The use of advanced mapping systems to guide right linear lesions in paroxysmal atrial fibrillation

Right atrial linear ablation has been used for the treatment of refractory atrial fibrillation (AF), with conflicting results. Conventional mapping techniques that have thus far been used for this purpose have resulted in lengthy procedure times and radiation exposure, while proving unsatisfactory in verifying the completeness of block lines. Alternative advanced three-dimensional non-fluoroscopic mapping systems that have recently been introduced may prove to be advantageous in transcatheter linear ablation to cure AF. This is because of their ability to improve the accuracy of ablation, to provide a highly detailed analysis of the atrial activation pattern once linear lesions have been created, and to reduce X-ray exposure time. Notwithstanding the lack of information on long-term follow up, the treatment of idiopathic drug-resistant AF using right atrial linear ablation guided by an advanced mapping system is, in our experience, both feasible and safe; a desirable clinical outcome may be achieved in more than two-thirds of patients, with some patients experiencing complete abolition of AF and others a statistically significant reduction in the number of symptomatic AF episodes. The use of advanced mapping systems in conjunction with atrial pacing on both sides of the lines of ablation is essential in order to assess completeness of the bidirectional block. Because procedural risks are very low, a first-step approach employing right atrial compartmentalization appears justified in selected patients with drug-refractory AF, who exhibit no evidence of focal substrates from which AF might initiate.