Our approach to maximizing the durability of pulmonary vein isolation during a paroxysmal atrial fibrillation ablation procedure.

Recurrence of atrial fibrillation (AF) after a single ablation procedure has been reported in the range of 15-60% depending on patient selection. A major factor leading to AF recurrence after catheter ablation therapy is electrical reconnection of one or more pulmonary veins (PVs) due to recovery of excitability of atrial tissue within ablation lesions. Maximizing the durability of pulmonary vein isolation (PVI) is critical to reduce recurrence rates and improve outcome after catheter treatment for AF. Strategies to increase the durability of the lesions include optimization of catheter contact by use of steerable sheaths, direct visualization by intracardiac ultrasound, and observation of the decrease in impedance at the beginning of ablation. Furthermore, currently achievable endpoints in addition to electrical PVI may reduce AF recurrence, such as identification of dormant conduction with adenosine administration and rendering the ablation line unexcitable to pacing. Integration of all these strategies into routine catheter ablation procedures for AF has reduced our AF recurrence rates and can easily be incorporated into practice without additional technological advances.