Longstanding Persistent Atrial Fibrillation Ablation: How Do You Perform It?
Keywords:
Atrial fibrillation; Radiofrequency ablation; Catheter ablationAbstract
Longstanding-persistent atrial fibrillation is one of the most challenging arrhythmias to treat. While radiofrequency catheter ablation is highly effective in paroxysmal atrial fibrillation, pulmonary vein antral isolation (including posterior wall isolation) alone is not enough for nonparoxysmal atrial fibrillation, other targets should be sought in this population. In this case report, we will describe our approach in a typical patient presenting for a first-time ablation procedure for longstanding persistent atrial fibrillation.
Downloads
References
Gianni C, Mohanty S, Trivedi C, Di Biase L, Natale A. Novel concepts and approaches in ablation of atrial fibrillation: the role of non-pulmonary vein triggers. EP Eur. 2018;20(10):1566-1576. doi:10.1093/europace/euy034.
Di Biase L, Conti S, Mohanty P, Bai R, Sanchez J, Walton D, John A, Santangeli P, Elayi CS, Beheiry S, Gallinghouse GJ, Mohanty S, Horton R, Bailey S, Burkhardt JD, Natale A. General anesthesia reduces the prevalence of pulmonary vein reconnection during repeat ablation when compared with conscious sedation: Results from a randomized study. Heart Rhythm. 2011;8(3):368-372. doi:10.1016/j.hrthm.2010.10.043.
Gianni C, Atoui M, Mohanty S, Trivedi C, Bai R, Al-Ahmad A, Burkhardt JD, Gallinghouse GJ, Hranitzky PM, Horton RP, Sanchez JE, Di Biase L, Lakkireddy DR, Natale A. Difference in thermodynamics between two types of esophageal temperature probes: Insights from an experimental study. Heart Rhythm. 2016;13(11):2195-2200. doi:10.1016/j.hrthm.2016.07.021.
O’Neill MD, Wright M, Knecht S, Jaïs P, Hocini M, Takahashi Y, Jönsson A, Sacher F, Matsuo S, Lim KT, Arantes L, Derval N, Lellouche N, Nault I, Bordachar P, Clémenty J, Haïssaguerre M. Long-term follow-up of persistent atrial fibrillation ablation using termination as a procedural endpoint. Eur Heart J. 2009;30(9):1105-1112. doi:10.1093/eurheartj/ehp063.
Elayi CS, Di Biase L, Barrett C, Ching CK, Aly MA, Lucciola M, Bai R, Horton R, Fahmy TS, Verma A, Khaykin Y, Shah J, Morales G, Hongo R, Hao S, Beheiry S, Arruda M, Schweikert RA, Cummings J, Burkhardt JD, Wang P, Al-Ahmad A, Cauchemez B, Gaita F, Natale A. Atrial fibrillation termination as a procedural endpoint during ablation in long-standing persistent atrial fibrillation. Heart Rhythm. 2010;7(9):1216-1223. doi:10.1016/j.hrthm.2010.01.038.