You will receive an instruction sheet that describes how to prepare for the procedure. Here’s an overview of those instructions.
What can I expect during the procedure?
Getting ready: Before the procedure begins, a nurse will help you get ready. You will lie on a bed and the nurse will start an IV (intravenous line) in a vein in your arm. The IV is used to deliver medications and fluids during the procedure, including medication to make you feel drowsy. Your neck, upper chest, arm and groin will be cleansed with an antiseptic solution. The catheter insertion site(s) will be shaved. Sterile drapes will be placed to cover you from your neck to your feet.
Symptoms/How you’ll feel: The medication you receive to relax you may cause you to fall asleep at times during the procedure. You will feel a burning sensation when the doctor first injects medication in the area where the catheter will be inserted.
You may feel some discomfort or a burning sensation (like heartburn) in your chest when the energy is applied through the catheter. It is important to remain quiet, keep very still and avoid taking deep breaths. If you feel pain, the doctor or nurse can give you more medication.
An anesthesiologist is available if you need to be more heavily sedated to stay comfortable.
Please note: In some cases, general anesthesia is used. Your doctor will discuss the type of sedation that will be used during your procedure, as well as the risks, before you have the treatment.
What happens during the ablation procedure?
After you become drowsy, the doctor injects medication to numb the catheter insertion sites. The doctor inserts several catheters (long, flexible tubes) into large veins in both sides of your groin and possibly your neck. The catheters are advanced to the heart.
Two of the catheters are guided into the left atrium through a small hole made with a needle and placed in the atrial septum (wall between the right and left atria).
A transducer is inserted through one of the catheters. This is used for intracardiac ultrasound. The ultrasound lets the doctor see the structures of the heart and correctly position the catheters.
A catheter in the left atrium is used to find (map) the abnormal impulses coming from the pulmonary veins. Another catheter is used to deliver the radiofrequency energy outside and around the pulmonary veins.
How long does the procedure last?
The pulmonary vein ablation procedure may last 4 to 6 hours. Each patient is different. Please let your family know that the preparation and recovery time take several hours. They should plan to be at the hospital all day. You will stay in the hospital overnight.
Monitors used during the procedure
Several monitors will be used during the procedure to check your heart rhythm and your body’s responses to any arrhythmias that occur.
- Defibrillator/pacemaker/cardioverter: Attached via wires to one sticky patch placed on the center of your back and one on your chest. This device allows the doctor and nurse to pace your heart rate if it is too slow, or deliver energy to your heart if the rate is too fast.
- Electrocardiogram (EKG): Attached to several sticky electrode patches placed on your chest. Provides a picture on the monitors of the electrical impulses traveling through the heart.
- Blood pressure monitor: Connected to a blood pressure cuff on your arm. Checks your blood pressure throughout the procedure.
- Mapping system: State-of-the-art technologythat helps your doctor locate the exact area of your arrhythmia.
- Ablation machine: Attached to a sticky patch on your back.
- Oximeter monitor: Attached to a small clip placed on your finger. Checks the oxygen level of your blood.
- Fluoroscopy: A large X-ray machine positioned above you to help the doctors see the leads on an X-ray screen during the procedure.
- Intracardiac ultrasound: Performed using a catheter transducer inserted into the heart: Used throughout the procedure to view the structures of the heart and the catheter when it is in contact with the heart lining.
What can I expect after the procedure?
Discussing the procedure results: After the procedure, the doctor will discuss the results of the procedure with you and your family.
Overnight hospital stay: You will be admitted to the hospital and stay overnight for observation. Most patients go home from the hospital the next morning.
Your heart rate and rhythm will be constantly monitored during your recovery. This is done using telemetry. A a small box is connected by wires to your chest with sticky electrode patches. The box sends the information about your heart rhythm to several monitors in the nursing unit.
The doctor will remove the catheters and put pressure on the insertion site to prevent bleeding. No stitches are needed. Bandages are placed on the insertion sites to reduce the risk of bleeding and bruising.
You will stay in bed for 6 to 8 hours after the procedure. Keep your legs still during this time to prevent bleeding.
How will I Feel After the Procedure?
You may feel general soreness, fatigue or chest discomfort during the first 48 hours after the procedure.
It takes several weeks for the lesions to heal and form scars. So, it is common to have abnormal or irregular heartbeats for 8 to 10 weeks after the procedure.
Rarely, atrial fibrillation may be worse for a few weeks after the procedure and may be related to inflammation where the lesions were created.
Driving Home: For your safety, a responsible adult must drive you home.
Activity: Usually you can return to your normal activities within 48 hours after the procedure. For one week after the procedure, you cannot lift anything that weighs more than 10 pounds. You should wait at least three weeks before you resume intense exercise.
Medications: For at least 3 months after the procedure, you will need to take anticoagulant medication. This prevents blood clots from forming and reduces your risk of stroke. You may need to take this medication for longer than 3 months, depending on your individual risk of stroke. You also may need to take an antiarrhythmic medication for 2 months after the procedure. This medication controls abnormal heartbeats.
Your doctor will give you all the prescriptions and medication instructions you will need. If you think you will have any problems paying for your medications, please let us know. We may be able to help.
Ask your doctor if you should keep taking the medications you took before you had the procedure.
Blood Tests: You must have frequent blood tests (called INR/Protime) to evaluate your dosage of your anticoagulant medication. Your doctor will tell you how often to have this test. Please schedule these blood tests with your local doctor’s office.
You will need two follow-up visits at Cleveland Clinic after your procedure. The first appointment will be 3 to 4 months after your procedure. You will receive a reminder card for this appointment. If you don’t get an appointment notice within 3 weeks after your procedure, please call our appointment offices: 216.444.6697 or 800.223.2273, ext. 46697.
The second follow-up visit will be one year after your procedure.
Please bring your telephone transmitter to your Cleveland Clinic follow-up appointment.
These tests may be performed at your follow-up appointment:
- Spiral computed tomography (CT) scan* to evaluate the presence of pulmonary vein narrowing: You will need to fast (not eat or drink anything) for 6 hours before this appointment.
- 2-D echocardiogram (Echo) or transesophageal echocardiogram (TEE)
- Electrocardiogram (EKG)
- Other blood tests/lab work
*The CT scan involves the use of an intravenous contrast material. If you are allergic to contrast material, dye or shellfish, please notify us immediately so you can receive a medication to take before the test.