Key result
Despite extensive investigation into supplementary techniques, no strategy has convincingly demonstrated superiority to pulmonary vein isolation alone for persistent atrial fibrillation.
Why the study?
Catheter ablation is well established for paroxysmal AF, but outcomes in persistent AF can be suboptimal.
This review highlights the ongoing challenges of catheter ablation in persistent atrial fibrillation and summarizes emerging techniques and technologies aimed at improving patient selection and procedural outcomes.
Reinforces PVI alone as standard for persistent AF ablation; leaves open identification of effective adjunctive strategies.
Purpose of Review Catheter ablation (CA) is a well-established treatment for paroxysmal atrial fibrillation (AF), but outcomes in persistent AF can be suboptimal. This review summarises recent evidence relating to the ideal patient population and target substrate for CA, and the techniques available. Recent Findings Risk scores can identify individuals with persistent AF who are more likely to benefit from CA. Pulmonary vein isolation (PVI) remains the most important ablation technique but non-pulmonary vein triggers explain the high recurrence rates in persistent AF. Novel electroanatomic mapping technologies, hybrid approaches, ethanol vein of Marshall ablation and thoracoscopic epicardial ablation are promising recent developments. Pulsed field ablation (PFA) is a new ablation modality with an excellent safety profile in trials to date; its role in persistent AF remains an area of study. Summary Improving outcomes of CA in persistent AF remains a significant research focus, with several encouraging directions for future study.
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Griffin et al. (2023) conducted a review in Persistent Atrial Fibrillation. Catheter ablation was evaluated. Despite extensive investigation into supplementary techniques, no strategy has convincingly demonstrated superiority to pulmonary vein isolation alone for persistent atrial fibrillation.
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