Paroxysmal atrial fibrillation ablation: Achieving permanent pulmonary vein isolation by point-by-point radiofrequency lesions

Abstract

Pulmonary vein isolation by point-by-point radiofrequency catheter ablation constitutes the cornerstone of catheter ablation strategies for the treatment of atrial fibrillation. However, despite advances in pulmonary vein isolation ablation strategies, long-term success rates after ablation remain suboptimal, which highlights the need to develop techniques to achieve more durable lesions. Strategies proposed to improve the durability of pulmonary vein isolation can be divided into two groups: Those addressed to improving the quality of the lesion and those that optimize the detection of acute PV reconnection during the ablation procedure. This manuscript reviews the role and potential benefits of these techniques according to current clinical evidence.

Keywords: Atrial fibrillation; Pulmonary vein isolation; Lesion durability; Contact force; Pulmonary vein reconnection

Core tip: Results of pulmonary vein isolation remains suboptimal in terms of long-term outcomes. Improving lesion durability could reduce atrial fibrillation recurrence rate after pulmonary vein isolation. This manuscript reviews current techniques proposed in order to achieve more durable pulmonary vein isolation by point-by-point radiofrequency ablation. The role and potential benefits of these techniques are discussed according to current clinical evidence. Furthermore a stepwise approach to achieve permanent pulmonary vein isolation is proposed.