The review highlights the evolution of atrial fibrillation ablation techniques, emphasizing that while pulmonary vein isolation is foundational, complex and long-standing AF may require multiple approaches.
Supports tailored ablation beyond PVI in complex AF; leaves open optimal strategies for prospective trials.
The morbidity and mortality of atrial fibrillation (AF) makes the search for a curative approach one of the main quests in modern electrophysiology. After the ground-breaking steps of surgery for AF, recognition of the pulmonary veins ’ (PVs) role in trig-gering AF, followed by the PV isolation (PVI) technique brought new hope for catheter ablation for AF. Safety and success were progressively improved in parallel with improvements in technological tools. The mechanistic heterogeneity of AF, enhanced in the chronic form, may explain the limited success of PVI alone in long-standing AF. This complex environment needs multiple approaches to extend the success rate to the whole spectrum of AF. Increase in mechanistic knowledge and technology may result in broader indications.
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Arrantes et al. (2007) studied this question.
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