Controversy: Circumferential versus segmental pulmonary vein isolation/circumferential PVI

Over the past decade, pulmonary vein isolation (PVI) has become a procedure implemented worldwide for the treatment of atrial fibrillation (AF). There are two main approaches utilized for PVI: ostial isolation and wide antral ablation. Ostial isolation is a selective ablation at the ostium of the pulmonary veins. The goal of this technique is to disconnect myocardial sleeves located inside or close to the PV, which are responsible for the rapidly firing activity that has been shown to initiate AF. Wide antral isolation involves a wider area encompassing part of the left atrial posterior wall. This technique includes ablation of a larger area of the pulmonary vein-left atrial junction, which has the potential to remove the heterogeneous electrophysiological milieu capable of sustaining AF. Scientific evidence points out that PVI performed with an antral approach is more effective than ostial ablation in achieving freedom from total atrial tachyarrhythmia recurrence.