Pulmonary vein isolation ablation
Find a heart specialistIf you’ve been diagnosed with atrial fibrillation (AFib), we provide expert evaluation and a full range of treatments to help get your heart back on a proper beat.
Your doctor may recommend pulmonary vein isolation (PVI) if medications aren’t working to alleviate your irregular heartbeat or if your AFib terminates spontaneously. A more extensive procedure requiring extra pulmonary vein sites may also be needed if you’ve been in AFib for a long time.
What does the pulmonary vein do?
Your pulmonary veins deliver oxygen-rich blood from your lungs to the upper left chamber of your heart, the left atrium. The pulmonary veins, which have muscle fibers, can be the site of triggers for AFib where extra beats originating from these sites can trigger AFib. Instead of traveling through the heart in a quick, coordinated way, the electrical signals cause the heart to quiver or contract rapidly. In more advanced situations, areas other than pulmonary veins may also be affected and sustain AFib in patients.
What is pulmonary vein isolation?
Pulmonary vein isolation is a type of cardiac ablation that uses gentle burning or freezing to treat small areas of heart muscle that are causing your irregular heartbeat. During these procedures, you’ll be put under anesthesia. However, the idea is to keep you comfortable as the procedure can take a few hours. During freezing, a balloon is inflated in each pulmonary vein, and freezing is performed for three to six minutes in each vein.
During radiofrequency catheter ablation, targeted heat is delivered at each site using a special catheter. Radiofrequency ablation can be used to isolate pulmonary veins or deliver energy at extrapulmonary sites as needed. Extra sites may be organized circuits called flutters or disorganized areas.
Hybrid approach
We’re also able to use other ablation strategies if you have persistent atrial fibrillation of long duration or if prior standard ablation procedures have failed. Persistent or long-lasting AFib is a type of AFib that includes episodes lasting a week or more and doesn’t revert to a normal rhythm. People with persistent AF often have more structural heart changes, such as an enlarged atria and extensive scarring of the atria.
During the hybrid procedure, your doctor can access the back of the heart without opening the chest by accessing the space between the heart and the layer surrounding it called the pericardium through a small incision and isolate the back of the left atrium.
There are two techniques to this. In the sequential approach, the back of the left atrium is isolated and the surgeon can clip the left atrial appendage, a pouch in the left atrium where blood clots during AFib can form. About six weeks later the standard procedure from inside, including PVI and other suites from inside as described above, are targeted.
In the other approach, both the outside and inside ablations are done during the same procedure. However, clipping of the left atrial appendage is not performed during this approach.
Prior to the ablation procedure, you'll see your physician for personalized guidelines for which type of procedure may benefit you and to prepare for the procedure including:
- Refraining from eating or drinking anything after midnight the night before your procedure
- How to get ready for your procedure, including any medications you may need to stop taking
- Answering your questions and concerns
- Possible success rates, risks, and other options
- Need for medications and if you’ll need more than one procedure
The ablation procedure may take three to six hours. You’ll receive a general anesthetic, so you’ll be asleep before the procedure begins.
After numbing the area in your groin, your doctor will thread catheters through a blood vessel in your groin and guide them to your heart. Your doctor then will send energy pulses through the catheters to isolate the heart tissue, such as pulmonary veins, that is causing the arrhythmia.
If you’re undergoing a hybrid procedure, a small incision will also be performed below the rib area in the middle to access the back of the heart.
You’ll stay in the hospital at least overnight, maybe longer if you’re starting new medications or if you had hybrid ablation. In hybrid ablation, a small tube will be left in the space between the heart and the layer around it for 24 hours to drain any blood. Be sure to arrange for someone to drive you home.
Your doctor will discuss detailed recovery and follow-up instructions, including if you’ll still need to take medication to help control arrhythmia. You’ll also receive a blood thinner, such as warfarin or newer drugs, that you’ll keep taking until your doctor says it’s OK to stop.
Be sure to contact us if you experience any of these symptoms:
- Shortness of breath
- Dizziness
- Palpitations
- Fainting
- Fever
- Increased drainage at your catheter sites
It's not unusual to experience some irritation for up to three to four months after the procedure. The real success of the procedure is thus ascertained after at least three months.
Usually, you’ll see your physician two to four weeks after the procedure.
A few weeks after your ablation, we may send you home with an event monitor to document your heart rhythm. The monitor is either a patch worn externally on your chest or a device the size of a pen clip implanted below the left breast. These monitors provide alerts if you experience an arrhythmia.
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