A majority of cases of atrial fibrillation originate within the pulmonary veins. Ablation of atrial fibrillation, also known as “pulmonary vein isolation” or PVI, electrically disconnects the erratic electrical activity in the pulmonary veins (which are creating action potentials at a rate of 400-600 beats per minute) from the rest of the heart thus effectively eliminating the atrial fibrillation. Ablation for atrial fibrillation is complex, requires multiple catheters and is performed via venous access then puncturing the interatrial septum to obtain entry to the left atrium where the pulmonary veins empty.
The highest success rates for atrial fibrillation ablation occur in patients where the arrhythmia is paroxysmal and not persistent or permanent. Those with smaller left atrial volumes and with shorter duration of atrial fibrillation also have higher success rates.
The indication for atrial fibrillation ablation is symptoms from atrial fibrillation and failure of at least 1 antiarrhythmic drug. An attempt at a second antiarrhythmic drug would also be reasonable.