Pulmonary vein isolation

Pulmonary vein isolation is a treatment for an irregular heartbeat called atrial fibrillation (AFib).

It is a type of cardiac ablation. Cardiac ablation uses heat energy, cold energy or high-energy electric pulses to make tiny scars in the heart. The scars block faulty electrical signals that cause an irregular heartbeat. This can help your heart beat in a regular heart rhythm.

In pulmonary vein isolation, a doctor makes tiny scars in the upper left heart chamber, where the four lung veins connect. Those veins are called the pulmonary veins. They bring oxygen-rich blood from the lungs to the heart.

Your care team may suggest pulmonary vein isolation to ease atrial fibrillation (AFib) symptoms. AFib symptoms may include a pounding, fluttering or racing heartbeat, shortness of breath, and weakness. Treating AFib can improve your quality of life.

Pulmonary vein isolation usually is done after you've tried other treatment options. Your healthcare team may first suggest medicines or other treatments.

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 conditions, called arrhythmias.
• Slow heart rate, which may need a pacemaker to correct.
• Blood clots in the legs or lungs.
• Stroke or heart attack.
• Narrowing of the veins that carry blood between the lungs and heart, a condition called pulmonary vein stenosis.
• Damage to the esophagus. That's the tube that connects the mouth and the stomach and runs behind the heart.

Talk with your care team about this treatment to understand if it's right for you.

Before your pulmonary vein isolation, your healthcare team may do some tests to get more information about your heart health.

You may need to stop eating and drinking the night before. Your care team gives you instructions on how to prepare.

Before

Pulmonary vein isolation is done in the hospital. A team member places an IV into your forearm or hand. Medicine called a sedative goes through the IV to help you relax.

The amount of sedation needed for the treatment depends on your specific irregular heartbeat and other health conditions. Sometimes a healthcare professional gives you a mix of medicines to put you in a sleeplike state. This is called general anesthesia.

During

During pulmonary vein isolation, the doctor makes a small cut to reach a blood vessel in the groin, shoulder or neck. Then the doctor guides one or more thin tubes called catheters through the blood vessel into the area of the heart to treat.

Sometimes dye flows through the catheters. The dye is often called contrast. It helps blood vessels show up more clearly on X-ray images.

Sensors on the catheter tips send electrical signals and record the heart's electricity. This part of the treatment is called an electrophysiology (EP) study. An EP study can show where an irregular heartbeat starts in the heart. The information helps your care team know where to apply the treatment.

The doctor guides the catheters into the upper left heart chamber where the lung veins connect. Then the doctor makes small scars to block faulty signals in the heart using one of the following methods:

• Heat energy, called radiofrequency energy.
• Extreme cold energy, called cryoablation.
• High-energy electric pulses, called pulsed field ablation.

Usually, the doctor treats each of the four lung veins during pulmonary vein isolation.

If you don't get general anesthesia, you may feel some minor pain when the catheter goes into your heart and during the treatment. If you have severe pain or shortness of breath, tell your healthcare team.

After

Pulmonary vein isolation usually takes about 3 to 8 hours. The time varies depending on the specific irregular heartbeat.

After pulmonary vein isolation, your care team typically takes you to a recovery area to rest quietly for a few hours. A member of the team checks your heartbeat and blood pressure.

Depending on your condition, you may go home the same day or stay overnight in the hospital. Plan for someone to drive you home after your treatment.

You may feel a little sore for about a week after your pulmonary vein isolation. Your care team will tell you when it's safe to return to your usual activities.

After pulmonary vein isolation, call your healthcare professional if you have any of these symptoms where the catheter was placed:

• Bleeding.
• Changes in skin color.
• Bruising, swelling or a lump.
• Skin that tingles or feels cold.

Call 911 or your local emergency number if you have any of the following:

• Changes in your heartbeat.
• Trouble breathing.
• Dizziness or lightheadedness.
• Chest pain or discomfort that spreads to your arm, neck or jaw.
• Face drooping, arm weakness or trouble speaking.

Most people see improvements in their quality of life after cardiac ablation, including pulmonary vein isolation. But sometimes the irregular heartbeat returns. If this happens, talk with your care team about your treatment options. Sometimes, pulmonary vein isolation is done again.

This treatment has not been shown to lower the risk of a stroke related to AFib. Your healthcare professional may suggest starting or staying on blood-thinning medicines.