Pulmonary vein isolation (PVI) ablation

This procedure is a treatment for atrial fibrillation (AF). AF can lead to symptoms of breathlessness, palpitations, dizzy turns, fatigue and in severe cases can weaken the heart muscle.

People with AF have a higher risk of stroke because blood can stagnate in pockets of the atria instead of being pumped through normally, and form blood clots which can cause a stroke.

The goals of treatment for AF include regaining a normal heart rhythm (sinus rhythm), controlling the heart rate, reducing symptoms, and reducing the risk of blood clots and stroke. 

Should the first PVI ablation not be successful long term and AF returns it may be possible to repeat the procedure.

What is radio-frequency ablation?

Radiofrequency ablation (RFA) is performed using specialised catheters, which deliver radiofrequency energy. This energy uses heat to create multiple small lesions around the opening of each pulmonary vein. RFA PVI takes 2-4 hours to perform

What is cryoablation?

Cryoablation utilises a catheter with a balloon at its tip. This balloon is inflated with cooling liquid at the entrance to each pulmonary vein. The cooling liquid freezes a ring of tissue around each pulmonary vein. Each freeze is 3 to 4 minutes long. Cryoablation PVI typically takes 1.5-2 hours to perform.

How should I prepare for my procedure?

Fasting: Please stop eating six hours before your procedure time. You may continue to drink clear fluids (water, weak BLACK tea and weak BLACK coffee) up to two hours before your procedure time. Do not consume milk as this is considered food. You may take your regular medications with sips of water.

Allergies: Please tell Intra staff at the time of booking if you have any medication or food allergies, or previous reactions to X-ray contrast (dye).

Diabetes: If you are a diabetic, please tell Intra staff at the time of booking. You may need to discuss your insulin/diabetes medication doses with your cardiologist.

Anticoagulation (blood thinner): Prior to the procedure you will be prescribed a blood thinning medication by your cardiologist unless you are already taking one. It is very important to NOT miss any doses of your blood thinner for 1 month prior to your AF ablation. Please contact Intra if you have any questions about this.

Other regular medications: Please continue to take these unless advised otherwise by your cardiologist. If you are taking a diuretic or water pills (e.g. frusemide, spironolactone) please advise Intra staff as you may need to withhold this on the morning of the procedure.

What will I experience during the procedure?

A PVI procedure is performed under general anaesthetic and can take 1.5-4 hours depending on the type of ablation (cryoablation or radiofrequency) procedure.

Once you are asleep, an anti-septic solution will be applied to the groin area to clean the skin. A small tube called a sheath will then be placed in the femoral vein (groin area). The ablation catheter is then passed up to the heart via this sheath and positioned in the left atrium (top chamber of the heart), by making a tiny hole in the septum between the right and left atria. This hole closes naturally after the procedure.

In many patients, a 3D electro-anatomical map is made of the left atrium, to help guide the catheters to exact locations. The ablation catheter is then moved to the entrance of each pulmonary vein so the ablation can be performed. At the end of the procedure, the catheters and sheaths are removed and pressure is applied to the vein to help manage any bleeding.

What happens after my procedure?

After the PVI procedure, you may feel discomfort in the throat where the breathing tube was placed, and in the groin area where the sheath was inserted.

Once you are awake and bleeding has stopped, you will be taken to Recovery or the ward for observations to ensure you recover as expected. You will be required to lie flat for several hours.

This is an overnight stay procedure. It is important transport arrangements are made when leaving the hospital as it is recommended you do not drive a car for 48 hours after the procedure.

Going home and recovery

  • Do not drive for 48 hours after your procedure. Please arrange for someone to drive you home or accompany you in a taxi.
  • You will need to arrange someone to be at home with you on the day of your discharge and overnight to support you in your recovery.
  • We advise you do not work for at least 1 week after your ablation procedure. This may be longer if your job involves heavy lifting (>5kg) or driving large vehicles.

Prior to your discharge, the nursing staff will give you information about resuming your normal activities, medication, wound care, and other information that is important for your recovery.

What are the risks?

As with any procedure, there are potential risks involved. Your cardiologist will explain the procedure, discuss possible risks and answer any questions you may have. You will then be asked to sign the consent form. This will occur either at an earlier appointment, or on the day of your procedure.