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Electrophysiology · UK

Pulmonary vein isolation - catheter ablation for AF, done properly.

The definitive catheter treatment for atrial fibrillation - cryoballoon, radiofrequency or pulsed-field, by a high-volume consultant electrophysiologist, in a proper EP lab with a full pre-ablation imaging pathway.

See indicative pricing
A radiographer guides a patient onto the bed of an advanced 3 Tesla MRI scanner in a London imaging suite

Indicative pricing

What a private PVI costs in the UK.

Indicative ranges across our partner EP units.

In short

£15,000–£22,000, home same day or next morning.

Procedure Indicative range
PVI - cryoballoon ablation £15,000–£22,000
PVI - radiofrequency (RF) ablation £16,000–£24,000
PVI - pulsed-field ablation (PFA) £18,000–£26,000
Redo PVI (recurrent AF) £17,000–£26,000
PVI with additional substrate ablation £20,000–£30,000
Left atrial appendage occlusion (Watchman) - separate £16,000–£24,000
EP consultation only £300–£500

Prices vary by hospital, by the electrophysiologist, by modality (cryo, RF, PFA) and by whether extra substrate or LAA work is combined. PFA is at the top of the range in most units because catheter costs are still high.

The problem

The right operator, the right modality, and honest numbers on success.

PVI is where AF care quietly under-delivers - low-volume operators, single-modality units, and success rates quoted without the redo caveat. We fix all three before you consent.

  • Volume, volume, volume

    Operator volume is the single strongest predictor of 12-month freedom from AF. Anything under 50 cases a year is a warning sign.

  • Pick the modality for the anatomy

    Cryoballoon, RF and PFA all have niches. A unit that only offers one is telling on itself.

  • Talk about redo up front

    One in four to five patients needs a second procedure. If nobody has said that, you have not been consented honestly.

When it helps

When pulmonary vein isolation is the right step.

The situations we see most, plus the one red flag that means A&E rather than a routine EP appointment.

  • Symptomatic paroxysmal AF

    The clearest indication - episodes that self-terminate within 7 days, felt as palpitations, breathlessness or fatigue, despite a rate or rhythm drug.

  • Symptomatic persistent AF (< 12 months)

    AF lasting longer than a week, still symptomatic on optimal drug therapy. Success rates are lower than paroxysmal but still worthwhile.

  • First-line for well-selected paroxysmal AF

    Recent ESC and NICE guidance places catheter ablation as a Class I first-line option for symptomatic paroxysmal AF - no drug trial required first.

  • AF with heart failure (HFrEF)

    CASTLE-AF and follow-up data show mortality benefit for PVI in AF with reduced ejection fraction - a strong indication in the right hands.

  • Drug intolerance or failure

    Beta-blocker, flecainide, sotalol or amiodarone that has failed, or side effects that are worse than the AF itself.

  • Occupational or lifestyle disability

    Pilots, drivers, elite athletes or performers whose work does not tolerate AF episodes - a reasonable indication in shared decision-making.

  • Athlete-related AF

    Endurance-related AF often responds well to PVI, especially when identified early and combined with training-load review.

  • Red flag: syncope, chest pain or new stroke

    Blackouts, ischaemic-sounding chest pain or new neurological symptoms are A&E, not a routine EP appointment - call 999 or 111.

Procedure options

Modality follows anatomy and AF pattern.

What each option involves - energy source, additional lesion sets, and where each sits in the modern UK AF pathway.

  • Cryoballoon PVI

    A balloon inflated in each pulmonary vein and cooled to about -50 °C to freeze a ring of tissue at the ostium. Fast, reproducible, best for round-vein anatomy.

  • Radiofrequency (RF) point-by-point

    A steerable catheter draws a circumferential burn around each vein under 3D mapping (CARTO, EnSite). Flexible for tailored substrate work in persistent AF.

  • Pulsed-field ablation (PFA)

    Non-thermal irreversible electroporation. Highly tissue-selective, sparing oesophagus and phrenic nerve. Now the fastest-growing modality in the UK.

  • High-power short-duration RF

    A modern RF technique - 50 W for 5 to 10 seconds per lesion - that shortens RF cases towards cryoballoon times without losing durability.

  • Additional posterior wall isolation

    For persistent AF, some operators add a roof and floor line to isolate the posterior LA. Evidence is mixed but often used in redo cases.

  • CTI ablation for concurrent atrial flutter

    A short additional line across the cavo-tricuspid isthmus if typical atrial flutter is present or induced on the day.

  • Hybrid convergent procedure

    A combined thoracoscopic surgical epicardial ablation with a subsequent endocardial PVI - for long-standing persistent AF resistant to catheter therapy alone.

  • LAA occlusion combined with PVI

    A Watchman or Amplatzer LAA occluder placed at the same sitting for patients with high bleeding risk who cannot tolerate long-term anticoagulation.

Safety and recovery

What to expect afterwards - honestly.

PVI is a mature procedure. The things worth planning are anticoagulation, the blanking period and long-term rhythm monitoring - not just the day itself.

  • Anaesthetic is GA or deep sedation

    Cryoballoon and PFA are commonly done under GA. Point-by-point RF may be done under deep sedation with a dedicated cardiac anaesthetist.

  • Groin haematoma and vascular injury

    The commonest issue - a bruise or small haematoma in 3 to 5 percent, symptomatic vascular injury in under 1 percent. Ultrasound-guided access has cut this substantially.

  • Cardiac tamponade

    Bleeding into the pericardium in 1 to 2 percent - recognised on the table and drained percutaneously. Very rarely needs surgical repair.

  • Stroke and TIA

    Under 1 percent. Minimised by pre-procedural DOAC, intraoperative heparin to an ACT over 300, and catheter hygiene throughout the case.

  • Phrenic nerve palsy (cryoballoon-specific)

    2 to 4 percent - usually transient. The team monitors diaphragmatic contraction with fluoroscopy or diaphragm CMAPs and stops freezing early if function drops.

  • Pulmonary vein stenosis

    Historic risk with early RF techniques - now under 1 percent with modern wide-antral isolation.

  • Atrio-oesophageal fistula (very rare)

    A catastrophic RF-specific complication - under 0.1 percent. PFA effectively eliminates the risk. Any fever, chest pain or new neurology in the weeks after PVI needs same-day review.

  • Recurrence and redo rates

    Around 70 to 80 percent single-procedure freedom from AF at one year for paroxysmal, 50 to 60 percent for persistent. A second ablation raises long-term success to around 85 percent.

  • Recovery timeline

    Back to office work in 2 to 3 days, light exercise at one week, full activity by two weeks. Driving next day after routine PVI. Palpitations during the 8 to 12 week blanking period are common and not failure.

Reading your procedure note

Your PVI note in four parts. Read the last one first.

Whichever modality was used - cryoballoon, RF or PFA - the note the electrophysiologist sends you keeps to the same shape.

A UK consultant electrophysiologist reviewing an atrial voltage map after PVI

A quiet reminder

EP language is precise and can read coldly - we translate it for you.

If you would like us to talk you through the procedure note and rhythm monitoring plan before your review, just ask.

  1. 01 Header

    AF pattern, modality and vein map

    The AF pattern being ablated, the modality used (cryo, RF, PFA), and confirmation that all four pulmonary veins were isolated.

  2. 02 Technique

    Access, mapping and adjuncts

    Femoral access, transseptal technique, mapping platform (CARTO, EnSite, Rhythmia), lesion set and any additional lines such as posterior wall or CTI.

  3. 03 Findings

    Entrance-and-exit block, inducibility

    Confirmation of bidirectional block at each vein, and whether AF or flutter was inducible at the end of the case after a waiting period.

  4. 04 Impression

    Anticoagulation, drugs and monitoring plan

    Read this first: your DOAC and antiarrhythmic plan for the blanking period, and when to return for the 3, 6 and 12-month rhythm review.

Recognised by major UK insurers

BupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealix

PVI is usually covered for symptomatic AF that has failed one antiarrhythmic drug. Some insurers now approve first-line PVI in line with the ESC and NICE guidance.

Frequently asked

Everything we get asked about PVI.

Quick answers on modality, success, anticoagulation, cost and recovery.

  • What actually happens in a PVI?

    Under GA or deep sedation, the electrophysiologist passes catheters up the femoral vein into the right atrium, crosses the septum into the left atrium, and creates a ring of scar around each pulmonary vein - either by freezing (cryoballoon), burning (radiofrequency) or brief high-voltage pulses (PFA). The scar electrically disconnects the veins from the atrium, where most AF triggers originate.

  • Cryoballoon, radiofrequency or pulsed-field - which is best?

    For paroxysmal AF with straightforward vein anatomy, all three achieve similar 12-month freedom from AF (around 70 to 80 percent). PFA is faster and has effectively eliminated oesophageal injury; cryoballoon is highly reproducible; RF is the most flexible when substrate work beyond PVI is needed. The right answer depends on your anatomy, your AF pattern and your operator.

  • How successful is a single PVI procedure?

    Single-procedure freedom from AF at one year is around 70 to 80 percent for paroxysmal AF and 50 to 60 percent for persistent. A second ablation raises long-term success to around 85 percent for paroxysmal. Success is higher in younger patients with a normal-sized left atrium and no long-standing persistent AF.

  • Do I still need blood thinners after PVI?

    Anticoagulation continues for at least two months after PVI, and lifelong decisions are made on CHA2DS2-VASc score - not on the ablation result. Even after a successful PVI, if your stroke-risk score is 2 or more, most UK EPs continue DOAC lifelong because subclinical AF recurrence is common and hard to detect.

  • How much does a private PVI cost in the UK?

    Roughly £15,000 to £22,000 for cryoballoon, £16,000 to £24,000 for radiofrequency, and £18,000 to £26,000 for pulsed-field ablation. Redo procedures and combined substrate work push toward £26,000 to £30,000.

  • How long is recovery?

    Most patients are home the same day or the next morning, back to office work in 2 to 3 days and driving the next day. Full exercise by two weeks. Palpitations during the 8 to 12 week blanking period are common as the scar matures - they do not mean the ablation has failed.

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