Key result
In patients with persistent atrial fibrillation, elimination of triggers via circumferential pulmonary vein isolation alone is insufficient, and efficient substrate modification is required.
Why the study?
Does additional substrate modification beyond circumferential pulmonary vein isolation improve ablation success rates in patients with persistent atrial fibrillation?
Does additional substrate modification beyond circumferential pulmonary vein isolation improve ablation success rates in patients with persistent atrial fibrillation?
In patients with persistent AF, CPVI alone is insufficient, but current additional substrate modification techniques also have limitations, highlighting the need for more precise interventions.
Answers are grounded in this paper and cite their sources.
May warrant refined substrate modification beyond CPVI in persistent AF; leaves open optimal technique identification.
Atrial fibrillation (AF) is a multifactorial disease with complex pathophysiology. Although restoring sinus rhythm delays the progression of atrial remodeling, non-pharmacologic intervention, such as radiofrequency catheter ablation (RFCA), should be done based on the background pathophysiology of the disease. While circumferential pulmonary vein isolation (CPVI) has been known to be the cornerstone of AF catheter ablation, a clinical recurrence rate after CPVI is high in patients with persistent AF (PeAF). Step-wise linear ablation, complex fractionate atrial electrogram (CFAE)-guided ablation, rotor ablation, ganglionate plexus ablation, and left atrial appendage isolation may improve the ablation success rate after CPVI. But, there are still substantial AF recurrences after such liberal atrial substrate ablation, and current ablation techniques regarding substrate modification still have limitations. Therefore, more understanding about AF pathophysiology and early precise intervention may improve clinical outcome of AF management. Keeping in mind "more touch, more scar," operators should generate most efficient substrate modification to achieve better long-term clinical outcome.
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Park et al. (2015) conducted a review in Persistent Atrial Fibrillation. Substrate modification in addition to trigger elimination was evaluated. In patients with persistent atrial fibrillation, elimination of triggers via circumferential pulmonary vein isolation alone is insufficient, and efficient substrate modification is required.
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