During pulmonary vein ablation, a doctor inserts catheters into the blood vessels of the leg (sometimes the neck) and guides the catheters into the atrium.
Energy is delivered through the tip of the catheter to tissue that is targeted for ablation. The energy is applied around the connections of the pulmonary veins to the left atrium. Frequently, other areas involved in triggering or maintaining atrial fibrillation are also targeted.
Small circular scars eventually form and prevent the abnormal signals that cause atrial fibrillation from reaching the rest of the atrium. However, the scars created during this procedure may take from 2 to 3 months to form.
Once the scars form, they block any impulses firing from within the pulmonary veins, thereby electrically disconnecting them from the heart. This allows the SA node to once again direct the heart rhythm and a normal sinus rhythm is restored.
Because it takes several weeks for the lesions to heal and form scars, it is common to experience atrial fibrillation early during the recovery period. Rarely, atrial fibrillation may be worse for a few weeks after the procedure and may be related to inflammation where the lesions were created. In most patients, these episodes subside within 1 to 3 months.
You will lie on a bed and the nurse will start an IV in a vein in your arm. A medication will be given through your IV to make you feel drowsy. Your neck, upper chest, arm, and groin will be cleansed with an antiseptic solution, and the catheter insertion site(s) will be shaved. Sterile drapes will be placed to cover you from your neck to your feet.
Due to the medication given to make you relax, you may fall asleep at times during the procedure.
You will feel an initial burning sensation when the doctor injects medication in the catheter insertion site. You may also feel some discomfort or a burning sensation in your chest when the energy is applied through the catheter.
It is important to remain quiet, keep very still, and avoid taking deep breaths. If you are feeling pain, your doctor or nurse can give you more medication.
After you become drowsy, the doctor numbs the catheter insertion sites by injecting a medication. The doctor inserts several catheters into large veins in both sides of your groin and sometimes in your neck. The catheters are advanced to the heart.
Two of the catheters are guided into the left atrium through a small hole made with a needle and placed in the atrial septum (wall between the right and left atria).
A transducer is inserted through one of the catheters so intracardiac ultrasound can be performed during the procedure. The ultrasound allows the doctor to view the structures of the heart and evaluate the position of the catheters during the procedure.
A catheter in the left atrium is used to find or map the abnormal impulses coming from the pulmonary veins.
Another catheter is used to deliver the radiofrequency energy outside and around the pulmonary veins.
The pulmonary vein ablation procedure may last from 4 to 6 hours, but each patient is different.
Please let your family know that the preparation and recovery time take several hours, so they should plan to be at the hospital all day for your procedure.