Journal
JOURNAL OF CLINICAL MEDICINE
Volume 10, Issue 18, Pages -Publisher
MDPI
DOI: 10.3390/jcm10184060
Keywords
persistent AF; pulmonary vein isolation; substrate ablation; AF mapping; novel ablation technology
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Atrial fibrillation (AF) is a common cardiac arrhythmia with a complex pathological basis. Catheter ablation has shown significant technological advances but long-term success rates in persistent AF patients are still modest. Mechanistic studies suggest different sustaining factors for AF in the persistent AF population, but applying mapping techniques to clinical ablation remains challenging.
Atrial fibrillation (AF) is the most common cardiac arrhythmia worldwide and represents a heterogeneous disorder with a complex pathological basis. While significant technological advances have taken place over the last decade in the field of catheter ablation of AF, response to ablation varies and long-term success rates in those with persistent AF remain modest. Mechanistic studies have highlighted potentially different sustaining factors for AF in the persistent AF population with substrate-driven focal and re-entrant sources in the body of the atria identified on invasive and non-invasive mapping studies. Translation to clinical practice, however, remains challenging and the application of such mapping techniques to clinical ablation has yet to demonstrate a significant benefit beyond pulmonary vein isolation (PVI) alone in the persistent AF cohort. Recent advances in catheter and ablation technology have centered on improving the durability of ablation lesions at index procedure and although encouraging results have been demonstrated with early studies, large-scale trials are awaited. Further meaningful improvement in clinical outcomes in the persistent AF population requires ongoing advancement in the understanding of AF mechanisms, coupled with continuing progress in catheter technology capable of delivering durable transmural lesions.
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