Electrophysiologically guided ablation of the pulmonary veins for the curative treatment of atrial fibrillation

Catheter ablation of triggers that induce paroxysms of atrial fibrillation (AF) is an emerging curative therapy for this most common of supraventricul ar arrhythmias. In a series of 225 consecutive patients with multidrug resi stant AF, 96% of triggering foci originated from one or several pulmonary v eins (PV) independent of ambient ectopy or structural heart disease. This a rticle describes an ablation procedure that is guided by activation mapping tailored to each individual PV, including criteria to define an arrhythmog enic PV, the use of provocative manoeuvres, the role of circumferential map ping catheters to provide information on the extent, distribution and activ ation of PV muscle as well as the monitoring of distal PV potentials (PVP) during ablation. Radiofrequency ablation to eliminate distal PVPs is perfor med by targeting the proximal PVP during sinus rhythm (right PV) or left at rial pacing (left PV). This end-point predicts a successful outcome more of ten than acute ectopy suppression. Complete elimination of AF is presently achieved in 70% of the patients, resulting in the elimination of antiarrhyt hmic treatment and suspension of anticoagulant treatment. It is anticipated that continued technological development will improve and facilitate this technique of curative treatment of AF.