Do you sometimes feel like your heart is beating too fast and irregularly? This condition, which feels like something is wrong inside your chest, is called Atrial Fibrillation (Afib) . This is an abnormality in the heart rhythm. If you don't take care of this, you may have to face serious conditions like stroke in the long run. So, today we are talking about a very successful and modern way to treat this Afib condition.
What is Pulmonary Vein Isolation (PVI)?
Simply put, Pulmonary Vein Isolation (PVI) is a procedure used to treat atrial fibrillation (Afib). It is a type of heart surgery, but it is not a major surgery.
Imagine, our heart's function is controlled by a system of electrical signals. In Afib, these electrical signals become confused and travel to the heart in an irregular manner. Most often, these faulty signals start in the four blood vessels that carry oxygen-rich blood from the lungs to the left atrium of the heart, called the pulmonary veins .
So, what this PVI treatment does is identify the places where those faulty electrical signals are coming from and create a very small scar tissue in those places. This is called heart ablation . This scar tissue acts like a wall and stops those faulty electrical signals from spreading to other parts of the heart. Then the heart beats normally again.
Who is this treatment suitable for?
This treatment is not for everyone. Your doctor is the best person to decide. This treatment is usually recommended for people who:
- For those who still have symptoms despite taking antiarrhythmic drugs to control their Afib condition.
- For those whose bodies cannot tolerate those medications or who experience side effects from them.
Some studies have now found that some patients get better results when they use PVI as the first treatment, before starting medication. However, this is not yet a standard treatment and is still being researched.
How do you know if this treatment is right for you?
Before deciding whether this is right for you, your doctor will examine you thoroughly. He or she will review your medical history and any tests you have done. Some of the tests that are usually done for this purpose are:
- Echocardiogram (Echo): This is an ultrasound scan of the heart. It can look at the structure and function of the heart.
- Electrocardiogram (EKG): A test that records the electrical activity of the heart.
- Holter monitor: This is a small device that is worn on the body and monitors your heart rate over a long period of time, such as 24 or 48 hours.
What are the treatments?
This PVI treatment is done using a method called catheter ablation . That is, this treatment is done by passing a very thin, flexible tube called a catheter through a blood vessel to the heart. There are two main methods for repairing the scar tissue that we mentioned earlier.
| Treatment method (Ablation Method) | How it works |
|---|---|
| Radiofrequency Ablation | This is the most commonly used method. It uses heat from radio waves to destroy the targeted tissue. |
| Cryoablation | Here, extreme cold is used to temporarily freeze and permanently destroy the target tissue. |
It's not possible to say that one of these two methods is better than the other. The results of both are almost the same, and there is no significant difference in safety. Your doctor will explain to you which method is best for you.
What happens during treatment?
During this treatment, you will be completely anesthetized (general anesthesia), so you will not feel any pain, you will be asleep. Sometimes, only a local anesthetic may be used. You will be informed about this in advance.
Simply put, this is what happens:
1. After anesthesia, a very small incision is made in the groin area or neck.
2. Through that incision, two catheters are passed along a blood vessel into the left atrium of the heart.
3. One catheter locates exactly where the faulty electrical signals are coming from.
4. The other catheter delivers heat or cold to create scars in those areas.
5. When the work is finished, the two catheters are removed and the small incision is closed.
How is your heart monitored during treatment?
Throughout the treatment, several devices will be used to monitor your heart function and other body functions. Don't worry, this is all for your safety.
| Monitor | Usage |
|---|---|
| Cardioverter | It is used to control the heart rate if it decreases or increases. |
| Electrocardiogram (EKG) | The heart's electrical activity is monitored on a screen through several stickers attached to the chest. |
| Blood Pressure Monitor | Blood pressure is continuously measured using a cuff attached to the arm. |
| Oximeter Monitor | A clip attached to the finger measures the oxygen level in the blood. |
| Fluoroscopy | Something like an X-ray machine is used to check where the catheter is in the heart. |
| Intracardiac Echocardiography | A small ultrasound device passed through the catheter clearly sees the inside of the heart. |
How long does the treatment take and what are the risks?
This treatment can usually take between 4 and 6 hours . It is a good idea to let your family know that you will be in the hospital all day, as it will take time to prepare and recover. You will need to stay in the hospital overnight after the treatment.
As with any heart procedure, there are very small risks . However, it is a very safe procedure. Possible complications include:
- Infections at the incision site.
- There is a small chance of minor nerve damage during cryoablation.
- Perforation of the heart (1% risk).
- Damage to the pulmonary vessels (1% risk).
- Stroke (0.5% risk).
- Damage to the esophagus (0.25% risk).
Recovery and aftercare
You may feel a little discomfort, fatigue, or chest pain during the first 48 hours after treatment. This is normal. You can return to normal activities after a couple of days. However, it will take a few weeks before you can start doing strenuous activities like exercise.
The most important thing is that after treatment, the scar tissue will form and it will take a few weeks for the full results to be seen. During that time, you may experience irregular heartbeats again. Sometimes, you may feel like your symptoms get worse before they get better. This is normal, so don't worry about it.
You will need to take several medications for several months after treatment.
- Antiarrhythmic drugs: Control the heart rate until the new scar tissue is fully functional.
- Anticoagulants (blood thinners): These are essential to reduce the risk of stroke.
You will need to go for follow-up appointments in 3-4 months and a year.
Take-Home Message
- Pulmonary Vein Isolation (PVI) is a very safe and effective treatment for Atrial Fibrillation (Afib), especially for those who have difficulty controlling their condition with medication.
- This involves creating small scars in the heart to block the pathways through which faulty electrical signals come.
- This is a treatment performed through a catheter without a large incision.
- It may take several weeks for full recovery and results to be seen. It is common for symptoms to recur during that time.
- Although this may control symptoms, it is not a cure. It is extremely important to continue taking the blood thinners your doctor prescribes to reduce your risk of stroke.
- If you experience any discomfort, chest pain, or difficulty breathing, see your doctor immediately.
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