Pulmonary vein ablation is a surgical treatment for atrial fibrillation. Atrial fibrillation occurs when the node that controls the contractions of the heart is overloaded with electrical signals, causing the heart to beat rapidly and irregularly. This can produce no problems — other than a fluttery feeling in the chest — for a long time, but it can eventually lead to weakening of the heart and increased risk of stroke. Atrial fibrillation is first treated with medications, but if the patient doesn’t respond to these medications or for some reason can’t take them, a pulmonary vein ablation can help control the condition.
In a normal heart, the SA node sends an electrical impulse to the atria, or the top two chambers of the heart, telling them to contract, and then does the same for the ventricles, or the bottom two chambers of the heart. In a person with atrial fibrillation, many electrical impulses come through the SA node, causing the heart to contract rapidly and irregularly. Someone with this condition might experience heart palpitations, or the feeling of their heart racing when they are not exercising, dizziness, faintness, chest pressure or pain, and trouble breathing even when at rest.
Atrial fibrillation can go on for a long time without causing any serious problems, but over many years it can weaken the heart and, in some cases, lead to heart failure. It also increases the risk of blood clots, which in turn raises the risk of stroke. Physicians first try antiarrythmic medications, rate control medications, and anticoagulant drugs to manage this condition, but if these are not possible or are not effective, a pulmonary vein ablation is a common second resort. The procedure uses a catheter to strategically make scars where the pulmonary vein meets the left atrium. These scars block some of the abnormal electrical impulses, thus controlling the fibrillation.
A pulmonary vein ablation is performed in an electrophysiology (EP) lab by an electrophysiologist. The patient is sedated through an intravenous (IV) medication that can be raised throughout the procedure, according to the patient’s needs. The patient may fall asleep for parts of the procedure. The physician then numbs the catheter insertion sites, usually in the groin and sometimes in the neck, and inserts several catheters.
The doctor then runs the catheters up into the heart and, with the help of imaging technology and a device to track the errant impulses, begins the ablation. One of the catheters has a device that administers radiofrequency energy to the place where the pulmonary vein meets the left atrium. This energy makes little scars that serve as a barrier between the impulses and the rest of the heart. It takes a few weeks for the scars to fully form, so some patients often still experience atrial fibrillation for eight to ten weeks after the procedure.
The pulmonary vein ablation takes around four to six hours, but the patient typically stays at the hospital overnight to make sure there are no complications. Though it’s a fairly safe procedure complications can include damage to the pulmonary vein, damage to the heart, stroke, and in rare cases, damage to the esophagus. The patient may feel chest pain, soreness, and fatigue for around two days following the procedure.