Pulmonary Vein Isolation Ablation

Treating Cardiovascular Diseases in Wisconsin and Northern Illinois

Pulmonary vein isolation (PVI) is one of several strategies used in treating a type of irregular heartbeat, or arrhythmia, known as atrial fibrillation, also called AF or A-Fib.

Your pulmonary veins deliver oxygen-rich blood from your lungs into the upper left chamber, or atrium, of your heart. In many patients with atrial fibrillation, the left atrium is stretched, which distorts the electrical connections between your heart and the pulmonary veins—common atrial fibrillation symptoms. Instead of traveling through the heart in a quick, coordinated way, the electrical signals back up, turn around or rewind around the pulmonary veins. This causes the heart to quiver or contract rapidly.

Your heart’s electrical system controls your heartbeats. Electrophysiologists are heart doctors who specialize in treating conditions that affect the heart’s electrical system. During a pulmonary vein isolation procedure, electrophysiologists destroy, or ablate, the abnormal electrical pathways that cause the arrhythmia symptoms.

Pulmonary vein isolation is a non-surgical procedure performed with a catheter (a long, thin, flexible coated wire) that is threaded through a blood vessel in the groin and into the heart. As the catheter touches various spots on the inside surface of the heart near the pulmonary veins, energy is applied to create lines of scar tissue.

Because electrical signals cannot flow through scar tissue, this procedure essentially isolates the pulmonary veins and their errant electrical pathways from the rest of the heart.

PVI can be performed during open heart or open chest surgery with instruments that touch the outer surface of the heart. This approach is sometimes recommended when patients undergo coronary artery bypass surgery or heart valve replacement surgery.

A new procedure is now available for pulmonary vein isolation. In this subtly invasive hybrid procedure, sometimes called a convergent procedure, the surgeon and electrophysiologist work together to ablate the outside of the heart.  But instead of making a large chest incision, a small incision is made under the breastbone and an optical scope guides the surgeon’s application of ablations. The electrophysiologist then uses a catheter to complete the electrical isolation from the inside of the heart. 

The Aurora Difference

Pulmonary vein isolation can be performed with heat (radiofrequency) or cold (cryo) energies. Aurora Health Care usually performs PVI with radiofrequency (RF) energy from cooled catheters, which provide better isolation than conventional RF catheters or cyrotheters.

Pulmonary vein isolation, by itself, is usually performed on patients with paroxysmal atrial fibrillation, a type of A-fib that comes and goes spontaneously, without treatment. Many times, we tailor our treatments to better treat our patients’ specific type of arrhythmia or their individual anatomy. In some cases, additional ablation may be applied in patients who have scarring in the main part of the atrium. Or we may treat other arrhythmias called flutters while performing a PVI.

We also use pulmonary vein isolation with other ablation strategies on patients who have persistent atrial fibrillation, a type of A-fib that has episodes lasting a week or more without reverting to a normal rhythm. Patients with persistent A-fib often have more structural heart changes, such as an enlarged heart, extensive scarring and electrical abnormalities.

Aurora Health Care performs ablations on many patients with persistent A-fib when many other providers may not attempt these treatments. However, some patients with persistent A-fib may need more than one procedure or may be candidates for the hybrid procedure. We have performed ablations on patients who have had atrial fibrillation for many years, allowing many to live a more normal life.  

We perform one of the highest volumes of ablation procedures in the Midwest. We have a stand-alone electrophysiology lab, staffed with electrophysiologists, nurses and technologists who specialize in conditions affecting the heart’s electrical system. We do not use a “swing lab” with staff from other departments filling in.

Possible Pulmonary Vein Ablation Complications

The nature, extent and purpose of the ablation procedure and the possibility of complications will be explained to each patient individually. 

How to Prepare for a Pulmonary Vein Isolation Ablation Procedure

Before your ablation:

  • Arrive at the hospital 3 hours before your procedure is scheduled. You will need to be earlier if you will be having a CAT scan done in the morning before you have the ablation.
  • Do not eat or drink for 8 hours before your procedure. You will be given specific instructions if you can take some of your meds with sips of water.
  • In the admission area there will be paperwork, insertion of an IV (intravenous) and a physical examination. The details of the procedure will be reviewed. You can have questions answered.
  • Plan to have someone drive you home or arrange other transportation.
  • Stop medication as instructed. Medications may be stopped at different times.

In the EP (Electrophysiology) Lab:

  • Catheters (soft wires) will be inserted in veins in your groin and neck area.
  • MDs, RNs and technicians will be present in the EP lab making preparations, monitoring you, and carrying out the EP study to map and ablate your arrhythmia.
  • Sedation and/or anesthesia will be given throughout the procedure.
  • Your family will receive updates as they wait.

After your Ablation:

  • After the procedure, catheters are removed, some pressure is applied to the areas to stop any bleeding and adhesive bandage strips or small dressings are applied.
  • Call your EP nurse or doctor if you have problems:
    • Abnormal or increased shortness of breath, dizziness, palpitations or fainting.

    • Increased drainage, swelling, fever or signs of infection at the ablation catheter sites

  • Discharge instructions will be given to you before you go home and include:
    • Activity restrictions for lifting and exercising are for 1-2 days after discharge.

    • Make an appointment with your electrophysiologist in 4-6 weeks.

    • You may return to work 2-7 days after your ablation depending on the type of work you do and your recovery.

    • Your discharge medications. (Bring your list and/or current med bottles to the visits.)

  • You will go to a hospital room to stay overnight or longer if necessary to start new medications.
  • You may eat and drink when you have recovered from the sedation.

After you go home:

  • Expect to have some atrial fibrillation symptoms after your procedure for 6 weeks to 6 months. This is normal. Individual treatment will be given based on your event monitor results, your symptoms, and your response to medications.
  • You will be instructed to take Coumadin™ or the generic medication called warfarin or other anticoagulation medication (blood thinner). You will need to set up appointments with your primary doctor for regular blood tests (called INR) and anticoagulation medication adjustment by your primary MD.
  • You will be sent an event monitor to use to document your heart rhythm for 3-4 weeks after your ablation. You may be using an event monitor again at 3 months, 6 months and 1 year after your ablation.