Objective To compare the success rate of 3 different approaches in circumferential pulmonary vein antrum ablation for atrial fibrillation. Methods A retrospective study was carried out on 173 patients with atrial fibrillation admitted in the Cardiology Department of Chinese PLA General Hospital from June 2015 to June 2017. According to the area of radiofrequency ablation line, they were divided into atrial antrum group (n=61), pulmonary vein antrum group (n=47) and antrum group (n=65). The operation time, X-ray exposure time and ablation time, and the plasma levels of C-reactive protein (CRP), N-terminal pro B-type brain natriuretic peptide (NT-proBNP) and interleukin-6 (IL-6) just after atrial septal puncture, immediately and 24h after operation were compared in the 3 groups. SPSS statistics 17.0 was used to analyze the data. Single factor variance analysis, rank sum test or Chi-square test was employed to analyze the intergroup comparison. Results The immediate success rate of complete electrical isolation was 84.39%(146/173) in all patients. The ablation time was significantly longer in the atrial antrum group than pulmonary vein antrum group [(120.67±13.12) vs (90.17±6.95)min, P<0.05]. Compared with the levels after atrial septal puncture, the IL-6 level immediately and 24h after operation were increased in all the 3 groups; the 24h NT-proBNP level was elevated in the pulmonary vein antrum group; and the 24h CRP level was higher in the pulmonary vein antrum group than the atrial antrum group [(1.99±1.09) vs (0.40±0.29)mg/L, all P<0.05]. Among them, 161 patients were followed up for 12 months, and 12 patients were lost during follow-up, with a rate of 6.94%(12/173). Recurrence of atrial fibrillation was observed in 27 cases. The success rate of operation was 83.23%(134/161), with the rate significantly higher in the atrial antrum group than in the pulmonary vein antrum group [89.83%(53/59) vs 73.33%(33/45), P<0.05]. Conclusion The approach of atrial antrum is superior to that of pulmonary vein antrum in circumferential pulmonary vein antrum ablation for atrial fibrillation.