One of the greatest discoveries in cardiac electrophysiology was the recognition of the crucial role of pulmonary vein (PV) myocardial sleeves for atrial fibrillation (AF) initiation. Based on this concept, catheter ablation of paroxysmal AF by pulmonary vein isolation (PVI) has become a routine approach for this arrhythmia.  

An attractive concept implies the selective isolation of the arrhythmogenic PVs only. Based on the most important studies regarding this approach, we describe pros and cons of a selective PVI compared to a complete PVI and try to illustrate why selective PVI did not find widespread acceptance in the electrophysiologic community.