Arrhythmia Treatment in Turkey

The electrophysiology (EP) study: Before ablation, a detailed electrophysiology study maps the arrhythmia mechanism: catheters are placed via femoral vein puncture into the heart chambers; programmed electrical stimulation induces and characterises the arrhythmia; 3D mapping reconstructs the cardiac anatomy.

Pulmonary Vein Isolation (PVI) for AF:

1. Trans-septal puncture: catheters cross from right atrium to left atrium via a puncture in the interatrial septum
2. 3D electroanatomical map of the left atrium is constructed
3. Circular mapping catheter identifies pulmonary vein potentials
4. Radiofrequency (RF) energy ablates a ring of tissue around each pulmonary vein ostium — electrically isolating the PVs from the LA
5. Entry and exit block confirmed in all four PVs

Cryoablation (Arctic Front Balloon):

• A compliant balloon is inflated at each PV ostium and cooled to -40 to -60°C — creating the PV isolation lesion in a single freeze per vein
• Single-shot technique — faster than point-by-point RF; excellent for paroxysmal AF; suitable for anatomically normal PVs

Post-ablation monitoring:

• 24 hours cardiac monitoring on EP ward; ECG, transthoracic echo to exclude pericardial effusion
• Anticoagulation continued for minimum 3 months post-ablation regardless of CHA₂DS₂-VASc score
• 3-month blanking period: arrhythmia in the first 3 months post-ablation may not indicate failure (healing inflammation)
• Holter monitoring at 3, 6, and 12 months

Pacemaker implantation:

• Led by the subclavian or cephalic vein; pacing leads positioned in the right ventricle ± right atrium under fluoroscopy
• Pocket under the collar bone; 1 overnight stay; wound check at 1 week
• Remote monitoring: most pacemakers have wireless remote monitoring capability — BB Global Health sets up remote monitoring at partner hospitals compatible with worldwide platforms

AF ablation post-procedure:

• Same-day or overnight stay for straightforward paroxysmal AF PVI
• Groin access: trans-radial alternative not usually possible for trans-septal procedures; femoral vein access requires 4–6 hours bed rest to allow haemostasis
• Anti-inflammatory therapy (colchicine or ibuprofen) for 2–4 weeks post-ablation to reduce pericarditis risk
• Anti-arrhythmic drugs (flecainide, propafenone, amiodarone) may be continued for 3 months then discontinued
• Anticoagulation: continue regardless of CHA₂DS₂-VASc during the blanking period; long-term anticoagulation decision revisited at 3 months; high-risk patients continue anticoagulation even after successful ablation

Pacemaker follow-up:

• 1-week wound check; 6-week interrogation; then annual remote follow-up
• Most modern pacemakers (Medtronic, Abbott, Boston Scientific) offer remote monitoring platforms compatible with worldwide follow-up
• Pacemaker ID card provided; device documentation compatible with airport security declaration

Cost comparison: AF catheter ablation Turkey: €7,000–12,000 all-inclusive; UK private: £15,000–25,000. Pacemaker implantation Turkey: €5,000–9,000; UK private: £12,000–18,000. ICD implantation Turkey: €10,000–16,000; UK private: £20,000–35,000.