Multielectrode Pulmonary Vein Isolation Versus Single Tip Wide Area Catheter Ablation-Paroxysmal Atrial Fibrillation: Is There Any Mystery in Pulmonary Vein Isolation?

In the past decade, catheter ablation of atrial fibrillation (AF) has evolved as one of the most frequently performed procedures in tertiary arrhythmia centers worldwide. With the observation of the actively firing trigger originating from within the pulmonary veins (PVs), ablation strategies have focused at least in paroxysmal AF patients on complete isolation of the PVs. Several different ablation devices (cryogenic energy, ultrasound, laser, etc) have been investigated to achieve more durable isolating lines around the PVs, with most of these novel ablation catheters allowing for a singleshot approach. Multielectrode-phased radiofrequency ablation probes (PVAC; Medtronic, Minneapolis, MN) have been proposed using the standard radiofrequency energy through smaller but multiple electrodes. The aim of all these ablation devices is not only to improve outcome but also to allow an easier ablation procedure eventually being performed by nonelectrophysiologists to be able to respond to the growing demand for AF ablation.