What to know before the ablation procedure

Be aware of your risk factors

Once you start discussing the possibility of ablation for atrial fibrillation (afib), it’s time to consider certain risk factors that you can control.

Although arrhythmias can occur in people who are normal or underweight, being overweight may increase the risk of developing atrial fibrillation. Alcohol consumption can also increase the risk of developing this condition. Obstructive sleep apnea is another important risk factor for atrial fibrillation.

It is a good idea to lose excess weight and limit your alcohol consumption long before having an ablation. If you have been diagnosed with sleep apnea, continue with treatment. If recommended by your healthcare provider, use a continuous positive airway pressure (CPAP) machine to help you resume normal breathing during sleep.

“When we perform these procedures, we want to get the best possible outcome,” says Michelle Mead-Salley, nurse coordinator for the Atrial Fibrillation Clinic at William Beaumont Hospital in Royal Oak, Mich. “We want to make sure patients change what they can change.” While CPAP ventilators can be uncomfortable and difficult for some people to tolerate, Mead-Salley notes that it’s important to see that patients are trying.

Avoid certain drugs

Before the ablation procedure, your doctor may tell you to avoid any medications that increase the risk of bleeding, such as aspirin. If you are taking a blood thinner such as warfarin, your doctor may or may not advise you to stop taking it a few days before the procedure. As Mead-Salley points out, it depends on your doctor and institution; every doctor’s preferences are different. Make sure all your medications are on the medication list, including vitamins and supplements.

If you are taking coumadin (warfarin), your doctor will also monitor how long it takes for your blood to clot. The test that measures this is called a prothrombin time (PT) test. The results are recorded in seconds and are usually reported as an International Normalized Ratio (INR).

If you are not taking blood thinners, a normal PT result is an INR between 0.8 and 1.1. If you are taking blood thinners, your target INR may range from 2.0 to 3.0.

According to a 2013 study published in the journal Circulation: Arrhythmia and Electrophysiology, complications were less common in people using Coumadin during ablation when the INR was between 2.0 and 3.0. As a result, researchers noted that INR levels should be carefully monitored in preparation for atrial fibrillation ablation.

“Patients need to keep their INR levels stable”. High INR levels can lead to cancelled heart surgery, while low INR levels can increase the risk of stroke.

Postponement of major diet and lifestyle changes

Starting a new exercise regimen, not drinking alcohol and eating more dark leafy greens are all healthy choices. However, Mead-Salley warns that your behavior and diet may affect your INR levels, which can lead to ablation procedures.

Vitamin K in green leafy vegetables can reduce the effectiveness of warfarin in preventing blood clots. The absorption of warfarin can also be affected by changes in exercise patterns.

Rather than making drastic changes before the procedure, it is better to slowly reduce the amount of alcohol consumed. After ablation, wait six weeks before starting a new diet or exercise program.

Also remember that other medications you take may have an effect on blood-thinning medications. “There are a lot of things that interact with Coumadin,” says Kenneth Ellenbogen, M.D., chief of cardiology at the Poly Heart Center at Virginia Commonwealth University Medical Center in Richmond. Drugs that may interact with warfarin include antibiotics, antifungals, antidepressants and epilepsy drugs. This is not the case for newer oral anticoagulants such as Pradaxa (dabigatran), Xarelto (rivaroxaban) and Eliquis (apixaban), which do not require as frequent monitoring, dose adjustments or dietary restrictions as warfarin, he said.

Reduce the risk of bleeding

After ablation, people usually take blood thinners for at least two months, Dr. Ellenbogen said. As a result, the use of nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and Advil or Motrin (ibuprofen) may be limited to reduce the risk of bleeding.

While recovery time varies from person to person, Ellenbogen added that many people feel back to normal within about a week. However, to reduce the risk of bleeding, he recommends that people who have undergone atrial fibrillation ablation avoid particularly strenuous exercise immediately after the procedure.

Get Moving Gradually

Limiting strenuous activity does not mean you should be sedentary. To reduce the risk of blood clots, go about your daily life and take frequent short walks.

People can usually resume their normal exercise routine a week after an ablation. But wait until six weeks after heart surgery and after seeing a doctor at a follow-up visit before starting a new healthy eating plan or a new exercise regimen.