Ablation of permanent AF |
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Authors: | Mauricio Arruda Andrea Natale |
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Institution: | (1) Electrophysiology and Atrial Fibrillation Center, University Hospitals Heart & Vascular Institute, Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Lakeside 5038, Cleveland, OH 44106, USA;(2) Texas Cardiac Arrhythmias Institute, Austin, TX, USA |
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Abstract: | Atrial fibrillation (AF) is highly prevalent and accounts for significant morbidity, mortality, and health care costs. Catheter
ablation has become a therapeutic option in the management of this challenging arrhythmia. To optimize procedure safety and
long-term efficacy, innovative technologies and ablation strategies have been targeting either the triggers initiating AF
or the substrate responsible for its maintenance. Pulmonary vein (PV) isolation, initially limited to the PVs, has been modified
to encompass the left atrial myocardium surrounding the PV ostia, namely the LA-PV antra. Our current intracardiac echo-guided
approach to PV antra isolation, including the adjunct of superior vena cava isolation, has likely accounted for higher success
rates by electrically isolating further AF trigger sites, modifying the substrate for AF maintenance and possibly by modulating
a dysfunctional autonomic cardiac nervous system. However, the long-term outcome following ablation of permanent AF can be
further improved by incorporating adjunctive ablation strategies to PV isolation, such as targeting ablation at sites exhibiting
complex atrial fractionated electrograms (CFAEs)during AF or at sites exhibiting the so-called AF nests during real-time spectral
mapping in sinus rhythm. |
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Keywords: | Catheter ablation Atrial fibrillation Atrial fibrillation ablation Permanent atrial fibrillation |
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