How to perform pulmonary vein isolation for the treatment of atrial fibrillation: use of the LocaLisa catheter navigation system

Atrial fibrillation (AF) is the most prevalent supraventricular arrhythmia in man; its treatment is a major challenge to clinicians. The concept of focally induced AF due to ectopy from the pulmonary veins (PV) has revolutionised the approach to non-pharmacological therapy 1. Prospective studies and reliable markers for the identification of patients most likely to benefit are lacking; in particular, it is unclear how many patients with paroxysmal AF actually have a (PV-related) focal mechanism. Short-term results of pulmonary vein isolation (PVI) in selected groups of patients are, however, highly promising. Conceptually speaking, the approach to PVI can be divided into two schools. In the more focus-driven/segmental method according to Haissaguerre et al., radiofrequency (RF) lesions are applied slightly distal to the PV ostia to induce electrical isolation of the muscular sleeves of the PV (and associated arrhythmogenic foci) from the left atrium 2. This method has since evolved to entail lesions just outside the PV ostia, and include additional lines of block between the left inferior PV and mitral annulus, and between the two superior PVs. This in effect brings it closer to Pappone et al.'s approach (described below) than the original ectopy-driven approach first described by Haissaguerre et al. All four veins are generally targeted. In most cases, segmental ablation …