Key result
Cardiac mapping is a necessary tool to comprehend the underlying mechanisms of atrial fibrillation in individual patients and to select the optimal ablation strategy when pulmonary vein isolation fails.
High-resolution cardiac mapping may be essential to understand the individual arrhythmogenic substrate in atrial fibrillation, especially when standard pulmonary vein isolation is ineffective.
May guide ablation after failed PVI; leaves open need for prospective validation.
Isolation of the pulmonary veins may be an effective treatment modality for eliminating atrial fibrillation (AF) episodes but unfortunately not for all patients. When ablative therapy fails, it is assumed that AF has progressed from a trigger-driven to a substrate-mediated arrhythmia. The effect of radiofrequency ablation on persistent AF can be attributed to various mechanisms, including elimination of the trigger, modification of the arrhythmogenic substrate, interruption of crucial pathways of conduction, atrial debulking, or atrial denervation. This review discusses the possible effects of pulmonary vein isolation on the fibrillatory process and the necessity of cardiac mapping in order to comprehend the mechanisms of AF in the individual patient and to select the optimal treatment modality.
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Yaksh et al. (2013) conducted a review in Atrial fibrillation. Cardiac mapping and pulmonary vein isolation was evaluated. Cardiac mapping is a necessary tool to comprehend the underlying mechanisms of atrial fibrillation in individual patients and to select the optimal ablation strategy when pulmonary vein isolation fails.
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