Atrial fibrosis detected by cardiac magnetic resonance in persistent atrial fibrillation: a useful risk stratifier but not ideal electrophysiological endpoint for catheter ablation

Comment on ‘Effect of MRI-Guided Fibrosis Ablation vs Conventional Catheter Ablation on Atrial Arrhythmia Recurrence in Patients With Persistent Atrial Fibrillation: The DECAAF II Randomized Clinical Trial’ which was published in the Journal of the American Medical Association, https://doi.org/10.1001/jama.2022.8831. Atrial fibrillation is an increasingly prevalent arrhythmia associated with significant health burden. Its management improved in the last decades through the growing use of ablative techniques, mostly based on PVI. However, the rate of AF recurrence still remains a significant and challenging issue. In the current prevailing view, AF is believed to be induced by focal triggers arising from the PV in the majority of patients, and consequently an encircling ablation lesion around PV can successfully suppress AF.2 Although PVI remains the most commonly adopted strategy, the approach to ablation varies among centres, with the common goal of protecting the atrium from AF onset and recurrence. A recent...