Patient history A 62-year-old female patient with lone atrial fibrillation. Treatment including a beta-blocker and specific antiarrhythmic drugs (flecainide) did fail in controlling recurrences of the arrhythmia. Stress electrocardiogram and transthoracic echocardiography has not shown relevant structural heart disease.
The left ventricular ejection fraction was normal with 60 %, the left atrium was slightly enlarged (42 mm in the parasternal long axis). Diagnosis Highly symptomatic, drug-refractory paroxysmal atrial fibrillation indicates catheter-interventional treatment with the aim of circumferential isolation of the pulmonary veins. What treatment procedure should be carried out ?
