Background-Pulmonary veins (PVs) play a pivotal role in initiating and perpetuating atrial fibrillation (AF). We investigated if PV electrical isolation from the left atrium is required for curing AF. Methods and Result-Fifty-one patients with paroxysmal or persistent AF underwent circumferential radiofrequency ablation of PV ostia performed with an anatomic approach. The end point of the ablation procedure was the recording of low peak-to-peak bipolar potentials (Ͻ0.1 mV) inside the lesions. Left atrium pacing was used to assess the conduction between the PVs and the left atrium. During a mean follow-up period of 16.6Ϯ3.9 months, 41 patients (80.4%) were free of atrial arrhythmias. When patients with and without AF recurrence were analyzed, no significant difference was observed in the mean number of PVs in which the ablation end point was reached (3.4Ϯ1.2 versus 3.7Ϯ0.87) and PVs isolated (1.5Ϯ1.4 versus 1.6Ϯ1). We noted that, although in 29 of 41 patients (71%) without AF recurrence, the ablation end point was reached in all PVs mapped, it was only possible to demonstrate the isolation of all PVs mapped in 2 patients. On the other hand, in 7 of 10 patients (70%) with AF recurrence, the ablation end point was reached in all PVs mapped, whereas one patient had all PVs isolated. Conclusions-Our findings show that with the use of a pure anatomic approach, it is possible to prevent AF in Ͼ80% of patients undergoing catheter ablation. Moreover, the isolation of PVs is not crucial for curing AF.

As first attempt, ultrasound-guided axillary method showed similarly high-success rate than subclavian approach and well performed when the first attempt in subclavian group failed. Axillary access can be considered a safe and effective alternative technique to the conventional subclavian method for device implantation.

Single site atrial pacing is effective in reducing AF recurrences, with decreasing efficacy in patients with greater right atrial conduction delay and wider refractoriness dispersion.

The creation of a complete bi-directional conduction block at the inferior vena cava-tricuspid annulus isthmus, plus flecainide administration, reduces the recurrences of both AF and atrial flutter in patients with class IC atrial flutter. Moreover, the early response to flecainide is safe and reliable in identifying patients who may benefit from this therapy.