Rate control vs. pulmonary vein isolation

Atrial fibrillation (AF) is a frequent arrhythmia encountered in clinical practice. It can be asymptomatic in some patients but incapacitating in others. Regardless of symptoms, patients at increased risk of embolism need chronic anticoagulation. In patients with AF and a rapid ventricular response that cannot be controlled with drugs, interventional procedures are required. Radiofrequency catheter ablation of the atrioventricular junction with pacemaker implantation is an effective therapeutic approach that relieves the symptoms associated with a rapid and irregular rhythm. This approach can also improve left ventricular function in patients with tachycardia-induced cardiomyopathy. Due to the irreversible nature of this approach, it is more suitable for older patients and those with advanced left ventricular dysfunction. Many patients with a structurally normal heart have symptomatic paroxysmal AF refractory to antiarrhythmic agents. This form of AF is frequently initiated by premature atrial beats arising from the pulmonary veins. A catheter ablation technique is available to electrically isolate the pulmonary veins. This procedure can eliminate AF in many patients but can result in complications, including embolic events, pulmonary veins stenosis, and cardiac perforation.