Key questions are helpful to prevent an unnecessary pulmonary veins isolation ablation procedure

Nowadays, invasive treatments for atrial fibrillation (AF) are generally accepted. Hence, an increasing number of patients are referred for pulmonary veins isolation (PVI) by catheter ablation. The report of Katritsis et al.1 shows that electrophysiological evaluation before PVI revealed in their population up to 7.6% of the patients with arrhythmias easy to treat by catheter ablation, for example, a counterclockwise atrial flutter in the right atrium, atrioventricular nodal re-entrant tachycardia, accessory pathways, and atrial tachycardia. This underscores the importance of appropriate selection of patients suitable for PVI because of AF. 2 Unfortunately, the authors do not mention whether the patients with the arrhythmias easy to treat by catheter ablation could have been identified before being in the electrophysiological laboratory. With some key questions, it is possible to identify patients suitable for a standard ablation before performing PVI. In favour of an arrhythmia suitable for a standard ablation may be: starting of the arrhythmia at a young age, possible to stop the arrhythmia by vasovagal manoeuvres, arrhythmias starting as regular rhythm and deteriorating in an irregular rhythm, and the absence of structural cardiac disease. A family history with document arrhythmias may also be helpful, as inheritance of AF becomes more clearly nowadays. 3 In case of doubt, registration of the beginning of the tachycardia should be pursued. If still uncertainty remains, a diagnostic electrophysiological investigation should be performed before starting PVI for AF. As the report of Katritsis et al. suggests, this approach may prevent an extensive PVI for AF.