Estrategias de aislamiento de las venas pulmonares durante la ablación de fibrilación auricular

introduction: ablation of pulmonary veins is a potentially curative procedure for atrial fibrillation (af). the objective is to electrically isolate the pulmonary veins from the left atrium. ablation of all pulmonary veins (pvs) has been more effective than the isolation of the pv responsible for the initiation of af (focal ablation). ablation lines to isolate pvs can be performed around the pv-la junction (circumferential) or at the pv os-tium. aim: to describe circumferential and ostium ablation strategies in a group of patients with af methods: patients with recurrent paroxistic af unresponsive to anti arrhythmic therapy or patients with persistent symptomatic lone af were included. focal vs 4 pv ablation as well as circumferential vs ostial techniques were compared. success was defined as being free from af, as judged by symptoms and holter recordings. results: 50 procedures were performed in 42 patients. 6 patients had a repeat ablation procedure and one had 2 additional ablation procedures, due to recurrence of af. 30 patients (71.4%) were af free after 19 ± 15 months of follow-up. 12 of 19 patients (63.1%) with focal ablation were af free as compared to 20 of 23 submitted to 4pv ablation (87%) (pns) . three of 22 patients (13.6%) had successful af ablation while none of right pvs ablation succeeded. ostial ablation was performed after failure of circumferential ablation in unsuccessful cases. one patient developed stenosis in a left pv, which was successfully treated with stent-less angioplasty. conclusion: ablation is an effective therapy to prevent recurrence of af. focal ablation is generally needed to achieve effective electrical isolation of pvs.