Evolving Treatment Strategies For The Ablation Of Chronic Atrial Fibrillation

Andrea Natale

Dimpi Patel

US Cardiology 2007;4(2):78–80

Atrial fibrillation (AF) is the most common sustained arrhythmia and is associated with an increased risk of morbidity and mortality. A subanalysis of the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) suggests that there is a significant survival benefit in the maintenance of sinus rhythm (SR), if it can be achieved without the potential adverse effects associated with antiarrhythmic drugs.1 The limitations associated with traditional AF therapies have fostered an interest in developing effective ablation strategies.

Over the past decade, catheter ablation has emerged as a potential cure for paroxysmal AF (PAF) and chronic AF (CAF). Currently, the two main strategies used for all AF ablation are pulmonary vein antrum isolation (PVAI)2 and circumferential pulmonary vein ablation (CPVA).3 In this article, the question of which of these two strategies is a better initial step for ablation of persistent and permanent forms of AF will be discussed, and the continuing evolution of adjuvant strategies in the quest to eradicate CAF will be explored.


Finding the ideal strategy for CAF ablation is still an ongoing quest. Ablation of CAF is a complex and challenging procedure. More extensive procedures that target all possible sources of AF tend to be associated with better success rates. Unfortunately, more extensive procedures carry an increased risk of complications. Therefore, a strategy that reduces the amount of ablation is more desirable. However, at present the minimal lesion set required for termination of AF has yet to be determined. In the experience of the authors, isolation of all four PV antra is paramount to all types of AF ablation strategies. Currently, the strongest predictor for failure after PVAI is left atrial scarring. In such groups, a strategy that targets all additional non-PV triggers and or modifies the substrate may be the only chance of achieving a cure.

Read the full article here: https://www.uscjournal.com/articles/Ablation-Chronic-Atrial-Fibrillation

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