Maureen is an active, 67-year-old with atrial fibrillation. Once every couple of months she develops an episode of shortness of breath, fatigue, and the sensation of an abnormal heartbeat. She has tried medications to treat atrial fibrillation (AFib) but these haven’t worked. She is considering atrial fibrillation surgery but is worried about the AFib ablation recovery time.
“When I am in AFib, it feels like someone has pulled the plug and all my energy drains away,” she says. “My doctor has talked to me about getting an AFib procedure to treat atrial fibrillation but I am the primary caregiver for my husband, who has advanced Parkinson’s, so I was concerned about the AFib ablation recovery time. He needs my help every time he wants to get up from his chair or get out of bed. We needed to know more about atrial fibrillation surgery and heart ablation recovery to know if an AFib procedure would even be an option for me.”
Maureen laughs, “My poor cardiologist; I brought in such a long list of questions. He probably thought the appointment would never end!”
Maureen is not alone. The decision of how to best treat atrial fibrillation can be complicated. Common questions people ask about atrial fibrillation ablation procedures and heart ablation recovery include:
How Long Does Ablation Take?
How long an atrial fibrillation ablation takes depends on the type of cardiac ablation being done. Generally, the less invasive the procedure, the shorter the procedure time. Catheter ablation treats atrial fibrillation from the inside of the heart. This procedure is done via catheters which are inserted into veins in the groin and then guided up into the heart. In contrast, a Maze procedure is a surgical ablation that gains access to the heart by making incisions in the chest wall. Both of these procedures are considered to be minimally invasive. The less invasive catheter ablation usually takes about 2 hours whereas the more invasive Maze procedure for AFib may take 3 to 4 hours.
How Serious Is Heart Ablation Surgery?
An AFib procedure is usually completed using a minimally invasive technique unless it is being done as a part of another heart surgery, such as heart valve replacement. This helps decrease procedural risks. As a result, minimally invasive AFib procedures like catheter ablation, Maze procedure, and watchman procedure for AFib have low complication rates. However, as with any invasive procedure, there are risks associated with AFib procedures including:
- Bleeding complications and blood vessel damage
- Infection
- Pericardial effusion (collection of fluid around the heart)
- Phrenic nerve injury
- Heart valve damage
- Slow heart rate which could require a pacemaker
- Arrhythmia (abnormal heart rhythm)
- Damage to the esophagus
- Kidney injury from the dye used during the AFib procedure
- Stroke or heart attack
- In rare cases, death can occur (approximately 1 in 1000)
Why Am I So Tired After My Cardiac Ablation?
Cardiac ablation is done under general anesthesia. Although the medications used during general anesthesia wear off after a few hours, it is not unusual to notice fatigue and grogginess during the ablation post-op period. Usually, this resolves in the first day or two after the procedure. But for some people, the symptoms may last for a couple of weeks.
Typically, the longer you are under general anesthesia the more likely you are to have persistent grogginess post cardiac ablation. It is commonly assumed that the after-effects of anesthesia are causing these continued symptoms after cardiac ablation. But there are actually a number of contributing factors including:
- Deconditioning as a result of symptomatic atrial fibrillation. Many people with atrial fibrillation experience a significant decrease in exercise capacity when they are in AFib. Therefore, the longer or more frequent the AFib episodes are the more likely someone is to become deconditioned. If you have become deconditioned as a result of your AFib, life after cardiac ablation can take longer to return to normal because in addition to AFib ablation recovery time you will also need to allow time to ‘get back in shape.’
- Pain medications. Atrial fibrillation surgery is a more invasive kind of AFib procedure and post-operative pain is not unusual in the first day or two. Opioids and gabapentinoids are commonly used to manage ablation post op pain. Fatigue and grogginess are common side effects of these medications.
- Circadian rhythm disturbance. General anesthesia interferes with the body’s internal sleep clock (circadian rhythm). The longer someone is under general anesthesia the greater the effect on the circadian rhythm. It can take days to weeks for the circadian rhythm to normalize. Adopting good ‘sleep hygiene’ can help speed up the process.
- Procedures cause tissue injury. Tissue injury and inflammation are expected after atrial fibrillation surgery. The body is excellent at cellular repair but this process requires increased nutrients and energy. These increased metabolic needs can cause fatigue. Rest and good nutrition are important components of heart ablation recovery.
AFib Recovery: What To Expect?
The most common problems after cardiac ablation are related to bleeding at the catheter insertion site or blood vessel damage from the catheter. Therefore, people are monitored closely and often stay overnight after their AFib procedure to make sure there are no bleeding complications. Other things to expect during your heart ablation recovery include:
- Lifting and activity restrictions. You will have lifting and activity restrictions for the first week or two after your procedure. During a catheter ablation, catheters are inserted into the veins in the groin. The veins need time to heal to minimize bleeding problems after catheter ablation. If you had a maze procedure for AFib, there will be small incisions on the chest wall. Regardless of the ablation type, activity and lifting restrictions help protect the access sites so they heal well and have no effect on your life after cardiac ablation.
- Symptoms after cardiac ablation. Some people experience no symptoms after cardiac ablation. However, it is normal to have mild shortness of breath and chest pain or discomfort during the first few weeks of ablation recovery. Also, as discussed above, many people note grogginess and fatigue after cardiac ablation.
- Medications. It is normal to continue the medications you were on to treat atrial fibrillation for a few months after a cardiac ablation. Atrial fibrillation surgery causes a lot of tissue inflammation. It takes about 3 months for heart ablation recovery to be complete at the cellular level. At that point, your cardiologist may decide to stop some of your atrial fibrillation medications if you do not have evidence of AFib recurrence.
- Recurrence of atrial fibrillation. Cardiac ablation uses heat or freezing to create scar tissue in the heart. This scar tissue blocks the abnormal electrical signals that cause atrial fibrillation. It takes time after an ablation for that scar tissue to form. Therefore, recurrences of atrial fibrillation during the first 3 months of ablation recovery do not mean that the procedure did not work. Whereas, atrial fibrillation at 6 months after heart ablation may mean that you need a ‘touch-up’ ablation to address areas of the heart that are still triggering AFib.
How Long Does Ablation Last?
There is currently no cure for atrial fibrillation. The goal of atrial fibrillation ablation is to give a person a period of being free from AFib. Over the past decade, there have been a number of changes in the way we treat atrial fibrillation.
One important evolution has been improved ablation technology and techniques which have increased ablation success rates. In addition, there is a better understanding of the importance of early, aggressive management of AFib risk factors and treatment of the underlying conditions that cause AFib.
Studies show that these changes have combined to make atrial fibrillation treatment more effective and last longer. There are still people who continue to have atrial fibrillation despite AFib ablation. But we see many people go for years, and even decades, without AFib recurrence after cardiac ablation.
How Many Times Can You Have Heart Ablation?
Atrial fibrillation originates in the left upper heart chamber (atrium) and pulmonary veins. The purpose of an atrial fibrillation ablation is to create scar tissue in the pulmonary veins and left atrium that blocks the abnormal electrical signals which cause AFib. If you have a recurrence of atrial fibrillation after heart ablation, your doctor may recommend a repeat ablation. Sometimes this is referred to as a ‘touch-up’ ablation.
If you have had 4 ablations and you continue to have recurrences of atrial fibrillation, your doctor will probably talk to you about other treatment options. This is because the after-effects of too many cardiac ablations are too much scar tissue in the left atrium and pulmonary veins. This makes them stiff which causes chronic shortness of breath and exercise intolerance.
When Can I Go Back After Surgery?
People can usually go back to work after a few days of AFib ablation recovery time. If your job requires lifting more than 10 pounds, you will need to wait for at least a week to give time for the ablation access sites to heal.
Will I Be In Pain Afterward?
It is normal to have some mild chest pain or pressure during the first days to weeks of AFib ablation recovery. Other than this, people generally report little or no pain after catheter ablation. AFib surgery recovery is usually longer and it is normal to have some pain for a few days after a Maze procedure for AFib. Pain after cardiac ablation is usually managed primarily with anti-inflammatory medications. Sometimes, steroids, opioids, or gabapentin are also used for a couple of days post-cardiac ablation.
An Update: Maureen, 6 Months After Heart Ablation
After talking with her cardiologist, Maureen decided to go ahead with catheter ablation for her paroxysmal (intermittent) atrial fibrillation. It has now been 6 months since her AFib ablation. She has had no recurrences of AFib since the ablation. “After my ablation, I had to take it easy for a week, but my daughter was able to come stay with us to help with my husband and the ablation recovery ended up being no big deal,” she says. “I have felt so great since my ablation and was even able to stop some of my AFib medications a few months ago, which I was really happy about. I know I may have AFib again in the future but for the time being, I am glad to have a break from the AFib and the medications.”
