Fully equipped to defeat the pulmonary vein potentials: on the quest for sinus rhythm

Abstract

This editorial refers to ‘Pulmonary vein isolation with radiofrequency ablation followed by cryotherapy: a novel strategy to improve clinical outcomes following catheter ablation of paroxysmal atrial fibrillation’ by M. H. Tayebjee et al. , on page 1250. Since its inception more than a decade ago, catheter ablation has dramatically changed our therapeutical approach to atrial fibrillation (AF). The irruption of catheter ablation occurred through the recognition of the pulmonary veins (PVs) as main triggers initiating paroxysmal AF.1 Initial ablation strategies aimed at suppression of these focal triggers. However, radiofrequency (RF) lesions placed inside the veins produced PV stenosis,2 so that ablation had to move from the veins to its antrum. Segmental PV isolation was based on this principle, and targeted only preferential connections between the antrum and the PV at its ostium. This yielded quite good results in paroxysmal AF, but produced much more modest outcome in patients with persistent forms of AF. In circumferential antral PV isolation ablation lesions are extended to encompass the left atrial PV mouth. Due to its complex histological structure, the PV antrum itself plays an important role not only in initiation, …