The catheter ablation technique, sometimes called “pulmonary vein isolation” (PVI), is a minimally invasive procedure to effectively control the heart rhythm. The procedure is performed by a cardiologist specialising in electrophysiology in a highly specialised cardiac catheter lab.

The procedure treats the electrical impulses that trigger or are associated with the rhythm, preventing them from spreading and continuing to cause AF. More complex ablation techniques may also be used if appropriate. Two main technologies, radiofrequency ablation and cryoablation, are offered by Dr. Hsieh.

Prior to the procedure, it is important not to eat or drink after midnight the night before, unless instructed otherwise. If you take warfarin, do not stop this medication, but have a blood test (INR) the day before. If you take an alternative medication (Eliquis, Pradaxa, Xarelto), the last dose taken should be the day before the procedure. It is important to pack for an overnight stay in the hospital, including all regular medications. Appropriate transportation arrangements should also be made as you may not be able to drive for 24 hours after the procedure.

Please note that the setup for the procedure may be lengthy and intricate, so we kindly ask for your patience. Our nursing staff will be there to guide you through the process. During the procedure, our experienced anaesthetist will ensure your comfort by administering anaesthesia as needed.

To rule out any blood clots, a transoesophageal echocardiogram will be conducted. This involves placing an ultrasound probe in your oesophagus to help exclude any blood clots. In the event that a blood clot is detected, we may have to postpone the procedure to another day.

A local anaesthetic will be applied to your groin where small flexible tubes called catheters will be inserted via a small incision. The catheters will then be gently steered up the veins to the right side of the heart using specialized x-rays called "fluoroscopy". A special needle will be used to cross from the right to the left-hand side of the heart, allowing access to the left atrium to treat the arrhythmia. Intravenous blood thinners will be administered to prevent blood clots for the duration of the procedure.

Please note that the setup for the procedure may be lengthy and intricate, so we kindly ask for your patience. Our nursing staff will be there to guide you through the process. During the procedure, our experienced anaesthetist will ensure your comfort by administering anaesthesia as needed.

To rule out any blood clots, a transoesophageal echocardiogram will be conducted. This involves placing an ultrasound probe in your oesophagus to help exclude any blood clots. In the event that a blood clot is detected, we may have to postpone the procedure to another day.

A local anaesthetic will be applied to your groin where small flexible tubes called catheters will be inserted via a small incision. The catheters will then be gently steered up the veins to the right side of the heart using specialized x-rays called "fluoroscopy". A special needle will be used to cross from the right to the left-hand side of the heart, allowing access to the left atrium to treat the arrhythmia. Intravenous blood thinners will be administered to prevent blood clots for the duration of the procedure.

After going home, activities will need to be limited for a few days to allow the insertion site to heal. You may feel some soreness in your chest or bruising or soreness at the insertion site. It is not uncommon to feel as if your rhythm problem has returned shortly after the procedure. This is often associated with healing and irritation from the procedure. If these episodes persist, please contact Dr. Hsieh or visit your local emergency department. If you develop fevers, dizziness, or difficulty/pain swallowing, contact Dr. Hsieh or present to the emergency department immediately. You should contact your doctor if the insertion site becomes warm, tender, painful, or swollen. You will remain on your anti-arrhythmic and anti-coagulation medications for at least 3 months after the procedure.

Although catheter ablation is generally considered a safe procedure, like any medical treatment, it does carry certain risks. These include a small chance of recurrence of AF if the pulmonary veins cannot be isolated, a less than 1% risk of injury to the blood vessel at the entry site, a less than 1% risk of a heart attack, stroke, puncturing of the heart with resulting fluid buildup, emergency surgery, pacemaker implantation, infection, blood clot in the leg or lung, or even death.

There is also a risk of damage to the phrenic nerve, which controls the diaphragm's movement, in approximately 2% of cases. However, the vast majority of these instances resolve within a year. In rare cases, there is also a chance of narrowing of the pulmonary vein, leading to shortness of breath. Additionally, there is a very small risk (less than 0.1%) of atrio-oesophageal fistula, which is a severe and rare complication.

Dr. Hsieh will thoroughly discuss these risks with you prior to the procedure, and will take all necessary precautions to minimize them. It's essential to communicate openly with Dr. Hsieh about any concerns you may have.