01. What is the duration of catheter ablation for AFib procedure?

The comprehensive process of catheter ablation, encompassing preparation, procedure execution, and catheter removal, usually spans around 3-4 hours in total.

02. What is the recovery period post-procedure?

Post-procedure, patients may intermittently experience episodes of atrial fibrillation during the initial three months, even while on medication. This period allows the development of scar tissue, leading to the full effect of the procedure. However, for a majority of patients, these sporadic episodes subside eventually.

03. Is there a possibility of requiring more than one catheter ablation procedure?

Certain patients might need one more procedure. This determination is generally made after the 3-month follow-up consultation, providing ample time for healing post the first procedure.

04. Does the catheter ablation procedure cause pain?

The catheter ablation process typically causes transient and mild discomfort. In many cases, patients experience minimal or no pain during the ablation.

05. When can I resume my work and other routine activities?

Provided your occupation doesn't involve heavy lifting or intense physical labour, you should be able to return to your workplace approximately five to seven days post-procedure. It is recommended to abstain from strenuous exercise and heavy lifting for at least a week.

Pulsed Field Ablation (PFA) for Atrial Fibrillation

Pulsed Field Ablation treats Atrial Fibrillation using precise electrical pulses that target only the faulty cells causing irregular heart rhythms. No heat. No extreme cold. Surrounding tissue remains completely unaffected.

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Understanding Pulsed Field Ablation for Atrial Fibrillation

Among the most common heart rhythm disorders, Atrial Fibrillation (AF) affects millions of people worldwide. Pulsed Field Ablation (PFA) is an advanced treatment for this condition. Unlike conventional ablation methods that rely on heat or extreme cold, PFA delivers targeted electrical energy to the heart tissue responsible for abnormal electrical signals. These pulses create microscopic openings in the cell membranes of targeted heart cells, causing them to stop conducting faulty signals and helping restore a normal heart rhythm.

This non-thermal approach makes pulsed field ablation for atrial fibrillation a highly precise treatment. Because the electrical pulses act selectively on heart muscle cells, structures in the surrounding area, including the oesophagus and phrenic nerve, are less affected than with traditional thermal techniques.

Choosing the right specialist matters for procedures of this complexity. Dr. Karthigesan, one of the leading interventional cardiologists in Chennai, brings a rich blend of experience and skill in complex Atrial Fibrillation ablation, backed by an unwavering commitment to patient-centred care.

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How Pulsed Field Ablation Works

How the energy is delivered

Unlike conventional Atrial Fibrillation procedures, which use heat, or cryoballoon ablation, which uses freezing energy, PFA ablation delivers short, high-energy pulses directly to the affected heart tissue. This process, known as irreversible electroporation, permanently disrupts the cell membranes of abnormal heart muscle cells, preventing them from transmitting faulty electrical signals. Because the energy acts selectively on heart muscle cells, the risk of injury to nearby structures is significantly lower than with conventional thermal techniques.

Pulmonary Vein Isolation

The primary target of PFA is pulmonary vein isolation (PVI), the cornerstone of catheter ablation therapy for AF. The pulmonary veins are the most common origin point of the abnormal electrical signals that trigger AF. By isolating them using electrical pulses rather than thermal energy, PFA achieves effective rhythm control while better protecting the surrounding tissue.

Assessment Prior to Pulsed Field Ablation

Not every patient with AF is a candidate for PFA. To evaluate your condition and confirm suitability, we may recommend a series of diagnostic tests before the procedure.

Electrocardiogram (ECG) or Holter monitoring
Event Loop Recorder (ELR) monitoring
Transthoracic or transesophageal echocardiogram
Cardiac CT
Blood tests, such as thyroid function
Coronary angiography, if clinically indicated

We will also review your current medications, particularly blood thinners, and adjust them if needed before the procedure.

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Pulsed Field Ablation Procedure

During the pulsed field ablation procedure, specialised catheters are guided into the heart through a vein in the groin. More than one catheter may be placed depending on the clinical requirement.
Advanced imaging is used to position the catheter precisely at the openings of the pulmonary veins, where the abnormal electrical signals that trigger Atrial Fibrillation most commonly originate.
Once in position, the pulses are delivered to the affected tissue, creating a barrier that blocks faulty signals from reaching the rest of the heart.
The procedure is performed under general anaesthesia and is completed faster than conventional thermal ablation, with most cases taking under two hours.
Patients go home the same day in the majority of cases.
If AF recurs after the procedure, further ablation may be considered following a clinical review.

What to Expect Before, During, and After the Procedure

Before the Procedure

During the Procedure

After the Procedure

You will receive instructions on which medications to stop and when. Blood thinners should be stopped up to 5 days before the procedure, whereas newer anticoagulants require only 24 to 48 hours. Follow Dr. Karthigesan's guidance on exact timelines.
A cardiac CT scan will map the anatomy of your pulmonary veins.
The team will also run an ECG and blood tests to confirm you are fit for the procedure.
Fast for at least six hours beforehand.
We will discuss sedation or general anaesthesia with you in advance, based on your health status and the clinical plan.

Local anaesthesia will be applied to the groin area where the catheter is inserted. The area will be fully numbed, and you should not feel any pain during insertion.
A mild sedative through an intravenous (IV) line may also be given if needed.
Using advanced imaging, specialised catheters are guided to the heart and positioned at the pulmonary veins. The pulses are then delivered to block the abnormal signals causing Atrial Fibrillation.
Most procedures are completed within two hours.

Expect to lie flat for four to six hours while the access site heals.
Bruising or mild discomfort around the groin is normal. This should settle within a few days.
Had a transesophageal echocardiogram (TEE) during the procedure? A mild sore throat is common and resolves on its own.
Strenuous activity and heavy lifting should wait at least one week. Most patients return to daily routines within five to seven days.
No driving for 48 hours.
The team will advise on when to restart blood thinners and other medications.
The clinic will schedule a follow-up appointment to monitor your heart rhythm. Contact the clinic immediately if you experience severe chest pain, heavy bleeding from the groin site, or sudden shortness of breath.

Risks and Benefits of Pulsed Field Ablation Procedure

Is Pulsed Field Ablation Safe? — Risks to Be Aware Of

No procedure is without risk. With PFA, the most common include minor bleeding, blood vessel damage, or infection at the access site. These are rare.
Some patients experience temporary irregular heart rhythms in the weeks that follow. This is expected and usually resolves without intervention.
More serious but uncommon complications include cardiac tamponade and coronary artery spasm.
Because PFA is non-thermal in nature, the risk of collateral tissue damage is significantly lower than with conventional ablation.

Benefits of PFA for Atrial Fibrillation

PFA is a minimally invasive, outpatient procedure. Most patients are discharged the same day.
Procedure times are shorter than those of conventional thermal ablation methods.
Treating Atrial Fibrillation through ablation reduces the long-term risk of stroke and heart failure associated with untreated AF.
Successful ablation can reduce or eliminate dependence on antiarrhythmic medications, which often carry significant side effects.

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Find Out if Pulsed Field Ablation is Right for You

If you have been living with Atrial Fibrillation and are looking for a treatment option beyond medication, speak with Dr. Karthigesan to understand whether PFA is suitable for your condition.

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Pulsed Field Ablation — Your Questions Answered

01. How long does a Pulsed Field Ablation procedure take?

Most PFA procedures are completed within two hours. The exact duration may vary depending on the complexity of your condition

02. What is the recovery period after Pulsed Field Ablation?

Recovery is quick. Most patients go home the same day, resume light activities within two to three days, and return to work within five to seven days. No driving for 48 hours.

One thing to be aware of: intermittent AF episodes in the weeks after the procedure are common as the heart heals. This settles on its own.

03. Is there a possibility of needing more than one PFA procedure?

It is possible but not common. If AF recurs, this is usually identified at the three-month follow-up, after the heart has had adequate time to heal. A second procedure may then be considered.

04. Is pulsed field ablation safe?

Over 500,000 PFA procedures have been performed worldwide since 2021. The safety profile is strong, largely because the energy source is non-thermal, which means the risk of damage to adjacent tissue is significantly lower than with traditional ablation.

As with any procedure, some risk exists. Dr. Karthigesan will walk you through this in detail before proceeding.

05. When can I return to work and normal activities?

Five to seven days for most desk-based or light-duty work. Hold off on strenuous exercise and heavy lifting for at least a week.