Why atrial fibrillation recurs in patients who obtained current ablation endpoints with longstanding persistent atrial fibrillation
Circumferential pulmonary vein (PV) ablation for patients with atrial fibrillation (AF) is an effective treatment that is becoming more widely accepted and practiced.1,2 A significant learning curve exists, however, and periprocedural and postprocedural management is important to maximize success rates and reduce complications. Until recently this procedure was considered a purely anatomic approach without clear electrophysiologic endpoints, operator dependent, and nonreproducible. This article describes the methodologic approach to this ablation procedure. We report our extensive experience based on approximately 4,000 patients with either paroxysmal or chronic AF, many of whom have structural heart disease (Fig. 1). Inclusion and exclusion criteria are listed in Table 1.