Preparation
If you are having a catheter ablation for atrial fibrillation please do not eat or drink after midnight before the procedure.  If you take coumadin (warfarin) we will ask you not to take it for several days prior to the procedure, and you will be given a prescription for a blood thinner (lovenox or fragmin) that is injected under the skin.  The effects of the injectable blood thinner lasts about 12 hours, and can be used to protect you against clot formation while waiting for your coumadin effect to wear off.  For several days prior to your ablation, you will self-administer the injections up until the night prior to the procedure.  The morning of your procedure do not inject the blood thinner.

During the procedure
Similar to other types of catheter ablation procedures, you will receive local anesthesia to numb the area in the right and left groins where the physician places the catheters.  You will also receive intravenous sedative and pain medication to keep you as comfortable as possible.  After the catheters are positioned in the heart, electrical activity will be assessed mainly in the left atrium of your heart and locations will be identified for ablation. At this point an anesthesiologist will put you under general anesthesia. After you are under general anesthesia, we start the ablation procedure. When the catheter is at a site that is appropriate for ablation, radio frequency current is delivered through the catheter tip and heats the heart tissue at the site. 

There are several aspects of the atrial fibrillation ablation procedure that make it different from other catheter ablation procedures.  Because of the length of the procedure (4-6 hours) and the amount of intravenous saline you will receive during the procedure, you will have a Foley bladder catheter placed in order to manage your urine output.  A transseptal puncture is always performed; this involves using a needle to cross the wall that separates the right atrium from the left atrium, in order to gain access for mapping and ablation.  In order to minimize the risk of clot formation on the catheters during the procedure, large amounts of blood thinning medication (Heparin) are administered.  Also, during the procedure you may undergo a cardioversion (electric shock to the chest)  while you are asleep, in order to restore normal rhythm. 

After the procedure the catheters will be pulled from the groin entry site and pressure will be held in order to prevent bleeding complications.  You will be asked to remain on bed rest for 4-6 hours while the catheter sites heal.

It is not uncommon for people to require more than one ablation procedure in order to gain effective control of their atrial fibrillation, especially if you had long-lasting atrial fibrillation beforehand.  In particular, atrial fibrillation can recur within the first several months after the procedure, even though your overall amount of atrial fibrillation may be significantly reduced in the longer term.