No Benefit Beyond Standard PVI in Ablation of Atrial Fibrillation … Again

We are always looking for techniques to improve the outcome of atrial fibrillation (AF) ablation. It has been difficult to show benefits beyond standard pulmonary vein isolation (PVI), whether by single isolation of all four veins or wide-area circumferential ablation (WACA). Investigators now report findings of a randomized, controlled trial evaluating whether a widened WACA approach is superior to standard PVI techniques for reducing AF recurrence (NCT02150902).

All 398 patients with symptomatic paroxysmal AF received a single WACA with documentation of entrance and exit block. They were then randomized to receive an additional WACA outside of the initial one or no additional treatment. During 1-year follow-up, 27% of patients receiving th…