The thoracic veins and ablation for atrial fibrillation

The last decade has witnessed a revolution in the management of paroxysmal atrial fibrillation (PAF). Fundamental to these changes has been the understanding that the thoracic veins, which include the pulmonary veins and superior vena cava, represent the initiating trigger site for atrial fibrillation (AF). In this article, we discuss the rationale for ablation around the thoracic veins for managing patients with PAF. We describe a selection of appropriate patients for venous isolation procedures, particularly in the context of the Indian subcontinent and then go on to explain ablation approaches that optimize safety and efficacy with the complex procedures. Although this article is targeted for interventional electrophysiologists beginning these procedures the rational, initial patient selection for referral and follow up of post ablation patients will be relevant to all practicing cardiologists.