Pulmonary vein ablation is a treatment for atrial fibrillation.
Pulmonary vein ablation is one option used to treat atrial fibrillation and may be most appropriate for patients who:
Have continued symptoms of atrial fibrillation, despite treatment with medications
Can not tolerate antiarrhythmic drugs, or have had complications from these drugs
What is Atrial Fibrillation?
Atrial fibrillation is an abnormal heart rhythm that originates in the top chambers of the heart.
With atrial fibrillation, the SA node does not direct the heart’s electrical rhythm. Instead, many different impulses rapidly fire at once, causing a very fast, chaotic rhythm in the atria. Because the electrical impulses are so fast and chaotic, the atria cannot contract and/or squeeze blood effectively into the ventricle.
Treatment for Atrial Fibrillation
Many options are available to treat atrial fibrillation, including lifestyle changes, medications, catheter-based procedures, and surgery.
The goals of treatment include:
Regaining a normal heart rhythm (sinus rhythm)
Controlling the heart rate
Reducing the risk of blood clots and stroke
The type of treatment that is recommended for you depends on the severity of your symptoms, prior treatments, and other medical conditions that may affect the risk of treatment.
Initially, medications are used to treat atrial fibrillation. The medications may include:
Rate control medications (to slow the heart rate)
Rhythm control medications (antiarrhythmic drugs)
Coumadin (anticoagulant or blood thinner) to reduce the risk of blood clots and stroke
During the procedure energy is delivered through the tip of the catheter to tissue that is targeted for ablation. The energy is applied in a circle around the connection of the left upper and lower pulmonary veins to the left atrium.
Monitors Used During the Procedure
Defibrillator/Pacemaker/Cardioverter: Attached to one sticky patch placed on the center of your back and one on your chest. This allows the doctor and nurse to pace your heart rate if it is too slow, or deliver energy to your heart if the rate is too fast.
Electrocardiogram/EKG/ECG: Attached to several sticky electrode patches placed on your chest as well as inside your heart. Provides a picture on the monitors of the electrical impulses traveling through the heart.
Blood pressure monitor: Connected to a blood pressure cuff on your arm. Checks your blood pressure throughout the procedure.
Oximeter monitor: Attached to a small clip placed on your finger. Checks the oxygen level of your blood.
Fluoroscopy: A large X-ray machine will be positioned above you to help the doctors see the leads on an X-ray screen during the procedure.
Mapping system: State-of-the-art technology that helps your doctor locate the exact area of your arrhythmia.
Intracardiac ultrasound: Performed by a catheter transducer inserted into the heart. Used throughout the procedure to view the structures of the heart and the catheter when it is in contact with the heart lining.
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.
After the Procedure
What to Expect After the Procedure
After the procedure, the doctor will discuss the results of the procedure with you and your family.
You will be admitted to the hospital and stay overnight for observation. In your hospital room, a telemetry monitor will be used to evaluate your heart rate and rhythm during your recovery. Telemetry consists of a small box connected by wires to your chest with sticky electrode patches. The box displays your heart rhythm on several monitors in the nursing unit.
The doctor will remove the catheters and apply pressure to the insertion site to prevent bleeding and no stitches are needed. To reduce the risk of bleeding and bruising, a pressure bandage will cover the catheter insertion sites in your leg and neck.
You will need to stay in bed for 6 to 8 hours after the procedure and keep your legs still during this time to prevent bleeding.
Most patients are discharged from the hospital the following morning. For your safety, a responsible adult must drive you home.
How You Will Feel After the Procedure
You may feel some discomfort at the catheter insertion during the first few days after the procedure. The doctor will tell you what medications you can take for pain relief.
You may also experience mild chest discomfort, mild shortness of breath, and fatigue after the procedure. The chest pain is due to underlying inflammation and is more noticeable in certain positions such as laying down and improves with sitting up. This usually resolves within a few days.
Extra heartbeats, a racing heart, atrial fibrillation, or skipped heartbeats commonly occur on and off for the first several weeks after the procedure. When these symptoms occur during your recovery, please notify your doctor. You may need to have a heart monitor.
These symptoms are common and usually improve several weeks after the procedure.
Rarely, atrial fibrillation may be worse for a few weeks after the procedure and may be related to inflammation where the lesions were created.
For at least 1 month after the procedure, you will need to take an anticoagulant medication to prevent blood clots and reduce the risk of stroke. You may need to continue this medication for longer than 3 months, depending on your individual risk for stroke. If you are on warfarin, you must have frequent blood tests to evaluate your dosage. Your INR should be between 2 and 3.
You may also need to take an antiarrhythmic medication to control abnormal heart beats for several months after the procedure.
Care For the Insertion Site
You may take a shower. However, avoid extreme water temperatures. Do not take a bath, swim or soak in water for 10 days after the procedure or until the incision sites have healed.
Important things to note:
Keep the procedure site clean and dry
Do not scrub the area
Do not need to keep the area covered with a bandage
Do not use creams, lotions, or ointments on the procedure site
Look at the area daily to make sure it is healing properly. If you notice any of the signs of infection, please call your doctor.
You may resume your normal exercise and activity routine 1 week after the procedure.
For the first week after your procedure:
Do not lift anything that weigh more than 10 pounds
Avoid activities that require pushing or pulling heavy objects
Stop any activity before you become overtired
Your doctor will tell you when:
You can resume driving
You can resume more strenuous activities or heavy lifting