Catheter Ablation Therapy for Atrial Fibrillation Current Advancements in Strategies

Abstract

Curing atrial fibrillation (AF) by catheter ablation has significantly improved patient morbidity and mortality. The circumferential pulmonary vein isolation technique is established as the principal procedure, with a high cure rate and acceptable safety, for paroxysmal AF, but new adjunctive ablation strategies targeting the AF substrates and sources for long-standing persistent/chronic AF have been developed. These new techniques include linear ablation, complex fractionated atrial electrogram guided ablation, dominant frequency map-guided ablation, ganglionated plexi ablation and disconnection of the coronary sinus and superior vena cava to ablate the AF substrates and sources. The long-term usefulness of the established technique and these innovative adjunctive approaches for the treatment of AF remains to be investigated. (Circ J 2007; Suppl A: A-82 -A-89)

Prevalence, Morphological and Electrophysiological Characteristics of Confluent Inferior Pulmonary Veins in Patients With Atrial Fibrillation

“…Several approaches targeting the ipsilateral PVs en bloc using linear ablation techniques, such as circumferential linear ablation using electroanatomical mapping 4 or circumferential 2-by-2 PVI methods, 5,6 have so far been widely practised, however, it should be realized that these techniques were developed based on the normal PV anatomy with the contralateral PVs widely separated. In cases with confluent inferior PVs, blinded applications of RF energy on the LA posterior wall to make linear lesions might injure the inferior PVs.…”

How Useful is the 3-Dimensional Image for Catheter Ablation of Atrial Fibrillation?

“…placed within the ipsilateral superior and inferior PVs. [3][4][5][6] In our EEPVI method, the encircling ablation line is created approximately 0.5-1 cm from the angiographically and electrophysiologically defined PV ostia without electroanatomical mapping. 3,4 The endpoint of EEPVI is the creation of bidirectional conduction block, which is indicated by either (1) elimination of PV potentials recorded by the 2 decapolar Lasso catheters during sinus rhythm or coronary sinus pacing (LA-PV conduction block) or (2) lack of LA capture during intra-PV, isthmus, and PV antrum pacing (PV-LA conduction block).…”

Real-Time 3-Dimensional Imaging of the Esophagus and Left Atrium With a Noncontact Mapping System

“…[1][2][3][4] Many efforts have been made to prevent any esophageal damage, including elucidating the esophageal course using esophageography, lowering the amount and/or duration of the radiofrequency (RF) energy applications to the left atrial posterior wall (LAPW), esophageal temperature monitoring, and esophageal cooling. 5,6 In all, recognition of the location of the esophagus relative to the LAPW is an inevitable initial step.…”