What is the optimal approach for ablation of paroxysmal atrial fibrillation?

The optimal approach for catheter ablation of paroxysmal atrial fibrillation (PAF) is the subject of some controversy. Recent guidelines define PAF as recurrent AF that terminates spontaneously within seven days. For patients with PAF, the three most commonly employed approaches for ablation include, (1) segmental ostial or antral pulmonary vein isolation (PVI), (2) circumferential pulmonary vein ablation (CPVA) alone or in combination with additional left atrial linear ablation (LALA), and (3) complex fractionated atrial electrograms (CFAE) ablation alone or in combination with segmental PVI or CPVA (with or without additional LALA). Each of these approaches will be described in detail in this article. Overall evidence suggests that segmental antral PVI may be as effective as CPVA with or without LALA in prevention of AF recurrence, but that CPVA with or without LALA may be associated with a higher incidence of atypical atrial flutter recurrence.