Incremental value of isolating the right inferior pulmonary vein during pulmonary vein isolation procedures in patients with paroxysmal atrial fibrillation.

Electrical isolation of the left superior, left inferior, and right superior pulmonary veins (PVs) is often, but not always, effective in eliminating paroxysmal atrial fibrillation (PAF). The incremental clinical value of also isolating the right inferior PV has not been well defined. PV isolation by ostial applications of radiofrequency energy guided by PV potentials was performed in 176 consecutive patients (mean age 52 +/- 11 years) with PAF. The left superior, left inferior, and right superior PVs were targeted in 106 patients, and all four PVs were targeted 70 patients. Successful isolation was achieved in 96% of targeted PVs. The mean duration of follow-up was 15 +/- 7 months. At 1-year follow-up, 58% of patients in whom three PVs were isolated were free of recurrent PAF in the absence of antiarrhythmic drug therapy, compared to 73% of patients in whom all four PVs were isolated (P = 0.07). There is a trend towards a better outcome when all four PVs are isolated than when only the three major PVs are isolated. Whenever feasible, the right inferior PV should be isolated along with the other three PVs during the first ablation procedure in patients with PAF.