What is pulmonary vein ablation?
Pulmonary vein ablation (also called pulmonary vein antrum isolation or PVAI), is a treatment for atrial fibrillation. Atrial fibrillation is an abnormal heart rhythm that originates in the top chambers of the heart (atria).
Atrial Fibrillation and The Electrical System of The Heart
When the heart beats normally, the electrical impulse begins at the sinoatrial (SA or sinus) node in the right atrium. The SA node produces the electrical impulses that set the rate and rhythm of the heart beat. The electrical activity spreads through the walls of the atria and causes them to contract. The electrical impulse then crosses the AV node and spreads down to the ventricles, causing them to contract. This creates the heart beat.
Normal Heart Rhythm Electrocardiogram
The heart’s electrical system triggers the heart beat. Each beat of the heart is represented on the electrocardiogram (ECG) by a wave arm. The illustration to the right shows a normal heart rhythm (also called normal sinus rhythm).The electrical activity in the heart is following the normal pathway, and the rhythm is relatively slow and regular (about 50 to 100 beats per minute).
In patients with atrial fibrillation, the SA node does not direct the heart’s electrical rhythm. Instead, many different impulses rapidly fire at once. This causes a very fast, chaotic rhythm in the atria. Because the electrical impulses are so fast and chaotic, the atria cannot contract and/or effectively squeeze blood into the ventricle.
Atrial Fibrillation Electrocardiogram
In patients with atrial fibrillation, many different impulses rapidly fire at once. This causes a very fast, chaotic rhythm. The heart beat is irregular and fast (100 to 200 beats per minute).
Treatment for Patients with Atrial Fibrillation
Treatment goals for patients with atrial fibrillation include restoring a normal heart rhythm (sinus rhythm), controlling the heart rate, reducing symptoms, and reducing the risk of blood clots and stroke. Many treatment options are available, including lifestyle changes, medications, catheter-based procedures and surgery.
The type of treatment that is best for you depends on the severity of your symptoms, prior treatments, and other medical conditions you may have. Medications are the first step in treatment. These may include:
- Medications to slow your heart rate
- Medications to control your heart rhythm (antiarrhythmic drugs)
- An anticoagulant (blood thinner) to reduce your risk of blood clots and stroke
Who should have pulmonary vein ablation?
Pulmonary vein ablation may be the best treatment option for patients who:
- Still have symptoms of atrial fibrillation, even after treatment with medications
- Cannot tolerate antiarrhythmic drugs, or have had complications from these drugs
Research has shown that atrial fibrillation usually begins in the pulmonary veins or at the point where they attach to the left atrium. There are four major pulmonary veins. All may trigger atrial fibrillation.
Patients who have treatments for atrial fibrillation often ask about Left Atrial Appendage (LAA) Closure.
Are you a candidate for pulmonary vein ablation?
To determine if ablation is an appropriate treatment, you will have a thorough evaluation. This may include:
- A review of your medical history
- Complete physical examination
- Electrocardiogram (ECG)
- Echocardiogram (echo – an ultrasound to evaluate your heart function and heart valves)
- Holter monitor test (a 24-hour ECG)
After the evaluation, your doctor will talk with you about what your best treatment option is and whether you are a candidate for this procedure.
How effective is the ablation procedure in treating atrial fibrillation?
Cleveland Clinic has extensive experience with atrial fibrillation ablation procedures.We carefully track our patients to be certain our data are accurate.
Success rate for single ablation procedure
The success rate for a single pulmonary vein ablation procedure depends on several factors. The highest cure rate is achieved in patients with paroxysmal atrial fibrillation in whom atrial fibrillation stops on its own within 1 to 3 days. Between 75 and 80 percent of these patients whose atrial fibrillation is not related to any other heart disease are completely cured with one pulmonary vein ablation procedure.
A single ablation procedure is less likely to cure patients who have had atrial fibrillation constantly for months or years and in patients who have extensive scarring in the atrium because of other heart disease. Nonetheless, patients with long-standing atrial fibrillation can be cured with a success rate of 50 to 70 percent, depending on their underlying heart disease and other factors. These patients are more likely to require more than 1 ablation procedure.
Success rate for repeat ablation procedure
Approximately 20 to 30 percent of patients need a second pulmonary vein ablation procedure because of recurrent atrial fibrillation that cannot be controlled with medications. Patients with other types of heart disease are more likely to need a second procedure. Second ablation procedures are generally very successful. Ablation of atrial fibrillation is successful in approximately 90 percent of patients with paroxysmal atrial fibrillation who have one or more ablation procedures.
Long-term treatment goal
The long-term goal of the pulmonary vein ablation procedure is to eliminate the need for medications to prevent atrial fibrillation. Most patients can stop taking an anticoagulant a few months after the procedure because their risk of stroke is lessened.
Even patients who are not completely cured of atrial fibrillation may benefit from the ablation procedure. The procedure helps them have a better response to medications that weren’t effective in the past.
It is difficult to predict whether your atrial fibrillation will be completely cured or if you will need to keep taking medication after the procedure. Our goal is to eliminate the need for medications. This goal is achieved in most patients.
Experience is Important
Pulmonary ablation requires special expertise. Physician credentials and experience lead to better outcomes. At Cleveland Clinic, more than 6,500 pulmonary ablation procedures were performed since 2004.
The vast experience Cleveland Clinic physicians have helps reduce procedural risks. We are equipped and prepared to quickly intervene if a complication does occur.
Additionally, the circumferential mapping technique used during the pulmonary vein ablation procedure was pioneered in the Cleveland Clinic Electrophysiology Lab.