Pulmonary Vein Isolation (Ablation) for Atrial Fibrillation

This report examines the use of pulmonary vein isolation (PVI) for atrial fibrillation (AF). Other uses of PVI are outside the scope of this report, as are any other issues, outcomes, patient categories, or questions about treating AF not explicitly mentioned in the key questions.

Pulmonary vein isolation (PVI), also called pulmonary vein ablation, is a catheter-based, minimally invasive procedure that employs radiofequency, ultrasound, or microwave energy to treat atrial fibrillation (AF). Electrical pathways between pulmonary veins and the atria are believed to contribute strongly to AF, and ablating these pathways may restore sinus rhythm. There are three approaches to PVI: segmental PVI (SPVI), circumferential pulmonary vein ablation (CPVA), and circumferential PVI (CPVI). All approaches ablate pathways at or near the ostia between the pulmonary veins and the left atrium. SPVI ablates only a segment of the ostium; CPVA and CPVI ablate the full circumference of the ostium. The distinction between CPVA and CPVI is that CPVI is intended to achieve complete electrical isolation of the pulmonary veins using a Lasso catheter; CPVA is not necessarily intended to complete this isolation. These three approaches represent a general evolution of practice and today SPVI is relatively rare. The majority of evidence we reviewed in this report described CPVA.

During these procedures, a physician inserts catheters into the blood vessels of the atrium. A machine delivers energy through the catheters, and the energy produces a circular scar that blocks any impulses firing from within the pulmonary vein, thereby “disconnecting” the pathway of the abnormal rhythm and preventing AF. The procedure takes...