pulmonary vein isolation ablation

overview

Pulmonary vein isolation (PVI) is a treatment for a kind of irregular heartbeat (arrhythmia) known as atrial fibrillation (also called AF or A-Fib). Your pulmonary veins deliver oxygen-rich blood from your lungs to the upper left chamber (atrium) of your heart. In many patients with atrial fibrillation, the left atrium is stretched, which distorts the electrical connections between the heart and the pulmonary veins. 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.

what to expect

In the electrophysiology (EP) lab, doctors, nurses and technicians work together to care for you. You’ll receive anesthesia or sedation. 

A heart doctor called an electrophysiologist, who specializes in treating conditions that affect the heart’s electrical system, performs pulmonary vein isolation ablation by destroying (ablating) abnormal electrical pathways. This is done with the help of a thin, flexible coated wire (catheter) 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. This scar tissue blocks electrical signals, isolating the pulmonary veins and their errant electrical pathways from the rest of the heart.

Sometimes, PVI is done during open-heart surgery with instruments that touch the outer surface of the heart. A new less invasive procedure is now available for PVI. In this procedure, sometimes called a convergent procedure, the surgeon and electrophysiologist work together to ablate the outside of the heart, using just a small incision under the breastbone. A special optical scope guides the surgeon, and the electrophysiologist uses a catheter to complete the electrical isolation from the inside of the heart.

recovery

When the procedure’s finished, the catheters are removed and the wounds are dressed. You’ll go to a hospital room to stay overnight – longer if you’re starting new medications. You may eat and drink when you have recovered from the sedation

Before you go home, you’ll get instructions on how to care for yourself and what activities you should avoid. You can usually go back to work a couple of days after your procedure, depending on what kind of work you do and how your recovery is going. You should come in for a follow-up appointment with your electrophysiologist in 4 to 6 weeks. Contact us if you have shortness of breath, dizziness, palpitations or fainting, or if you develop a fever or have increased drainage at your catheter sites. It’s normal to still have some A-Fib symptoms for about 6 weeks to 6 months after your procedure.

You’ll get a prescription for a blood thinner (anticoagulant), such as Coumadin™ (warfarin). Taking this drug will mean you’ll have to see your primary care doctor for regular blood test (called INR) to adjust your anticoagulation medication as necessary. About 3 to 4 weeks after your ablation, we’ll send you an event monitor to document your heart rhythm. You’ll probably use an event monitor again in 3 months, 6 months and a year afterward.

why Aurora?

PVI can be done with hot (radiofrequency) or cold (cryo) catheters. At Aurora, we do PVEs with radiofrequency energy from cooled catheters, which provide better isolation than conventional RF catheters or cyrotheters. We’re also able to use PVI with other ablation strategies if you have persistent atrial fibrillation, a type of A-fib that includes episodes lasting a week or more and don’t revert to a normal rhythm. People with persistent A-fib often have more structural heart changes, such as an enlarged heart, extensive scarring and electrical abnormalities. Some may need more than one procedure, or may be candidates for the hybrid procedure.

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