Close the gap to get a circle ! The role of visual gaps during circumferential pulmonary vein isolation

This editorial refers to ‘Acute electrical isolation is a necessary but insufficient endpoint for achieving durable PV isolation: the importance of closing the visual gap’ by M.A. Miller et al ., on page 653 Since Michel Haissaguerre in the late 1990 delineated the importance of pulmonary vein (PV) triggers and drivers in the pathogenesis of atrial fibrillation (AF), PV isolation has become the cornerstone of successful interventional treatment of AF.1 Initially, segmental or focal PV disconnection was the main treatment strategy. With the awareness of the role of PV antra in the initiation and maintenance of AF, ablation targets have moved away from isolating PVs inside the atria. Nowadays, circumferential ablation around PVs is the main approach.Different energy sources such as radiofrequency, cryo, and laser have been introduced to produce electrical conduction block between PVs and the atrial tissue by creating precise tissue damage. By placement of a circular ablation line around PVs, these are …