Antral Pulmonary Vein Isolation and Elimination of Nonpulmonary Vein Triggers Are Sufficient

AHA: 12/1/12

Since its original description in 1998, the technique of catheter-based atrial fibrillation (AF) ablation has undergone several modifications.¹ Currently, many operators use an anatomic approach consisting of circumferential lesions encircling individual or ipsilateral pulmonary veins (PVs) with additional empirical left atrial (LA) ablation (lines), whereas others perform a more PV-specific approach using entrance/exit block to validate isolation, deferring any additional non-PV lesions unless clinically indicated.^2–7 Despite these differences in technique, the outcome data for AF patients undergoing ablation seem remarkably consistent between centers, with overall single procedure efficacy of ≥70% in achieving long-term arrhythmia control for patients with paroxysmal AF but significantly lower success rates for patients with persistent or long-standing persistent AF. These observations imply that the mechanisms underlying persistent/long-standing persistent AF may be different from paroxysmal AF. It has been posited that once in the persistent stage, the underlying substrate rather than triggers alone maintains this arrhythmia. Although this hypothesis remains to be proven, it has nevertheless resulted in the development of adjunctive substrate modification strategies for patients with more established forms of AF. Read more