Optimal endpoint for catheter ablation of longstanding persistent atrial fibrillation: A randomized clinical trial

Abstract

In patients of LPeAF, pursuing AF termination during ablation was associated with similar long-term clinical outcome compared to that with technical endpoint. Ablation to termination is not the best strategy during ablation.

Heterogeneity of the action potential duration is required for sustained atrial fibrillation

“…In humans, the initiation of AF is frequently triggered by increased automaticity within the myocardial sleeves of pulmonary veins. However, isolating the pulmonary veins by ablation is often not curative because AF can also be initiated by triggers outside the pulmonary veins, for example, within the posterior atrial wall (6). The discovery of electrical rotational activity in the atria, called rotors or spiral waves, shown using high-resolution optical mapping in animal models of AF, and activation mapping in humans with multi-electrode, intra-atrial basket catheters (7) and body surface electrograms has driven new ablative therapeutic approaches.…”

Predicting acute termination and non-termination during ablation of human atrial fibrillation using quantitative indices

“…For example, using a stepwise ablation procedure that involved pulmonary vein isolation, electrogramguided, and linear ablation, it was shown that inability to terminate AF during ablation was the strongest predictor of arrhythmia recurrence (Scherr et al, 2015). Other studies have failed to show this association and that further studies are required to reconcile the divergent clinical outcomes (Estner et al, 2008;Elayi et al, 2010;Wang et al, 2018). Nevertheless, termination remains the only acute endpoint that correlates with long-term outcome and knowing whether termination is achievable could enable an electrophysiologist to add or constrain lesion sets accordingly.…”