision to stop blood thinners like warfarin/coumadin is individualized, based on a particular patient’s risk of stroke, regardless of outcome of the ablation. In other words, even though a patient may feel great after an ablation, if he/she is at a high risk of stroke, coumadin may be continued. However, if you are deemed to be at low risk of stroke by your doctor, Coumadin may be stopped after a successful ablation.

 

How do I know if my Electrophysiologist is well trained to do A Fib ablations?

Since A Fib Ablation is a very specialized procedure and requires large volume experience, it is very important for you to find out how many A fib ablations your EP doctor does per year. Minimum recommended number by the Heart Rhythm Society is 30-50 A fib ablations per year.  Also find out how many A Fib ablations are done at the specific hospital you are looking at, since this procedure requires a highly trained team of nurses and technicians to make it successful. In other words, the more A Fib ablations done by your EP Doctor and your Hospital team, the better your outcome will be.

 

 What is “Cryo ablation”?

Cryo ablation or “freezing ablation” is a newer technique to treat A Fib. It is showing some promise in the group of patients who have intermittent A.fib ( or paroxysmal A Fib). However, in the most experienced centers,  results of Cryo ablation are similar to conventional Radio frequency ablation. CRYOABLATION HAS NOT BEEN SHOWN TO BE BETTER THAN RADIOFREQUENCY ABLATION. IN FACT, IT IS ONLY USEFUL IN ONE TYPE OF AFIB CALLED PAROXYSMAL A FIB OR INTERMITTENT AFIB. In patients who are in A Fib all the time or in persistant A Fib, Cryoballon is not adequate and Radiofrequency ablation is still needed.

Again, Catheter based Radio Frequency Ablation can treat both paroxysmal as well as persistent A Fib, unlike Cryoballoon Ablation, which can only treat paroxysmal A Fib (since it can only do Pulmonary Vein isolation, but not linear lesions needed for persistent A Fib). Also, in experienced hands, Catheter based ablation is done quicker and with less radiation/X-ray exposure. (In our lab, most A Fib ablations are done with 5-15 minutes of Fluoro time and 2-3 hours of procedure time.)

 

What is a “Convergent” procedure or “Hybrid” procedure for A Fib?

This is an INVESTIGATIONAL procedure in which a Cardiac Surgeon and and Electrophysiologist combine to do a Surgery. First, the cardiac surgeon places lesions outside the heart, then Electrophysiologist will do catheter based ablation. The entire procedure can take 5-6 hours. Since this is a very new procedure, we still do not know how safe or effective it is. Further research is needed in this technique before it is widely accepted. In the future, once surgical techniques are perfected, this procedure may have a role in treating very advanced A Fib. HOWEVER, AS OF NOW, THE MOST WIDELY USED ABLATION TECHNIQUE FOR A FIB REMAINS CATHETER BASED ABLATION.