5 Things to Know Before an Ablation Procedure
What to do and what to avoid right before your heart procedure for atrial fibrillation.
If an ablation for atrial fibrillation is on your calendar, now is not the time to upend your life. Medical experts advise you not make drastic changes to your diet or lifestyle a few weeks before the procedure. Do take time, though, to learn more about what you should do in advance — and what you can expect afterward.
You can help ensure things go smoothly by taking these five steps.
1. Pay Attention to Your Risk Factors
Once you begin discussing the possibility of having an ablation for atrial fibrillation (afib), it's also time to consider certain risk factors that you can control.
Although people who are a normal weight or underweight can also develop an irregular heartbeat, being overweight may increase your risk for afib. Drinking alcohol can also increase your risk for the condition. Obstructive sleep apnea is another significant risk factor for afib.
Long before undergoing an ablation, it's a good idea to shed extra pounds and limit your alcohol intake. If you've been diagnosed with sleep apnea, follow through on your treatment. If recommended by your healthcare provider, use a continuous positive airway pressure (CPAP) machine to help normalize your breathing during sleep.
"When we do these procedures, we want the best possible result," says Michelle Mead-Salley, RN, nurse coordinator of the Atrial Fibrillation Clinic at William Beaumont Hospital in Royal Oak, Michigan. "We want to make sure patients change what they can." Although CPAP may be uncomfortable and hard for some people to tolerate, Mead-Salley notes that it's important to see that patients are making an effort.
2. Avoid Certain Kinds of Medication
Before an ablation procedure, your doctor may tell you to avoid any medication that increases your risk of bleeding, such as aspirin. If you're taking a blood thinner, like warfarin, your doctor may or may not advise you to stop taking it a few days before your procedure. As Mead-Salley notes, this depends on your physician and the institution; each doctor's preference is different. Make sure you have all of your medication, including vitamins and supplements, on a medication list.
Your doctor will also monitor how long it takes for your blood to clot if you're taking the drug Coumadin (warfarin). The test that measures this is called a prothrombin time (PT) test. The result, noted in seconds, is usually reported as an international normalized ratio (INR).
If you're not taking a blood thinner, a normal PT result is an INR between 0.8 and 1.1. If you are taking a blood thinner, your target INR range is likely between 2.0 and 3.0.
Complications for people on Coumadin during ablation were less common when INR was between 2.0 and 3.0, according to a study published in 2013 in the journal Circulation: Arrhythmia and Electrophysiology. Because of this, the researchers noted that INR levels should be carefully monitored in preparation for an ablation for atrial fibrillation.
"Patients need to keep their INR levels steady," Mead-Salley says. INR levels that are too high could result in the heart procedure being canceled, and levels that drop too low increase the risk for stroke.
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3. Put Off Major Diet and Lifestyle Changes
Starting a new exercise regimen, not drinking alcohol, and eating more dark leafy greens are all healthy choices. But Mead-Salley cautions that what you do and eat could affect your INR level leading up to an ablation procedure.
The vitamin K found in green leafy vegetables can make warfarin less effective at preventing blood clots. The absorption of warfarin can also be affected by changes in exercise patterns.
Rather than making drastic changes ahead of the procedure, cut back on alcohol consumption slowly. And after your ablation, wait six weeks before beginning a new diet or workout program.
Also keep in mind that other medication you take can have an effect on blood-thinning drugs. "There are a lot of things that interact with Coumadin," says Kenneth Ellenbogen, MD, chairman of the division of cardiology in the Pauley Heart Center at Virginia Commonwealth University Medical Center in Richmond. Drugs that may interact with warfarin include antibiotics, antifungals, antidepressants, and seizure medication, among others. This is less true he says for newer oral anticoagulants, such as Pradaxa (dabigatran), Xarelto (rivaroxaban), and Eliquis (apixaban), because these new drugs do not require the same frequent monitoring, dosing adjustments, or dietary restrictions as warfarin.
4. Reduce Your Risk for Bleeding
After an ablation, people typically take a blood thinner for a minimum of two months, says Dr. Ellenbogen. Because of this, the use of nonsteroidal anti-inflammatory drugs (NSAIDs), like aspirin and Advil or Motrin (ibuprofen), may be limited in order to reduce the risk of bleeding.
Although the length of recovery varies from person to person, Ellenbogen adds that many people feel like themselves in about a week. Still, to reduce the risk of bleeding, he suggests that people who've had an ablation for atrial fibrillation avoid especially strenuous workouts right afterward.
5. Get Moving Gradually
Limiting strenuous activity doesn't mean you should be sedentary, Ellenbogen says. To reduce your risk for blood clots, go about your daily routine and take frequent short walks.
People can typically return to their normal exercise routine one week after having an ablation. But wait until six weeks after your heart procedure, and after you've seen your doctor at a follow-up visit, Mead-Salley says, before starting a new healthy diet plan or a new workout regimen.