Long-Standing Persistent Atrial Fibrillation Ablation: How Do You Perform? Left and Right Atrial Linear Ablation in Addition to Pulmonary Vein Isolation

Authors

Keywords:

Radiofrequency catheter ablation; Atrial fibrillation.

Abstract

Catheter ablation of long-standing persistent atrial fibrillation is not yet clearly defined with respect to endpoints, and different ablative strategies are offered to patients. Presented here is an approach aiming at biatrial debulking in the form of extensive linear ablation, specifically targeting areas of low-voltage complex fractionated electrograms, in addition to pulmonary vein isolation. Its main advantage is that it is not dependent on operator/system variability, since the strategy of isolating the pulmonary veins, superior vena cava and left atrial posterior wall together with achievement of bidirectional block during linear ablation provides objective endpoints that can consistently be reproduced.

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References

Kirchhof, P. et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur. Heart J. 37, 2893–2962 (2016).

Marrouche, N. F. et al. Catheter ablation for atrial fibrillation with heart failure. N. Engl. J. Med. 378, 417–427 (2018).

Calkins, H. et al. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation: Executive summary. Europace 20, 157–208 (2018).

Schmitt, C. et al. Radiofrequency ablation of complex fractionated atrial electrograms (CFAE): Preferential sites of acute termination and regularization in paroxysmal and persistent atrial fibrillation. J. Cardiovasc. Electrophysiol. 18, 1039–1046 (2007).

Nademanee, K. et al. A new approach for catheter ablation of atrial fibrillation: Mapping of the electrophysiologic substrate. J. Am. Coll. Cardiol. 43, 2044–2053 (2004).

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Published

2020-06-20

How to Cite

Brunelli, M., & Sammut, M. A. (2020). Long-Standing Persistent Atrial Fibrillation Ablation: How Do You Perform? Left and Right Atrial Linear Ablation in Addition to Pulmonary Vein Isolation. JOURNAL OF CARDIAC ARRHYTHMIAS, 33(2), 106–114. Retrieved from https://jca.emnuvens.com.br/jca/article/view/3407