Atrial Fibrillation (AF, a-fib) Ablation

South Denver Cardiology First In The State for New A-Fib Ablation Technique

March 12th, 2024, Dr. Sri Sundaram at AdventHealth Porter has performed the first cardiac ablation procedure in a three-state region, Colorado, New Mexico, and Wyoming, using the new FARAPULSE™ #PulsedFieldAblation System, a newly approved device for the treatment of atrial fibrillation (AF). This technology has been used extensively globally, and such safe, effective therapies allow physicians to treat more patients, reduce complications, and benefit public health. Dr Sundaram says the main reason this technology is so important is that it is safer for patients. He continues to say, there are currently three FDA-approved ways to perform cardiac ablation. One is with Cryo energy (which is freezing the heart cells). The 2nd is with Radiofrequency (which is burning the heart cells). The 3rd and most recently approved is with Pulse Field Ablation. In the most basic terms, Pulse Field Ablation (PFA) is the equivalent of applying microwave energy to the heart. The most severe complications that can occur with both Radiofrequency and Cryo do not happen with Pulse Field, so its thought to also be safer. The main point is that PFA is faster and safer.

What are the goals of the procedure and what is the success rate?

The goal of the procedure is to treat the underlying cause your atrial fibrillation, and in turn improve your quality of life. Some individuals are extremely symptomatic with their a-fib, or their a-fib is causing structural changes/damage to their hearts. In these instances, an a-fib ablation might be right for you. The estimated success rate for a first-time ablation is approximately 75%, although success rates depend on the clinical state of your a-fib. Your specific success rate should be discussed with your provider prior to having the procedure. The success rate can vary depending on how long you have had a fib for, and if any structural changes to your heart have occurred because of your arrhythmia. Notably, it takes three months for results to be determined, and it is common to have a return of a-fib during those first three months after an ablation. Sometimes, individuals will require more than one ablation. Typically, the success rate with each repeat ablation increases.

What are the risks?

An a-fib ablation is considered a safe procedure, however like any invasive procedure, there are risks associated with it. Risks include bleeding, infection, damage to the blood vessels, damage to the heart structures/valves, recurrence of arrhythmias, stroke, blood clots, and in very rare incidences death. Some of the major risks associated with an a-fib ablation are described in more detail below:

  1. Bleeding: during the procedure, there is a risk of bleeding, both at the catheter insertion site and within the heart. In rare cases, significant bleeding may require blood transfusion or surgical intervention.
  2. Infection: There is a risk of infection at the catheter insertion site and within the heart. Precautions are taken to minimize this risk, but it can still occur. Infections may require antibiotics or, in rare cases, additional procedures to address the infection.
  3. Damage to blood vessels or heart structures: The catheters used in the ablation procedure are threaded through blood vessels to reach the heart. In rare instances, there is a risk of injury to the blood vessels or heart structures during the catheter insertion process.
  4. Stroke: Manipulating catheters within the heart can occasionally dislodge small blood clots, which may then travel to other parts of the body, potentially causing a stroke or other complications.
  5. Arrhythmia recurrence: There is still a possibility of recurrent atrial fibrillation or other abnormal heart rhythms after the ablation. Additional treatments or procedures may be necessary to address any recurrence.
  6. Damage to adjacent structures: There is a small risk of damaging nearby structures, such as the esophagus, nerves, or coronary arteries, during the ablation procedure.

It is important to note that these risks are low, and most patients experience successful outcomes after an a-fib ablation. However, the specific risks and their likelihood can vary depending on many factors including your age and other medical comorbidities. Your provider will discuss your risks with you prior to the procedure.

Why should I have this procedure with South Denver Cardiology?

South Denver Cardiology’s expert electrophysiology physicians were the first in the state and region to perform A-fib cardiac ablations without fluoroscopy x-ray, saving the patient from high doses of radiation.  Dr. Dan Alyesh, Dr. William Choe, Dr. Sri Sundaram, and Dr. Nick Palmeri  routinely do this procedure.  These doctors specialize in treating atrial fibrillation and perform a large number of a-fib ablations annually. Our center has consistently maintained a lower rate of complications compared to the averages seen in the literature.

What happens during the procedure?

Your provider places a catheter into a blood vessel in the groin and threads it up to the heart giving access to the inside of the heart. The catheter is used to either burn (radiofrequency energy) or freeze (cryoablation) the areas in the heart where the a-fib is coming from. These areas create scar tissue. Over time, the scar tissue becomes deeper and wider, and prevents the heart from conducting the abnormal electrical signals that cause a-fib.

Where is it done?

The procedure is done in an Electrophysiology Lab  at Porter Adventist Hospital or Swedish Medical Center.

How long does it take?

2-3 hours

What type of anesthesia is used?

General anesthesia

What happens right after the procedure?

Anticipate same-day discharge or staying the night.

Depending on what time your procedure starts, you typically can go home that same night. However, if your procedure starts later in the day, or if there are concerns from your doctor, it might be recommended to stay in the hospital 1-2 nights after your procedure.

Will I need someone to drive me home?

Yes, you will need someone to drive you home. After receiving general anesthesia driving is not recommended for at least 24 hours.

What about traveling home if from out-of-state?

We recommend staying in the local area 1-2 nights after discharge from the hospital.

 How will I feel after the procedure?

Everyone’s experience varies, however some common and expected symptoms after an ablation include soreness, fatigue, and chest discomfort.

Soreness and discomfort: You may experience some soreness, bruising, or tenderness at the catheter insertion site, typically in the groin area. This discomfort should subside gradually over a few days.
Fatigue: Feeling tired or experiencing fatigue is common. The body needs time to recover from the procedure and to adjust to the changes made in the heart’s electrical system.
Irregular heart rhythm: You may experience episodes of irregular heart rhythm or palpitations after the procedure. This is also a normal and expected part of the healing process.
Chest discomfort: Some individuals may have mild chest discomfort or tightness for a few days following the procedure. This typically improves within a few days.
Improved heart rhythm: In many cases, patients experience a significant improvement in their heart rhythm following the ablation procedure. However, it is common to have a return of irregular rhythm or a-fib during the first three months.

Remember that everyone’s experience can differ, and it’s essential to communicate any concerns or unusual symptoms to your healthcare provider. They will be able to provide            personalized guidance and support throughout your recovery.

What is my expected recovery course?

After the procedure you will be taken to the recovery area where you will be continually monitored until you are OK for discharge. Your medical team will provide you with specific aftercare instructions. You can drive 24 hours after your procedure.  However, you may be sore and may want to wait longer to drive, especially long distances. You may be required to take new medications for a short period of time. Your other medications might be adjusted as well. It is imperative that you continue to take your blood thinners to decrease your risk of stroke, especially during those first three months after the ablation. Your activity restrictions aim to prevent groin incision bleeding. Any activities that involve a lot of movement in the groin region, or those that increase pressure in the abdomen, will put pressure on the blood vessels where the incision(s) were made. Therefore, during the first 4-7 days after the ablation, avoid heavy lifting (more than 10 lbs), straining during bowel movements, excessive bending over, stooping, walking long distances, running, or climbing many flights of stairs. You may resume normal activity 1 week after the ablation.  It takes 3 months for the heart cells to heal after an ablation and to know if the procedure was successful. You will follow up with a nurse in 1 week, a nurse practitioner in 1 month, and your doctor in 3 months after the procedure.

Note on Pre-Op and Post-Op instructions:  The most up-to-date pre- and post-operative instructions will be the ones provided to you during your pre-op visit & on your hospital DC instructions given to you when checking-out of the hospital.

Helpful Resources


Preoperative Instructions

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Postoperative Instructions

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