Pulmonary vein isolation or atrioventricular junction ablation – what for whom?

Atrial fibrillation is the most common reason for arrhythmic hospitalizations and one of the leading causes of stroke. Recently we have been witnessing growing morbidity related to this arrhythmia, mostly in developed countries. The therapeutic approach should incorporate both elimination and limitation of risk factors and tailored pharmacologic and invasive treatment. There are two possible strategies for invasive management of symptomatic atrial fibrillation: rhythm control and heart rate control. The first strategy implies pulmonary vein isolation (PVI) and it should be restricted to younger patients with fewer risk factors. The second strategy, which involves pacer implantation and atrioventricular junction ablation, may be considered in older patients with numerous risk factors and comorbidities.