Procedural End Points in Pulmonary Vein Antrum Isolation

If you have ever been on a long car trip with a small child, you have almost certainly encountered the age-old question, “Are we there yet?” Although a careful review of the literature reveals surprisingly little in the way of rigorous studies on this matter, strong anecdotal evidence suggests that the longer or more arduous the journey and the more desirable the destination, the more likely it is this question will be asked. In our quest to develop a cure for atrial fibrillation (AF) with our catheters, electrophysiologists have found ourselves asking the very same question. This is no surprise, because the journey has been difficult, with long, technically demanding procedures, and the destination, the cure of a disease with often profound symptoms and morbidity that affects millions, is coveted. In the world of pulmonary vein antrum isolation (PVAI), what we are really asking is whether our lesions will provide our patients with a lasting cure of their AF: “Are we there yet?”Article p 136 Unfortunately, the answer to this question has not come easily. AF is notoriously sporadic. Just because a patient’s AF is gone one moment does not mean it will not return the next. No imaging or serological testing can yet identify or rule out the heart’s propensity to develop this arrhythmia. Instead, we must hunt for surrogates to tell us whether or not we have adequately diminished the ability of a patient’s heart to develop AF. Here again, though, the questions and their answers are difficult to illuminate. Ablation strategies aimed at curing AF have sought to either eliminate the triggers of AF by isolating them from the rest of the atrial myocardium or to alter the atrium in such a way that reentrant wave fronts of AF can no longer be maintained, also referred …