Overview

Pulmonary vein isolation is a procedure to treat an abnormal 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 your heart to block abnormal electrical signals and restore a normal heartbeat.

In pulmonary vein isolation, the tiny scars are created in the left upper chamber of your heart in the area where the four lung (pulmonary) veins connect. Your pulmonary veins bring oxygen-rich blood from your lungs to your 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 can 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 arrhythmia
  • Slow heart rate that could require a pacemaker to correct
  • Blood clots in your legs or lungs (venous thromboembolism)
  • Stroke or heart attack
  • Narrowing of the veins that carry blood between your lungs and heart (pulmonary vein stenosis)
  • Damage to your kidneys from dye, if used during the procedure (dye is not used in all types of ablation)
  • Injury or ulceration of the swallowing tube (esophagus), which runs behind the heart
  • Death in rare cases

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

How you prepare

Your doctor may order several tests to get more information about your heart condition before your cardiac ablation.

You'll need to stop eating and drinking the night before your procedure. Your doctor or nurse 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. A specialist will insert an IV into your forearm or hand and give you a medication called a sedative to help you relax.

The amount of sedation needed for the procedure depends on your specific arrhythmia and other health conditions. You may be being fully awake or lightly sedated, or you may be given general anesthesia (fully asleep).

During

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

Your doctor may inject dye through the catheter, which helps your blood vessels show up more clearly on X-ray images. Dye isn't always used. It depends on the specific type of ablation.

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

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

You may feel some minor discomfort when the catheter is moved into your heart and when energy is being delivered. If you have severe pain or shortness of breath, let your doctor know.

After

Pulmonary vein isolation usually takes three to six hours to complete (but it can vary a lot based on your specific type of arrhythmia).

Afterward, you'll be taken to a recovery area to rest quietly for a few hours. Your heartbeat and blood pressure will be monitored continuously 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 normal 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 your abnormal heartbeat may return. If this happens, the procedure may be repeated or you and your doctor might consider other treatments.

Pulmonary vein isolation has not been shown to reduce your risk of a stroke, so your doctor may recommend that you continue blood-thinning medications.

Pulmonary vein isolation care at Mayo Clinic

April 24, 2021
  1. Huang SKS, et al., eds. Pulmonary vein isolation for atrial fibrillation. In: Catheter Ablation of Cardiac Arrhythmias. 4th ed. Elsevier; 2020. https://www.clinicalkey.com. Accessed March 10, 2021.
  2. Noseworthy PA (expert opinion). Mayo Clinic. Feb. 5, 2021.
  3. Passman R. Atrial fibrillation: Catheter ablation. https://www.uptodate.com/contents/search. Accessed March 8, 2021.
  4. Zipes DP, et al., eds. Ablation for atrial fibrillation. In: Cardiac Electrophysiology: From Cell to Bedside. 7th ed. Elsevier; 2018. https://www.clinicalkey.com. Accessed March 8, 2021.
  5. Catheter ablation. National Heart, Lung, and Blood Institute. https://www.nhlbi.nih.gov/health-topics/catheter-ablation. Accessed Jan. 21, 2021.
  6. Brown A. Allscripts EPSi. Mayo Clinic. Feb. 4, 2021.
  7. Zipes DP, et al., eds. Catheter ablation: Clinical aspects. In: Cardiac Electrophysiology: From Cell to Bedside. 7th ed. Elsevier; 2018. https://www.clinicalkey.com. Accessed Feb. 2, 2021.
  8. Bonow RO, et al., eds. Therapy for cardiac arrhythmias. In: Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 11th ed. Elsevier; 2019. https://www.clinicalkey.com. Accessed Feb. 2, 2021.
  9. Ganz LI. Overview of catheter ablation of cardiac arrhythmias. https://www.uptodate.com/contents/search. Accessed Feb. 2, 2021.