A FIRM Grip on Atrial Fibrillation⁎

American College of Cardiology Foundation: August 7, 2012
Since the seminal paper by Haissaguerre et al. (1) describing the importance of pulmonary vein (PV) triggers in the initiation of paroxysmal atrial fibrillation (AF), PV isolation has become the cornerstone of catheter ablation for AF, demonstrating acceptable results (2). By contrast, reported long-term success rates after catheter ablation for persistent or long-standing persistent AF are suboptimal at best, not uncommonly requiring repeat ablation attempts to establish sinus rhythm (4). The ablative strategy in nonparoxysmal AF typically involves targeting areas of complex fractioned electrograms and/or a stepwise approach that entails deployment of linear lesion sets within the left atrium (LA) (5). In these patients, triggers from the PVs are less dominant, and the arrhythmogenic substrate shifts to a larger portion of the LA. Since the underlying pathophysiologic mechanism of persistent AF remains ill defined, extensive substrate-based ablation may result in excessive destruction of LA tissue. Read more