Key result
Driver-guided AF ablation lacks clear clinical efficacy and requires further validation.
Why the study?
The efficacy of PVI is limited for non-paroxysmal AF, highlighting the need to understand AF maintenance mechanisms and develop additional ablation strategies.
This review provides a comprehensive overview of the current state of knowledge regarding atrial fibrillation drivers and the various mapping approaches used to identify them to guide catheter ablation.
Driver-guided AF ablation should not yet alter practice; leaves open whether mapping improves outcomes in randomized trials.
Understanding the initiating role of pulmonary veins in atrial fibrillation (AF) has led to the development of pulmonary vein isolation (PVI). The efficacy of PVI is high for paroxysmal AF, whereas it is limited for non-paroxysmal AF. This fact highlights the necessity of understanding the mechanism through which AF is maintained, to develop ablation strategies that would be required in addition to the PVI. Mapping AF in animal models and humans has led to the identification of focal or rotational drivers. New technologies have been developed to identify those AF drivers and are used as a guide for catheter ablation. This review article aims to provide a comprehensive overview of the current state of knowledge regarding AF drivers and the various mapping approaches used to identify them.
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Yoshihide Takahashi (2024) conducted a review in Atrial fibrillation. Atrial fibrillation driver mapping and ablation was evaluated. Various mapping technologies can identify focal and rotational drivers of atrial fibrillation, but the clinical efficacy of driver-guided ablation remains unclear and requires further validation.
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