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(Circulation. 2005;111:2866-2868.)
© 2005 American Heart Association, Inc.

Editorial

Comparing Different Strategies for Catheter Ablation of Atrial Fibrillation

David J. Callans, MD

From the Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pa.

Correspondence to David J. Callans, MD, Hospital of the University of Pennsylvania, Cardiology, 9 Founders Pavilion, 3400 Spruce St, Philadelphia, PA 19104. E-mail david.callans@uphs.upenn.edu

Key Words: Editorials • ablation • fibrillation • electrophysiology • arrhythmia

An extract of the first 250 words of the full text is provided, because this article has no abstract.

To doubt everything or to believe everything are two equally convenient options; both dispense with the necessity of reflection.

— —Jules Henry Poincaré

Opportunities for progress in clinical medicine often follow contradiction of previously accepted data. The impact of the first study comparing circumferential pulmonary vein (PV) ablation (left atrial catheter ablation) and segmental PV isolation was sweeping. The finding by Oral and colleagues that left atrial ablation improved outcomes over PV isolation in patients with paroxysmal atrial fibrillation (AF)¹ was immediately accepted. This acceptance was based on the respect due these investigators, as well as on the consistency of these results with those reported using the separate techniques via different programs; previous reports of circumferential PV ablation² and PV isolation³ estimated single-procedure success rates of 85% and 56%, respectively, in patients with mostly paroxysmal AF. Many practitioners "waiting in the wings" were convinced to begin AF ablation programs using the left atrial ablation technique on the basis of this information. This reaction was reinforced because most viewed this technique as easier, requiring a single transseptal puncture and avoiding the complexities of interpreting PV electrogram end points.

See p 2875

The study by Karch and coworkers, presented in this issue of Circulation, takes on even greater importance when viewed through this perspective.⁴ The authors compared circumferential PV ablation and segmental PV vein isolation in 100 patients with frequent, drug-refractory, and mostly (89%) paroxysmal AF. Their hypothesis, in line with conventional wisdom, was that circumferential ablation would reduce the . . . [Full Text of this Article]

Related Article:

Freedom From Atrial Tachyarrhythmias After Catheter Ablation of Atrial Fibrillation: A Randomized Comparison Between 2 Current Ablation Strategies

Martin R. Karch, Bernhard Zrenner, Isabel Deisenhofer, Jürgen Schreieck, Gjin Ndrepepa, Jun Dong, Katrin Lamprecht, Petra Barthel, Etienne Luciani, Albert Schömig, and Claus Schmitt
Circulation 2005 111: 2875-2880. [Abstract] [Full Text]

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