Pulmonary vein isolation

Date Updated: 02/22/2022

Overview

Pulmonary vein isolation is a procedure to treat an irregular heart rhythm called atrial fibrillation.

Pulmonary vein isolation is a type of cardiac ablation. Cardiac ablation uses heat or cold energy to create tiny scars in the heart to block irregular electrical signals and restore a regular heartbeat.

In pulmonary vein isolation, the tiny scars are created in the left upper chamber of the heart in the area where the four lung (pulmonary) veins connect. The pulmonary veins bring oxygen-rich blood from the lungs to the heart.

Why it's done

Pulmonary vein isolation is done to reduce the signs and symptoms of atrial fibrillation, such as heart palpitations, shortness of breath and weakness. If you have atrial fibrillation, the procedure may help improve your quality of life.

Pulmonary vein isolation is usually done after you've tried medications or other treatments first.

Risks

Possible risks of pulmonary vein isolation include:

Bleeding or infection at the site where the catheter was inserted
Blood vessel damage
Heart valve damage
New or worsening heart rhythm problems (arrhythmias)
Slow heart rate that could require a pacemaker to correct
Blood clots in the legs or lungs (venous thromboembolism)
Stroke or heart attack
Narrowing of the veins that carry blood between the lungs and heart (pulmonary vein stenosis)
Injury or ulceration of the swallowing tube (esophagus), which runs behind the heart
Death, rarely

Discuss the risks and benefits of cardiac ablation with your health care provider to understand if this procedure is right for you.

How you prepare

Your health care provider may order several tests to get more information about your heart health before your cardiac ablation.

You'll likely need to stop eating and drinking the night before your procedure. Your care provider will tell you how or if you should continue any medications before a cardiac ablation.

What you can expect

Before

Pulmonary vein isolation is done in the hospital. The amount of sedation needed for the procedure depends on the specific arrhythmia and other health conditions. You may be fully awake or lightly sedated, or you may be given general anesthesia (fully asleep).

During

The health care provider inserts long, flexible tubes (catheters) through a blood vessel into the heart. The catheters may be inserted through a blood vessel in the groin (most common), shoulder or neck (less common).

Depending on the type of ablation, the health care provider may inject dye (contrast) through the catheter, which helps blood vessels show up more clearly on X-ray images.

Sensors on the tip of the catheter send electrical impulses and record the heart's electricity. The health care provider uses this information to identify the area that is causing an arrhythmia and to decide where to apply the ablation. This part of the procedure is called an electrophysiology (EP) study.

The health care provider moves the catheters from the upper right chamber of the heart to the upper left chamber of the heart where the pulmonary veins connect. Heat (radiofrequency energy) or extreme cold (cryoablation) is used to create small scars in the target area and block the irregular heart rhythms. Usually, each of the four pulmonary veins is treated during pulmonary vein isolation.

There may be some minor discomfort when the catheter is moved into the heart and when energy is being delivered. If you have severe pain or shortness of breath during pulmonary vein isolation, let your care provider know.

After

Pulmonary vein isolation usually takes three to six hours to complete, but may vary depending on the specific arrhythmia.

After pulmonary vein isolation, you'll likely be taken to a recovery area to rest quietly for a few hours. A care provider continuously monitors your heartbeat and blood pressure to check for complications of the procedure.

Depending on your condition, you may go home the same day or spend the night in the hospital. Plan to have someone else drive you home after your procedure.

You may feel a little sore after your procedure, but the soreness shouldn't last more than a week. You'll usually be able to return to your regular activities within a few days after having pulmonary vein isolation.

Results

Most people see improvements in their quality of life after cardiac ablation, including pulmonary vein isolation. But there's a chance that the irregular heartbeat may return. If this happens, the procedure may be repeated or you and your health care provider might consider other treatments.

Pulmonary vein isolation has not been shown to reduce the risk of a stroke, so your health care provider may recommend starting or continuing blood-thinning medications.