Has the Time Come to Abandon the Concept That “Pulmonary Vein Isolation Is the Cornerstone of Atrial Fibrillation Ablation”?

Abstract

During the past decade, catheter ablation of atrial fibrillation (AF) has emerged as an important treatment option for patients with symptomatic AF refractory to antiarrhythmic drug therapy. Electric isolation of the pulmonary vein (PV isolation [PVI]) musculature has been identified as the primary end point for both catheter and surgical AF ablation procedures.1 In fact, both the 2007 and the 2012 Heart Rhythm Society/European Heart Rhythm Association (EHRA)/European Cardiac Arrhythmia Society (ECAS) Consensus Documents have both concluded that PVI is the cornerstone for most AF ablation procedures.1 Article see p 310 In the present issue of Circulation: Arrhythmia and Electrophysiology , Zhao et al2 report the results of a prospective randomized multicenter clinical trial examining the relative efficacy and safety of a novel non-PVI-based ablation strategy, referred to as pulmonary antrum radial-linear ablation (PAR) as compared with standard circumferential PVI for treatment of patients with paroxysmal AF. Forty-two patients underwent PAR ablation and 42 underwent PVI. These patients were followed closely at 3-month intervals using 3-day event and 24-hour Holter monitors. Ablation success was defined in accordance with the Heart Rhythm Society/EHRA/ECAS Consensus Document as freedom from AF, flutter, tachycardia lasting 30 seconds or longer after a 3-month blanking period.1 At 14 months of follow-up after a single procedure, 31 of 42 patients (74%) in the PAR ablation group had experienced no AF recurrence as compared with 22 of 44 patients …