Atrial Fibrillation Ablation

Detail of Pulmonary Vein Isolation

In some people, a fast heartbeat, or heart arrhythmia, is triggered by "hot spots." These hot spots are extra electrical pathways in the heart and are most commonly found in the pulmonary veins, which return blood from the lungs to the heart. In the ablation procedure, patients first undergo electrophysiology testing to locate precisely of the extra electrical pathways in the heart.

Before pulmonary vein isolation procedure

Patients come to the clinic several days before the ablation procedure. The patient will meet with physicians who specialize in treating heart arrhythmias. Together, the patient and physicians will decide the best treatment option.

If the need for an ablation procedure is indicated, the patient may have some tests — an echocardiogram, a CT scan and a lung perfusion scan — even if the tests have been previously performed on the patient. Patients usually are admitted to the hospital on the morning of the ablation procedure.

During the pulmonary vein isolation procedure

The procedure causes little or no discomfort and can usually be done with only mild sedation and a local anesthetic.

During the procedure, four to eight catheters (long, narrow tubes) are inserted into different veins and threaded through the blood vessels to different locations in the heart. Some catheters are used to record the heart's electrical activity. In some cases, medications may be given to trigger the heart arrhythmia. Areas of the heart are then mapped to identify abnormal tissue. Sometimes, if the fast heartbeat does not resolve itself, shocks may be needed to stop the arrhythmia. Before any shock is administered, patients are given medication for sleep so they don't feel the shock.

Once the hot spots on the heart have been identified, the electrophysiologist uses the catheter tip to apply energy (either radiofrequency to heat, or liquid nitrogen to freeze). This destroys, or ablates, the hot spots and interrupts the triggers for the heart arrhythmia.

Generally, the procedure takes from four to nine hours. The length of the procedure depends on the number of hot spots and whether other abnormal electrical circuits in the heart need to be treatment.

Care following pulmonary vein isolation

When the procedure is done, patients stay at the hospital for at least 24 hours so that their heart rhythm and overall condition can be monitored. Before going home, patients may have a chest X-ray, electrocardiogram (ECG) and transesophageal echocardiogram for the physicians to view the heart and rule out complications.

If there are no complications or recurrence of heart arrhythmia, patients may leave the hospital. If complications arise, or the arrhythmia returns, the patient will be hospitalized longer. The patient and medical team will discuss instructions regarding medications, activities and follow-up care before the patient leaves the hospital.

Most people resume normal activities a few days after the procedure.