Pulmonary vein ablation of atrial fibrillation: beyond the traditional

The present review aims at giving a synthesis on the evolution in the last decade of the catheter-based ablative treatments for atrial fibrillation (AF). We report the rationale of current pulmonary vein (PV) ablation techniques: segmental PV isolation and circumferential PV ablation. The endpoint is the electrical isolation of the PVs from the left atrium, as they house foci triggering AF in 80% to 95% of cases and seem to play a key role in arrhythmia maintenance. Recurrence rates of AF after these PV ablation strategies are very encouraging. Two recent randomized trials, AFFIRM and RACE, showed no significant difference in outcomes between a strategy of pharmacological heart rate control and that of restoration and maintenance of sinus rhythm with antiarrhythmic drugs. However, multicenter randomized trials comparing PV ablation with drug therapy are required. Future refinements in catheter technology and navigation systems should provide simpler and faster procedures and render PV ablation more widespread and accepted from the scientific and medical communities.