Recovery following cardiac ablation surgery for Atrial Fibrillation
Recovery following cardiac ablation surgery for Atrial Fibrillation.
How can I best recover following my AF ablation surgery?
Article written by Dr Boon Lim, interventional electrophysiologist, and specialist in AF ablation
So you have now had your atrial fibrillation ablation surgery. You are now home wondering “what next?”, and “ how can I best recover and maximise the chance of ablation success?”. In this article, Dr Boon Lim will share some insights on optimising your recovery after a catheter ablation procedure for atrial fibrillation through a series of commonly asked questions and answers.
Questions:
- How long do I have to stay in hospital after a catheter ablation procedure for AF?
In general catheter ablation procedure is a low risk, fairly straightforward procedure and in most cases, patient can be discharged between 4 and 6 hours after having the catheter ablation performed on the very same day. There are exceptions to same-day discharge which includes significant frailty, or previous problems with general anaesthetic recovery, or other medical illnesses which may make recovery somewhat slower which include obstructive sleep apnoea and significant respiratory conditions such as chronic obstructive pulmonary disease (COPD).
- Can I take public transport home on the same day after an ablation procedure?
No. If you are going to be discharged on the same day, we would strongly advise that a family member or friend pick you up and travel home by car. Ideally, you should have someone staying at home to help support you particularly in the first 24 hours.
- What do I look out for in the first few days after a catheter ablation procedure?
In the first 24 hours after the catheter ablation procedure, there may be a little risk of a gentle ooze / bruising from the groin puncture site, which can be on the right and the left groin, depending on the access needed by your cardiologist. In general however most AF ablation procedures can be done through a single groin puncture on the right-hand side and before your discharge, the nurses on the ward will give you advice on the best ways to manage your groin. In general, avoiding abdominal strain by keeping your stools soft, avoiding strenuous exercise particularly with sit ups, and avoiding heavy bouts of coughing, ways to minimise the risk of a groin bleed or ooze. Following the catheter ablation procedure, you will have a clot formed on the outside surface of the vessel (femoral vein) where the groin puncture has been performed which stops the bleeding from the vein puncture. Therefore, minimising any pressure (such as during straining on the toilet, or coughing) on this vein will mean that the clot is less likely to dislodge leading to an ooze.
However even if you have a slight bleed/ooze, do not be too concerned as this is very likely to be a vein ooze (a very low pressure system) and firm pressure on top of the wound site for 8 to 10 minutes will almost always stop this ooze, even if you are taking anticoagulation.
Some patients will experience mild residual chest pain in the first 24-48hours after ablation – this usually settles with time, but if needed, some paracetamol can be taken to help with pain.
- What is the best way maximise my chance of success following a catheter ablation procedure?
There are many factors that predict successful ablation. These are mostly patient factors – including how long you have had AF for, whether AF is persistent (24h a day) or paroxysmal (intermittent), and whether you have other risk factors which may be promoting AF, such as a prior heart attack, heart failure, valvular heart disease, diabetes, hypertension and obstructive sleep apnoea. If an ablation has been offered to you by an electrophysiologist, you should ask what your chances of ablation success are, given your personalised risk factors.
However, the best chances of success will come from a combination of a good ablation (where the pulmonary veins are electrically isolated), and also addressing risk factors which can perpetuate AF.
In this regard, the most important thing you can do, is to know what your risk factors are and improve these factors. For example, if you are overweight, a strong focus on weight loss through a combination of diet and exercise, may help to improve hypertension and diabetic risk and minimize sleep apnoea risk, all of which, together with weight reduction, help to reduce the incidence of AF. In addition, staying positive and calm in the weeks after the ablation, and being aware that sometimes following ablation, there can be “blips” where you may continue to experience palpitations for 4 to 6 weeks before the heart eventually settles down, after healing from the ablation procedure, can help you adjust to life following ablation, and minimize stress being a trigger for AF.
- Is there a period beyond which I know that the ablation hasn’t worked?
Sometimes, even with the best ablation endpoint (i.e. confirmed electrical pulmonary vein isolation for the first procedure), patients continue to have symptoms. We would normally not consider that a procedure has failed until 8 week or more has passed. It’s common for patients to have palpitations in the first 8 weeks, but in a majority of patients, these settle down with time. However, if you continue to have ongoing symptoms unabated after 8 -12 weeks, it means that the ablation has likely not had the desired impact on your heart and you will need to discuss further options, including a repeat ablation, to help with your symptoms.
- When should I agree to a repeat (redo) ablation procedure?
A repeat procedure for paroxysmal (intermittent) AF is generally something that should be seriously considered – the likelihood in this scenario is that one or more pulmonary veins have electrically reconnected despite having been isolated during the initial procedure. In the redo procedure, your electrophysiologist will typically remap the pulmonary veins, and reisolate those veins which have reconnected, and this should lead to a reasonable success (>75%)
However, if you have had longstanding persistent AF (more than 1 year) and following the initial ablation, you have not been able to maintain normal rhythm at all (reverting back into AF within 24hours of the first procedure) then the success rates for repeat AF ablation may be more limited, depending on the other risk factors. Please take the time to discuss options with your local electrophysiologist about the next steps.
- How long do I have to stay off work for, following a catheter ablation procedure?
Typically, most patients are advised to take it easy, and not attend the office or do physical activity for at least a week. However, you may be able to work from home on a PC, so long as you are not physically or emotionally strained doing so. It is entirely reasonable to take a whole week off work following a catheter ablation procedure.
- Do I have to continue to take my medications after a catheter ablation procedure?
Unless your doctors explains otherwise, it is crucial that you continue taking ALL medications, particularly anticoagulation, which will minimize the risk of perioperative stroke following ablation.
- When will the doctor follow me up in how will I know procedure has been success?
Most electrophysiologists will want patients to get through the “blanking period” of around 8 -12 weeks, before ascertaining if the procedure has been successful or not. Typically a Holter monitor (24h ECG) and ECG will be performed after 8 weeks before your doctor reviews you again. Timings will vary between doctors.
- Can I exercise after a catheter ablation procedure?
You will be able to walk slowly on the same day as the procedure during discharge, but I would advise taking it easy, and not engaging with strenuous physical activity for at least 2 weeks, before building up very slowly when starting again. Provided your slow build up in activity does not trigger AF, you are likely to be able to resume normal exercise a month following your catheter ablation
- Can have sex after a catheter ablation procedure?
Yes you can, but ideally not for the first 3 days following ablation. Ease back slowly into sex (like exercise) and take it relatively easy initially before resuming normal sex life after 2 weeks or so.