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September 18, 2018Frontiers in PhysiologyOpen Access

Targeting the Substrate in Ablation of Persistent Atrial Fibrillation: Recent Lessons and Future Directions

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Key result

Computational mapping of atrial substrate and aggressive lifestyle risk factor modifications are emerging as important strategies to improve outcomes in the treatment of persistent atrial fibrillation.

Population

Patients with persistent atrial fibrillation

Design

Review

Authors

MSMartin K. StilesPSPrashanthan SandersDLDennis H. Lau

Discussion

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Overview

Supports consideration of computational mapping and lifestyle modification in persistent AF; leaves open confirmation in randomized trials.

Structured PICO

P
Population
Patients with persistent atrial fibrillation
I
Intervention
Substrate ablation guided by computational mapping and imaging techniques (e.g., CFAE, DF, FIRM, ECGI, LGE-MRI)

This review highlights the evolution, clinical trial outcomes, and current limitations of computational and imaging-based approaches for targeting the substrate in persistent atrial fibrillation ablation.

Limitations

  • Non-disclosures of proprietary algorithms in the detection of AF drivers may be a major obstacle toward rapid translation into clinical practice.
  • Technical challenges with LGE-MRI detection of atrial fibrosis include spatial resolution, motion artifact, and lack of standardized image acquisition protocols.
  • Reproducibility of LGE-MRI analysis has been questioned and diagnostic accuracy to detect ablation lesions is suboptimal.
  • Non-disclosure of proprietary algorithms for mapping
  • Technical challenges with LGE-MRI including spatial resolution and motion artifact
  • Lack of standardized image acquisition protocols for fibrosis detection

Cite This Study

Stiles et al. (2018) conducted a review in Persistent Atrial Fibrillation. Substrate ablation and lifestyle modifications was evaluated. Computational mapping of atrial substrate and aggressive lifestyle risk factor modifications are emerging as important strategies to improve outcomes in the treatment of persistent atrial fibrillation.

synapsesocial.com/papers/6a15bfa5a2352da34782dc8dhttps://doi.org/10.3389/fphys.2018.01158
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1The Atrium in Atrial Fibrillation – A Clinical Review on How to Manage Atrial Fibrotic Substrates2022 · 41 citations
  2. 2Contemporary Concepts in the Onset and Maintenance of Atrial Fibrillation: Mechanisms, Substrates, and Clinical Implications2026
  3. 3Editorial: Atrial Fibrillation: Technology for Diagnosis, Monitoring, and Treatment2022 · 1 citations
  4. 4Targeting the Substrate for Atrial Fibrillation2024 · 47 citations
  5. 5Catheter ablation of persistent atrial fibrillation: The importance of substrate modification2015 · 5 citations