Atrial ablation procedures for atrial fibrillation aim to balance conversion to normal sinus rhythm with the preservation of atrial contractility, though achieving transmurality remains a challenge.
Surgical and percutaneous atrial ablation procedures face limitations in achieving transmurality and defining ideal lesion configurations, highlighting the need to balance sinus rhythm restoration with atrial contractility preservation.
This article reviews the development of procedures designed to eradicate atrial fibrillation by creating nonincisional lesions in the atria. Percutaneous interventional and surgical data are reviewed and analyzed. A major limitation of the surgical approaches, which utilize a variety of energy sources, appears to be the difficulty in achieving transmurality in all patients. A second limitation is related to a poor understanding of the underlying mechanisms of atrial fibrillation, and the consequent uncertainty as to the ideal lesion configurations necessary to counter these mechanisms. The article also discusses the various types of clinical atrial fibrillation, and discusses the differences between endocardial and epicardial application of thermal energy sources. Finally, atrial contractility is addressed, and the authors conclude that the ideal procedure will achieve a balance between conversion to normal sinus rhythm and the preservation of atrial contractility.
Melo et al. (Sat,) conducted a review in Atrial fibrillation. Atrial ablation was evaluated. Atrial ablation procedures for atrial fibrillation aim to balance conversion to normal sinus rhythm with the preservation of atrial contractility, though achieving transmurality remains a challenge.
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