Methods and techniques for increasing the safety and efficacy of pulmonary vein isolation in patients with atrial fibrillation

Abstract

The most common type of sustained arrhythmia is atrial fibrillation (AF). Pulmonary vein isolation (PVI) is the cornerstone of catheter ablation for atrial fibrillation, which has emerged as the primary therapeutic strategy for atrial fibrillation patients. Unfortunately, about one-third of patients experience recurrent atrial arrhythmias after the procedure. The leading cause of AF recurrence after PVI, especially during the first year, is reconnection of the pulmonary veins. There are different techniques and methods that could increase the efficacy of the procedure by making durable pulmonary vein isolation. A literature search was conducted using the terms atrial fibrillation, ablation, pulmonary vein isolation, and durable PVI in the PubMed, Scopus, and Web of Science databases. Durable pulmonary vein isolation could be achieved by avoiding gaps in the ablation line and PV reconnections using pharmacological testing, waiting time, various indexes based on data from the electroanatomical mapping system, and special ablation catheters. Furthermore, detecting the gaps in the ablation line in the end of the procedure using different pacing and mapping techniques and application of additional energy to close those gaps could increase the success rate of the procedure. Most commonly, AF recurrence after PVI is due to PV reconnections caused by gaps in the ablation line. To achieve safer and more effective PVI, the procedure has to be standardized and operator-independent with reproducible success rate and safety profile.