Maryland Heart Center

Electrophysiology Lab

Patient Instructions for Atrial Fibrillation Ablation

Pre-procedure

You will be called by the Heart Center to set-up scheduling of a cardiac CAT scan which will be used for "mapping" your left atrium (upper chamber of the heart).This needs to be done 3-5 days prior to the procedure.
Blood work needs to be done 3-5 days prior to the CAT scan.
You will need to stop taking Coumadin (warfarin) 5 days prior to the procedure. You may be instructed to begin injecting Lovenox (enoxaparin), a blood thinner, 3 days prior to the procedure. Do not inject any Lovenox on the morning of the procedure.
You're to have nothing to eat or drink after midnight the day of the procedure.
Take all other medications with a sip of water unless instructed otherwise. Special instructions will be given if you are taking Insulin or a water pill (example: Lasix ( furosemide).
You will be scheduled for a TEE (transesophageal echocardiogram)-ultrasound of the heart performed from inside the tube leading from the mouth to the stomach. This will be done the morning of the procedure to look for any blood clots in the left atrium. If any are seen the procedure will have to be rescheduled.
You will be seen by an anesthesiologist the morning of the procedure to evaluate you and obtain your consent for general anesthesia.

During the Procedure

The procedure generally will take 4-8 hours to complete.
A local anesthetic will be given in both right and left groins and on the right side of the neck.
Long, thin tubes called sheaths will be placed in your veins in the groins and neck and catheters (a long flexible wire) will be guided by X-ray to specific locations in your heart.
A thin needle will be used to pass across the wall between your right and left atrium.
The ablation is done by using radioenergy applied to the tip of the catheter to create heat. This destroys the heart tissue around the openings of the pulmonary veins that cause atrial fibrillation. Research has shown that the majority of atrial fibrillation signals come from the openings of the four pulmonary veins in the left atrium.4 The ablation electrically "disconnects" the pulmonary veins from the left atrium and the abnormal signals can no longer reach the rest of the heart and trigger atrial fibrillation. Additional lesions may be required. http://www.a-fib.com/PVA(PVI).htm

After the procedure

After the ablation, the blood thinner (heparin) is allowed to wear off and the sheaths are then removed. Bedrest is required, with your legs straight, for 4 hours after sheath removal.
You will usually stay overnight in the hospital for 1 night and then be discharged the next morning.
You will be restarted on your previous medications including your blood thinner called Coumadin (warfarin).
Since Coumadin takes 3-5 days to reach a good level, you will be discharged with a blood thinner (Lovenox) injected twice a day, along with your Coumadin dose, until your INR is above 2.0.
Your doctor will decide how long you need to remain on Coumadin thereafter. You will remain on Coumadin for a minimum of 3 months. Prompt and continued monitoring of your INR at ACT clinic is essential during this time period to prevent stroke.
Avoid vigorous activity or lifting greater than 20 pounds for 1 week.
You may bathe or shower the next day.
It is not uncommon to have some chest discomfort especially when taking a deep breath for 2-3 weeks after the procedure due to irritation of the lining of the heart.
You should notify the doctor if you have any swelling or bleeding in the groin where the catheters were placed. Also notify your doctor if you are experiencing dizziness, pain or difficulty with swallowing, difficulty breathing, fever, return of atrial fibrillation, or just don't feel right, even if this occurs several weeks after the procedure.
Early recurrences of atrial fibrillation are common during the first one to three months, and this does not mean the procedure was unsuccessful. It has been shown that 20-57% of patients experiencing this will not have any further occurrence during long term follow-up. http://www.HRSonline.org/Policy/ClinicalGuidelines.

Please call if you would like to make an appointment or talk to someone about our services. Patients dial 1-866-408-6885, physicians dial 410-328-6622 or 1-800-318-1019.